Symptoms and treatment of rubrophytia (rubromycosis). How to distinguish rubromycosis of smooth skin from other forms

Rubromycosis (or rubrophytia) refers to mycotic (fungal) skin diseases and is accompanied by damage skin feet, hands, inguinal-femoral folds and other areas of the body. Among mycoses, it is considered a common disease, and the likelihood of infection with it is high. The main manifestations of this disease, which is more often observed among adults, are such signs as redness, roughness, dryness, cracking and floury exfoliation of the affected areas of the skin. According to statistics, the proportion of rubromycosis ranges from 60 to 90%.

In this article we will introduce you to the symptoms of different types of rubromycosis and methods of diagnosis, treatment and prevention of this disease. In addition, you will receive an answer to the question: “Is this disease contagious?”

Initially, this mycosis was more often observed in Japan and some other countries. During the Great Patriotic War, this disease became widespread in the countries of Europe and the former USSR.

Is the disease contagious?

The causative agent of the disease is a pathogenic fungus.

Rubromycosis is a highly contagious disease (that is, the risk of skin infection by its pathogen is extremely high). Only people get sick from it.

The likelihood of getting rubromycosis increases with dry skin, excessive, non-compliance with hygiene rules, taking cytostatics, antibiotics and corticosteroids. According to statistics, this mycosis is observed in 20% of the world's inhabitants.

Infection with a pathogenic fungus - red trichophyton (Trichophyton rubrum) - occurs through contact with a patient or through common objects (towels, gloves, household and public objects, etc.). That is why, when treating a disease in one of the family members or a team, measures must be taken to monitor other people in contact with the patient.

In some cases, a person becomes infected with trichophyton red spores, but the disease long time doesn't show itself at all. This means that he becomes a carrier of rubromycosis and can be infectious to others.

Clinical types of rubromycosis

The fungus Trichophyton rubrum can affect different areas of the body. Depending on this, the following clinical varieties of the mycosis we are considering are distinguished:

• rubromycosis of the feet;
• rubromycosis of the hands;
• rubromycosis of nails;
• generalized rubromycosis.

The incubation period of rubromycosis - that is, the period when the symptoms of the disease have not yet appeared - may vary. So far, experts cannot give a clear answer to the question of the reasons for this. It is possible that the rate at which symptoms appear is determined by the condition immune system and depends on each individual case.

Symptoms

Rubromycosis of the feet

In patients with rubromycosis, the skin of the feet is dry, red and flaky.

When the skin of the feet is affected, the patient first shows signs of damage to all interdigital folds, and then the fungus spreads to the soles. With rubromycosis, the skin in the affected area becomes:

• dry;
• flushed;
• compacted;
• with a pronounced skin pattern and furrows;
• flaky (mucoid type).

Areas of peeling are more pronounced in places of natural grooves. Sometimes single rashes appear in the affected areas.

All these signs of rubromycosis are accompanied by sensations of itching in the area of ​​skin changes. In areas of infection, the skin color becomes stagnant red.

In children, another symptom that is characteristic and complicates the diagnosis of rubromycosis is exudation - weeping. And in some cases - single rashes: vesicles or seropapules.

If the patient does not begin timely treatment, then such lesions appear on the backs of the feet and fingers. In advanced cases fungal infection Invades nail plates and other areas of the skin.

Rubromycosis of nails

Rubromycosis of the nails in most cases is detected in patients with other forms of this fungal disease and is rarely observed independently. This mycotic lesion of the nail plates is characterized by simultaneous damage to the nails on all fingers.

Symptoms of rubromycosis of nails are:

• stripes of yellow-gray and grayish-white color;
• thickening of the nail plate;
• the nail plate crumbles and becomes brittle.

There are the following stages of nail rubromycosis:

• normotrophic - nails only change color;
• hypertrophic – nails thicken and become deformed;
• atrophic - nails become thinner and destroyed.

If left untreated, the disease becomes atrophic. At the same time, the nails begin to thin and can completely collapse. The remains of the nail plate with this course of rubromycosis are visible only in the area of ​​the nail fold.

Rubromycosis of the hands

Rubromycosis of the hands most often becomes a consequence of self-infection that occurs in patients with lesions of the feet, but primary infection with red trichophyton can also be observed. It manifests itself with the same symptoms as rubromycosis of the feet, but they are less pronounced, because a person washes his hands more often. As the disease progresses, an intermittent ridge, characteristic of this disease, forms around the skin lesions.

Generalized rubromycosis

This type of rubromycosis develops in those patients who have had other limited forms of this fungal disease for a long time. The following factors can contribute to the transition of the disease to this form:

• chronic diseases internal organs;
• pathology of the nervous system;
• endocrine diseases;
• trophic changes in the skin;
• taking cytostatic, hormonal and antibacterial drugs.

Generalized rubromycosis is accompanied by signs of infection in different parts of the body and is expressed in a combination of symptoms of different varieties of this disease. This means that the patient has combined lesions of the feet, hands, nails and other parts of the body in different variations.

Depending on the variability of symptoms, there are following forms generalized rubromycosis:

• erythematous-squamous;
• follicular nodular;
• body rubromycosis.

Generalized rubromycosis in advanced stages in children and people with weakened immune systems can lead to the development of severe allergic reactions. In such cases, a rash appears on the patient’s body.

Erythematous-squamous form

This form of generalized rubromycosis can appear on any part of the body, often similar to the manifestation of diseases such as parapsoriasis or atypical eczema. The foci of skin changes in this form of the disease look the same as in other varieties of this mycosis. But they can form groups and tend to appear in the form of rings, arcs, garlands and semi-arcs.

In areas of skin lesions, hyperpigmentation and peeling appear, the severity of which is directed from the center to the outer borders. The outlines of the changes have the appearance of a scalloped edge with a swollen intermittent ridge.

The erythematous-squamous form occurs in waves and chronically. Exacerbation of the disease is more often observed in the warm season.

Follicular nodular form

In the follicular nodular form, rubromycosis is accompanied by damage to the skin of the feet, legs, buttocks and forearms. Sometimes the skin of the face is also involved in the infection process.

Foci of skin changes in this form of the disease grow from the center to the periphery and are similar in their external manifestations with diseases such as erythema nodosum and vasculitis. When skin lesions appear on the face, rubromycosis is masked by its symptoms under clinical picture, papulonecrotic tuberculosis, Bazin's indurative erythema and other dermatological diseases.

Rubromycosis of the body

With this form of rubromycosis, the foci of skin lesions are localized under the mammary glands and in the intergluteal folds. In people with the same symptoms may be observed in other folds of the skin.

Foci of skin changes become denser and have a brown or yellowish-red color. Peeling is observed on their surface, which is directed from the center to the edge. The lesions are outlined by an intermittent ridge characteristic of rubromycosis, and this sign makes it possible to distinguish this disease from microbial eczema or candidiasis of the skin. Differentiate the disease from these skin diseases such a symptom as the absence of maceration observed when infected by the fungus Candida, and the absence of polymorphism of elements present with.

Diagnostics

To correctly diagnose rubromycosis, in addition to an examination, a dermatologist always conducts differential diagnosis this fungal disease with the following dermatological diseases:

• candidiasis;
• trichophytosis;
• intertriginous and squamous athlete's foot;
• microbial eczema;
• deep pyodermatitis;
• infiltrative-suppurative trichophytosis;
• Erythema induratum of Bazin;
• vasculitis;
• favus;
• red lichen planus nails;
• neurodermatitis;
• papulo-necrotic tuberculosis.

After this, to eliminate errors and confirm the diagnosis, the patient is prescribed tests to identify the pathogen and determine further treatment tactics:

• cytological examination;
• sowing with cultural examination.

Material collection (or skin scraping) for these tests should be performed as follows:

• on the skin, scraping is carried out from the marginal ridges or skin grooves;
• on nail plates, scraping is performed from the free edge of the plate.

Cytological analysis allows you to confirm the fungal nature of the pathogen, but does not make it possible to identify its type. For precise definition For the cause of mycosis, a cultural analysis should be performed, which not only identifies the type of fungus, but also makes it possible to determine its sensitivity to drugs.

Treatment

Treatment of rubromycosis should always be comprehensive and aimed not only at destroying the fungus, but also at eliminating factors contributing to the development of the disease - weakened immunity, chronic pathologies internal organs, unreasonable or prolonged use medicines, hormonal imbalance etc. The tactics of etiotropic therapy are determined individually and depend on the severity of the manifestations of the disease.

• treating the lesions with exfoliating ointments - Whitefield or Arievich ointment - and applying bandages;
• treatment of lesions with a 2% iodine solution followed by application of antifungal or drying ointments (Mikozolon, Exoderil, Pimafucin, Lamikon, Tolmitsen, Nizoral, Tar ointment 2-3%, Wilkinson ointment, Konkov, Sulfosalicin or Sulfuric ointment 10-15%).

Instead of using peeling ointments, fungicidal-keratolytic varnishes can be prescribed. They are applied to the skin (for example, feet) daily for 3-4 days. After this, a warm bath is performed with a solution of soda or potassium permanganate and the remaining varnish along with the exfoliated skin is removed. Then the lesions are lubricated with iodine solution and ointments.

The use of fungicidal-keratolytic varnishes, in contrast to peeling ointments, has a number of advantages:

• the tightness of the lesion is ensured, preventing further spread of fungal infection;
• There is no need for bandaging, which causes a lot of inconvenience (especially for children).

To treat rubromycosis in other areas of the body (for example, in skin folds), adhesive patches and lactic-salicylic-resorcinol collodion are used to peel off tissues affected by the fungus and seal the lesions. In the future, as in the treatment of rubromycosis of the feet and hands, lesions skin lesions treated with iodine solution and antifungal and drying ointments.

With damage to vellus hair and with widespread skin rashes, for the treatment of rubromycosis, antifungal drugs are prescribed for oral administration:

• Griseofulvin;
• Diflucan;
• Orungal;
• Lamisil (Lamicon).

Antifungal powders are used at all stages of treatment and to prevent infection:

• Quinofungin;
• Galmanin;
• Aspersept;
• Distundan;
• Batrafen;
• Iodoform et al.

After eliminating the progressive symptoms of rubromycosis, anti-relapse treatment is recommended to prevent relapse of the disease. It consists of performing the following activities:

• lubricating the affected areas with liquid antimycotic compounds - Yoddicerin, Nitrofungin, Gorosten, Antifungin, 2% iodine solution, Betadine, etc.;
• periodic hot baths with solutions of potassium permanganate or soda and soap;
• treatment of mycosis of the nails, which are a reservoir for the persistence of fungal infection.

Can be used to treat rubromycosis of nails different techniques. Therapy for this type of disease requires only individual approach and scrupulousness, since it is the nail plates that can become a reservoir for the preservation of fungal spores, which cause relapse.

A combined technique is considered more effective, consisting of taking antimycotic drugs orally and external therapy. Usually, the nail plate is peeled off first, and then Griseofulvin or another drug is prescribed. But sometimes oral antifungal agents are prescribed in parallel with nail removal.

The following methods are used to peel off the nail plate:

1. Keratolytic nail polishes. Varnish is applied to the nail plate according to the instructions attached to the drug Batrafen, Lotseril or Mycospor. Subsequently, the affected areas are removed using a special scraper included in the package along with the drug.
2. Keratolytic patches. Substances such as urea, salicylic or trichloroacetic acid are applied to the affected nail in a thick layer. The nail plate is sealed with a plaster and the bandage is left for 48 hours. The procedure is repeated 2-4 times until the nail is completely softened. After this, it is removed using nippers and a scalpel.
3. Keratolytic ointments. An ointment based on lanolin and potassium iodide is applied in a thick layer to the nail, covered with compress paper, cotton wool and bandaged. The bandage is left for 4-5 days. After this, the ointment is applied in the same way until the plate is completely softened. Then it is painlessly removed with tweezers and a scalpel.
4. Surgical operations. Performed after local anesthesia or general anesthesia using surgical instruments.

After removing the nail, local antimycotic therapy is carried out, which consists of treating the affected area with such antiseptics, such as a 5% iodine solution, Fukortsin, Multifungin, Nitrofungin, etc. After such treatments, ointment preparations are applied to the skin.

Rubromycosis of smooth skin - infection, occurs due to a fungus of the genus trichophytes. Most often, large folds of the skin are affected, axillary region, gluteal, arms and some areas of the body. In itself, it is particularly contagious and requires increased attention. It is transmitted both from direct contact with an infected person and through personal hygiene items.

Collapse

Symptoms

The rash can occur anywhere on the body. On smooth skin, lesions have different shapes. On the lower leg, spots form on the extensor surface, externally resembling rings or arcs. The color of the rash is most often reddish; in advanced forms it can be blue.

Vellus hair is most often affected. They begin to look dull and discolored. They break quickly upon contact with clothing. Externally, the disease may resemble eczema or lupus erythematosus in the early stages, but only to the untrained eye. A qualified dermatologist will find the differences even without tests.

Common locations of lesions are the face, thighs, buttocks, and legs. In some cases, the surface of the spots may be covered with scales and blisters. Almost always there is intense itching and burning in the affected areas.

Photo of rubromycosis of smooth skin

Diagnosis with other diseases

Very often, rubromycosis of smooth skin can be confused with the following diseases:

• Erythema nodosum. The lesion occurs on the arms, torso, and thighs. The knots are dense, the size is slightly smaller chicken egg. On palpation there is strong pain. Externally, the skin color becomes bluish, and after a while it peels off.
• Cutaneous tuberculosis. It occurs on the thighs, buttocks, and the formation of subcutaneous tissue the size of a small walnut is noted. At any time, the nodes can be pulled together, and in their place there are indentations. The disease always lasts a long time; after healing, a smooth scar remains.

On initial stage Only an experienced dermatologist can distinguish them. The only differences are in the localization of the rashes.

Treatment

Rubromycosis of smooth skin takes a long time to treat; therapy should be comprehensive and correspond to the stage of development of the disease:

1. If the disease affects not only smooth skin, but hair and nails, experts prescribe Lamisil or Orungal.
2. If severe swelling or inflammation with weeping occurs, it is necessary to eliminate the inflammation. The patient should be completely at rest and apply lotions with Burov's liquid.
3. Large bubbles need to be disinfected; alcohol is used for this. You cannot pierce them yourself; this can only be done by the attending physician.
4. Cut off the stratum corneum on the skin once a day using special scissors.
5. After the inflammatory process subsides, the patient should use fungicidal ointments or solutions, for example, mycoseptin, uncedin.
6. Treat the peeling stratum corneum with ointment or varnish with a keratolytic substance. It is also necessary to treat such areas of the skin with iodine or sulfur ointment.
7. Treat the affected palms and soles one at a time.

Rubromycosis of smooth skin, which occurs in severe form, is treated in a hospital or outpatient setting. The patient is lubricated with lactic-salicylic collodion on the affected areas. From the very beginning of treatment, it is necessary to treat sore spots with fungicidal agents. Nizoral and Griseofulvin are taken orally, but only if there are no contraindications.

Treatment of rubromycosis is a long and complex process; the effectiveness of therapy will depend primarily on how promptly the patient contacts the medical institution. It is necessary to follow all the recommendations of the attending physician, monitor your hygiene and avoid contact with sick people.

The content of the article

A chronic relapsing disease affecting the feet, nail plates (foot, hand), skin folds, trunk, limbs and other areas of the skin.

Etiology and pathogenesis of rubrophytosis

The causative agent is the fungus Trichophyton rubrum Castellani. Infection occurs from a sick person, household items and as a result of non-compliance with hygiene rules. Development is promoted by exogenous factors (trauma, hyperhidrosis or dry skin of the feet) and endogenous (endocrinopathies, immunodeficiency, vascular disorders).

Rubrophytia Clinic

Rubrophytosis of the feet

Intertriginous form. In the interdigital folds of the feet, peeling and cracks are detected. On the dorsal and plantar surfaces of the feet, hyperemia, infiltration, nodules, blisters, crusts, and mealy peeling are observed. Subjectively itching.
Dyshidrotic form. Blisters, erosions, and weeping form on the back and arches of the feet. Subjectively itching, pain. Children get sick more often. Squamous-hyperkeratotic form. On the plantar surface of the feet, hyperemia, dryness, hyperkeratosis, pronounced skin grooves, and mealy peeling appear.
Differential diagnosis.
Athlete's foot.
At laboratory research Trichophyton mentagraphytes is detected. Intertriginous form: in the interdigital folds between the 5th and 4th, 4th and 3rd toes - erythema, maceration, vesicles, cracks, itching, burning. Dyshidrotic form: on the arches of the feet, in the interdigital folds of the feet - erythema, blisters, blisters with cloudy contents (reminiscent of “boiled sago grains”). Weeping erosions with purulent discharge. Subjectively itching, pain. Lymphangitis, lymphadenitis, and secondary allergic rashes (epidermophytide) may occur. Squamous-hyperkeratotic forms: on the plantar surface of the feet there are areas of thickening like callus, lamellar peeling, cracks. Candidiasis of interdigital folds. In the interdigital folds of the feet and hands, the skin is red-bluish in color with a whitish-gray coating. Maceration, weeping, erosion, and cracks are detected. The edges of the lesions are scalloped with fragments of exfoliated macerated epidermis. Subjectively itching, burning. Candida albicans is detected.

Rubrophytosis of hands

On the palms, back of the fingers, and wrist, the skin is red-bluish in color, dry, with flour-like peeling. Along the periphery of the lesions, a ridge consisting of nodules, vesicles, and crusts is detected.
Differential diagnosis.
Plaque parapsoriasis.
On the trunk, proximal limbs, buttocks, and less often in other areas, one (several) flat rounded (oval) plaques with clear (vague) edges, up to 10 cm or more in diameter, are noted. The skin over the plaques is not infiltrated, folded, with triangular and rhombic fields (similar to lichenification). The color of the plaques varies - pink-red, pink-yellow, pink-brown with a liquid tint. The surface is smooth, flaky (peeling when scraped). After regression, hyperpigmentation, mild atrophy, and telangiectasia remain. Chronic course and resistance to therapy. Neurodermatitis limited. Dense nodules appear on the back and side surfaces of the neck, elbow and popliteal fossae, and in the anal-genital area against a background of itching and scratching. They are covered with scales and merge to form flat, pink or brown-red plaques. The skin pattern intensifies, lichenification develops (shagreen skin appearance). There are 3 zones in the lesion: central (lichenization), middle - isolated shiny pale pink papules and peripheral - hyperpigmentation. Excoriations covered with hemorrhagic crusts are noted. The course is long, for years.

Rubrophytosis of nail plates

Types of lesions. Normotrophic. White, yellow spots, stripes. The free edge is unchanged, sometimes jagged. Hypertrophic. The nail plate is grayish-brown in color, dull, thickened, deformed (subungual hyperkeratosis), and crumbles easily. Atrophic. Thinning of the nail body occurs, up to its rejection (onycholysis).
Differential diagnosis.
Candidal onychia, paronychia. The nail plates are brown, lumpy, unequal in thickness, and sometimes peel off. Hyperemia, infiltration, swelling of the nail ridges, and absence of nail skin (eponychium) are noted. When pressing on the nail plate, a drop of pus is released from under the nail. Laboratory testing reveals Candida albicans. Athlete's foot. More often, the nail plates of the 1st and 5th toes are affected, in the thickness of which yellowish spots appear. The free edge of the affected nail plates becomes loose and crumbles. The nail plates of the hands are not affected. Laboratory testing reveals Trichophyton mentagraphytes.

Rubrophytosis of large folds

Large, yellowish-red, scaly lesions with scalloped outlines in the form of arcs, rings, and garlands form in the folds of the skin. Along the periphery there is a ridge consisting of nodules and crusts.
Differential diagnosis.
Athlete's foot.
In the folds of the skin (inguinal, intergluteal, axillary, etc.), often on the skin of the scalp, torso, and limbs, pink, round spots with peeling in the center are revealed. Along the periphery, an edematous ridge is determined, consisting of vesicles, pustules, erosions, crusts, and scales. Weeping may occur. Subjectively itchy skin. The examination reveals Epidermophyton floccosum. Candidiasis of large skin folds. In the lesions, the skin is bright red, shiny (as if covered with varnish) with a gray-white coating on the surface, a linear crack. The boundaries extend beyond the closure of the folds, are polycyclic, sharply defined, with a fringe of exfoliated epidermis. Along the periphery there are multiple “daughter” screenings, consisting of flabby blisters, papules, and erythematous-squamous spots. The examination reveals Candida albicans.

Rubrophytosis of smooth skin

Deep follicular-nodular elements appear on the torso, buttocks, and legs. Hair may be affected. Subjectively itching.
Differential diagnosis.
Erythema nodosum.
The lesions are mainly localized on the legs, less often on the thighs, torso, upper limbs and are represented by symmetrically located dense nodes, ranging in size from a pea to a chicken egg. The nodes are painful on palpation. The skin over the nodes is hyperemic, with a bluish tint. Later it becomes brown in color, long-term pigmentation and peeling remain. Intensified tuberculosis of the skin. On the legs, less often on the thighs, buttocks, dense, limited, up to size, are formed in the subcutaneous tissue. walnut painless nodes. The skin over them becomes red-bluish in color. Nodes can spontaneously undergo reverse development. In their places there remains a slight depression and a bluish-brown color of the skin. In other cases, the nodes may ulcerate and mildly painful ulcers with smooth edges and serous-purulent discharge occur. Typical is ulceration of part of the infiltrate, and dense areas of undisintegrated infiltrate remain at the edges. The course is long. After spontaneous healing, a smooth, somewhat retracted scar with pigmentation along the edges remains. Tuberculin tests are positive.

Treatment (athlete's foot, rubrophytosis)

For widespread lesions of the skin and nail plates, antifungal drugs are prescribed internally. Griseofulvin - orally after meals, 0.125 g 3 times a day with 1 teaspoon vegetable oil at every appointment. For body weight 61-70 kg - 6 tablets; 71-80 kg - 7 tablets and more than 80 kg - 8 tablets. During the first month it is recommended to take it daily, for the 2nd month - every other day, then once every 3 days, for 8-10 months. Children are prescribed at the rate of 16-18 mg/kg body weight per day, daily for 2 weeks, then 2 weeks every other day, and the next 3 weeks 2 times a week. "Dermazol ™" (ketoconazole) - prescribed 1 tablet (200 mg) 1 time per day with meals, 6-7 months. "Izol" (itraconazole, Glen Mark Ltd, India) - 200 mg 2 times a day for 1 week, then a break of 3 weeks and a total of 2-4 courses. "Exifin" (terbinafine, "Dr. Reddy's") - 250 mg once a day or 125 mg 2 times a day (from 6 weeks to 3 months). functional disorders liver and while taking systemic antimycotics, Antral® (Tris-aluminum hydrate, an original hepatoprotector developed by the Institute of Pharmacology and Toxicology of the Academy of Medical Sciences of Ukraine) is prescribed for prevention. Adults and children over 10 years old, 0.2 g orally 20-30 minutes after meals, 3 times a day, 20-30 days (children from 4 to 10 years old, 0.1 g per dose), 20-30 days). "Antral®" has a pronounced hepatoprotective, membrane-stabilizing, antioxidant, anti-inflammatory, immunomodulatory and analgesic effect. For acute inflammatory phenomena, antihistamines and hyposensitizing drugs. "Cetrin" (cetirizine hydrochloride, "Dr. Reddy's") - prescribed orally 10 mg with a small amount of water once a day, 10-14 days. It has a strong antiallergic effect, does not block cholinergic and serotonin receptors, does not penetrate through blood-brain barrier and does not cause sedative effect, acts quickly (30 minutes after administration and within 24 hours), is well absorbed into gastrointestinal tract, binds to plasma proteins up to 93% and is excreted unchanged in the urine. In chronic cases, immunomodulators, biogenic drugs and stimulants, angioprotectors, vitamins. Externally for acute inflammatory phenomena on the feet, baths 1 time per day (15-20 min) with a solution of potassium permanganate diluted 1:10,000 (37-38°C) or with a decoction oak bark(20 g per 3-4 liters of water) or chamomile decoction (10 g per 3-4 liters of water). Lotions with a solution of silver nitrate (0.25%-0.5%), resorcinol (2%), tannin (2%), potassium permanganate (1:6000-1:8000), etc. After the acute effects on the affected skin have subsided aniline dyes (1-2% solutions), alcohol solution of iodine (2%), fucorcin, antimycotic ointments (creams) are prescribed. In the squamous-hyperkeratotic form, a soap and soda bath is prescribed to the feet, followed by mechanical cleansing of the skin of the feet, and then keratolytic varnishes and ointments. Varnish used: crystalline iodine 10.0; salicylic, lactic, benzoic acids 30.0 each; dimexide 20.0; collodion 100.0 ml (Rationalization proposal No. 1200 dated February 19, 1988, “Composition for the treatment of miners with squamous-hyperkeratotic form of mycosis of the feet”; R.F. Ayzyatulov et al.). The varnish is applied to the lesions 5-6 times a day. On days 4-5 of treatment, it is recommended to apply a compress with 10% salicylic ointment for 12 hours, after which a soap and soda bath is made and the exfoliated stratum corneum is scraped off with a blunt scalpel. Then, for 1-2 months or more, antifungal ointments (creams) are applied to the affected areas of the skin. 2% Dermazol™ cream (ketoconazole, Kusum Healthcare, India) is applied 1-2 times a day for 2-4 weeks or more. 1% cream "Exifin" ("Dr. Reddy's") is applied thin layer 2 times a day, 2-4 weeks or more. When treating onychomycosis, a soap and soda bath is recommended. Mechanical cleaning of the affected nail plates is carried out and softening ointments (plasters) are applied. Mandatory mechanical cleaning of the nail plates is carried out once a week until new nail plates grow within 6 months.

Prevention of rubrophytia

Public - good sanitary and hygienic condition of baths, showers, laundries; normal functioning drainage sewer system. Compliance with the rules hygienic regime. Regular medical checkup workers of baths, laundries (identification and treatment of patients). Supplying bathhouse and laundry workers with individual footwear. Personal - careful hygienic maintenance of the skin of the feet. Use of individual shoes. Fight against sweating (powder, 3% formaldehyde solution or rub in a mixture of the following composition for 3 days - methenamine, distilled water 20.0 each, zinc oxide, talc 25.0 each, glycerin 10.0; in case of relapse, repeat this 3-day rubbing but not earlier than after 3-4 months.

Rubrophytosis (rubromycosis, rubrophytosis, mycosis caused by red trichophyton) is a chronic infectious disease caused by fungi of the genus Trichophytes, characterized by a frequent relapsing course affecting mainly the skin and nail plates of the feet and hands, less often the skin on the trunk and limbs in the area of ​​large folds (gluteal folds). , axillary).

The disease is quite widespread in the countries of the Far East (Russia: Amur region, Yakutia, Khabarovsk region, Magadan region, Kamchatka region, Sakhalin region, Chukotka autonomous region; Indonesia, China, Cambodia, Mongolia, Korea, Thailand, Japan) and South-East Asia(India, Maldives, Pakistan, Nepal, Sri Lanka). After the Second World War, rubrofitia spread to the countries of Europe and America.

Only people suffer from rubrophytosis. Age and gender do not affect the incidence rate.

A number of factors contribute to the development of rubrophytosis:

exogenous (factors from environment, which affect the outer skin):

• Increased sweating of the skin;
• Excessive dryness of the skin;
• Frequent trauma to the skin;
• Calluses and dropsy on the skin of the feet;
• Failure to comply with personal hygiene rules (walking barefoot in public baths, gyms, showers, wearing someone else's shoes).

endogenous (factors that lead to a decrease in the body’s resistance to various infections, due to the characteristics of the organism itself):

• Endocrinological diseases (hypothyroidism, diabetes);
• Metabolic disorders (obesity);
• Patients with HIV infection, AIDS;
• Cancer patients;
• Persons undergoing organ transplantation;
• Long-term treatment with antibiotics, chemotherapy, hormones;
• Chronic diseases of internal organs.

Treatment of the disease takes quite a long time, since the process is chronic with frequent relapses. The prognosis for the disease is favorable.

Causes of Rubrophytia

The causative agent of the disease is Trichophyton rubrum. The disease is transmitted from person to person in the presence of exogenous and endogenous infection factors.

Infection occurs through direct contact with a patient with rubrophytosis, and through his personal belongings (towel, washcloth, pumice stone, nail file, scissors). Less commonly, infection can occur when visiting a swimming pool, showers, or baths.

Classification of Rubrophytia

By localization infectious process highlight:

• Rubrophytosis of hands and feet.
• Rubrophytosis of smooth skin.
• Rubrophytosis of large folds.
• Rubrophytosis of the nail plates.
• Generalized (widespread) rubrophytosis.

Symptoms of Rubrophytia

The incubation period has not been precisely established. The onset of the disease depends on the amount of pathogen that gets on the skin and on the state of the body’s immune system.

Foot lesions

The skin on the plantar surface of the foot becomes a deep red color. The stratum corneum of the skin thickens, becomes rough, and fine striations begin to be clearly visible. The skin becomes dry, and whitish peeling appears in the folds. The lesions cover the entire plantar surface, lateral surface and dorsum of the feet, folds between the toes, and nail plates.

There are 3 types of damage to the nail plates due to rubrophytosis:

• Normotrophic type - spots and stripes appear on the lateral surfaces of the nails white-yellow color, the entire nail gradually changes color.
• Hypertrophic type - the color of the nail plates becomes brownish-gray. Nails suddenly thicken, lose their shine, become dull and brittle. In some cases, nail destruction may occur, starting from the lateral surface. Often patients with this type of lesion experience pain when walking.
• Onycholytic type - the affected part of the nail becomes brownish-gray in color and is torn away from the nail bed, subsequently the nail is completely separated from the nail bed.

Hand lesions

The palms and nail plates are most often affected. The changes are similar to rubrophytosis of the feet, only the peeling is slightly less pronounced.

Damage to smooth skin

Foci of rubrophytia are most often found on the skin of the thighs, buttocks and legs. The disease begins with the appearance of spots of rounded outlines of a pink-red color and a bluish tint. The spots are sharply demarcated from healthy skin. The surface of the lesions is covered with whitish scales. At the periphery of the spots, a small roller covered with bubbles and crusts forms. The spots are prone to rapid growth and merging with each other, after some time without treatment they can affect quite large areas of the skin. The lesion process may also involve vellus hair, this is accompanied by loss of shine and increased hair fragility.

Damage to large folds (inguinofemoral, axillary)

The lesions are similar to rubrophytia of smooth skin. It is distinguished by the appearance of severe itching and the fact that the inflammatory process does not spread beyond the area of ​​the folds.

Diagnosis of Rubrophytia

• General blood analysis.
• General urine analysis.
• Blood glucose.
• Biochemical studies (total and direct bilirubin, total protein and its fractions, transaminase levels - ALT, AST, alkaline phosphatase, thymol test, urea, creatinine).
• Specific research:
  • microscopic examination of skin scales, nail plates taken from the lesion - detection of fungal mycelium in them.
  • cultural research - when a fungus is grown on a nutrient medium, colonies are formed that begin to secrete a bright red secretion.

Treatment of Rubrophytia

Treatment consists of two stages:

Preparatory stage

Removal of horny layers and scales in the area of ​​rubrophytosis. For this purpose, keratolytic agents are used:

• Detachment according to Arisvich - an ointment containing 12 g is applied to the lesions for two days salicylic acid, 6g lactic acid and 82g petroleum jelly.
• lactic-salicylic colloid – 10g lactic acid, 10g salicylic acid, 80g colloid. The lesions are lubricated twice a day for 6–8 days, after which baths with soap and soda solution are prescribed; the skin from the lesions, which begins to peel off, is removed with pumice.

Direct treatment

For the treatment of rubrophytosis of the skin, hands and feet, antifungal (antimycotic) drugs are prescribed local action: lamisil, mycosolone, clotrimazole, mycopolitside, nitrofungin, mycoseptin, Castellani liquids.

Treatment of nail plate rubrophytosis requires appointment antifungal drugs systemic action, that is, orally in the form of tablets.

• Lamisil 250 mg 1 time per day for 6 – 12 weeks for the treatment of rubrophytia on the nails of the fingers, 12 – 30 weeks for the treatment of the nail plates of the toes. Local treatment is not carried out.
• Orungal 400 mg once a day for 7 days, then the course is repeated after 3 weeks. To localize the fungus on the nail plates of the hands, the course of treatment is repeated 1 time, for localization on the nail plates of the feet - 2 times. Local treatment is not required.
• griseofulvin - prescribed 6 - 8 tablets per day every day for 1 month, then 6 - 8 tablets every other day for 1 month, and then 2 times a week until the nail is completely replaced by a healthy one. The drug is combined with local treatment.
• Nizoral (ketoconazole) 200 mg once a day. The course of treatment is 6 – 8 months. The drug is combined with local treatment.

Local treatment for rubrophytosis consists of removing the affected nail plate. There are different removal methods:

• surgical removal;
• removal by applying patches that dissolve the nail plate, for example ureplast (20g urea, 5g wax, 10g water, 20g lanolin, 45g lead plaster). This drug is applied for two days. The nail plate is completely dissolved, and the exposed nail bed is further treated antifungal agents(lamisil, clotrimazole, nitrofungin, Castellani liquids).

Complications of Rubrophytia

• cosmetic defects on the skin;
• long-lasting nail lesions.

Prevention of Rubrophytia

• compliance with personal hygiene rules;
• preventive examinations of persons who are predisposed to rubrophytosis;
• timely detection and adequate treatment of patients;
• regular cleaning and disinfection of public showers, baths, swimming pools, use a solution of 1 - 2% bleach;
• health education work among the population.

Rubromycosis – infectious lesion skin in the area of ​​the hands, feet, knees, inguinal-femoral folds and other areas. Pathology is accompanied by overcrowding blood vessels, which manifests itself in redness and swelling of the affected area. The skin of a sick person becomes dry and cracked. The manifestations of the disease do not end there. Below we will talk in detail about how rubromycosis and rubrophytosis develop.

The main cause of damage to the human body is the fungus Tr. Rubrum. The mechanism of infection is quite simple - transmission of infection occurs through contact with a carrier of microorganisms. Pathogenic fungi are highly active, so you can become infected by using common household items. Doctors identify several other causes of rubromycosis:

• application hormonal drugs, antibiotics and cytostatics. As a result long-term use of these drugs, the body becomes weak and loses protective forces. As a result, viruses, bacteria and fungi easily penetrate the human body, spread throughout it, and affect vital systems and internal organs;
• weakening of blood vessel tone. This factor causes fungal spores to quickly spread throughout the body, causing intoxication;
• weakening of the immune system. Hypothermia, intense sports, nervous and physical stress, lack of sleep and vitamins are the reasons why the body becomes weak and cannot independently repel attacks of viruses, bacteria and fungi;
• visiting the swimming pool, showers, public baths without personal shoes. When the foot comes in contact with the foot, the fungus can easily enter the body and cause infection. If the skin of the feet is covered with cracks, the risk of developing rubromycosis increases. The same applies to excessive sweating.

Risk factors include: diabetes mellitus, chronic diseases of internal organs, metabolic disorders, obesity, HIV infections and AIDS, cancer, and the recovery period after organ transplantation.

Treatment of the disease is complicated by frequent relapses, so it goes away for a long time, however, in most cases it ends well. After an illness, immunity to it is not developed, so the likelihood of “catching” rubromycosis always remains.

Clinical manifestations of rubromycosis

When infected with the fungus Tr. Rubrum 90% of cases are rubrophytosis of the feet and nails. Immediately after infection, the symptoms of the disease appear very weakly or not at all, so the person may not even suspect that he is sick. At the end incubation period Rubromycosis manifests itself quite clearly:

• the skin of the interdigital folds and soles becomes compacted, overdried and inflamed. Furrows, irregularities and skin patterns are clearly visible on it;
• floury peeling appears over the entire surface of the affected area - as if the skin was sprinkled with flour. In the area of ​​the furrows, changes of this type become more pronounced;
• If treatment is not started in a timely manner, rubromycosis extends beyond the affected area and spreads to the fingers, dorsum of the hands and feet, resulting in rubromycosis of smooth skin. The nail plates are affected if rubrophytia acquires running form. Children exhibit exudation - inflammation of tissue as a result of filling of blood vessels excess liquid. This process complicates the course of the disease and diagnosis;
• Rubromycosis of the hands is a consequence of self-infection. In this case, fungi do not enter the body from the outside; they are already in the body in a latent state. Symptoms of the disease are similar to rubromycosis of the feet, but less pronounced;
• if the fungus penetrates the nail area, then all plates are affected almost simultaneously. Rubromycosis of the nails manifests itself in thickening of the nail, the appearance of yellow or white stripes on the edges of the nail, crumbling and brittleness. The nail may become curved and bulging. An atrophic form of the disease may develop. In this case, the nail plate slowly deteriorates, becoming thin, brittle and lifeless. Usually a small part of the nail remains near the roller, but in some cases the nail is completely separated from the bed.

The listed signs are individual and may or may not be observed depending on the human body, the form and stage of the disease.

Generalized rubromycosis

Generalized rubrophytia is a condition when, after a long-term local lesion, rubromycosis turns into new uniform. This is facilitated by:

• diseases of internal organs;
• failure of the nervous and endocrine systems;
• long-term use of antibiotic drugs;
• lack of treatment for localized forms of the disease;
• trophic changes in the skin.

Generalized rubromycosis exists in erythematous-squamous and follicular-nodular forms. In the first case, the disease can easily be confused with atopic dermatitis or eczema, parapsoriasis. The lesions form rings, garlands, and semi-arcs. The disease is accompanied severe itching and worsens in the warm season. It can only be diagnosed by careful examination and analysis of scrapings.

With the follicular nodular form, deep damage occurs to the forearms, buttocks, feet, hands, legs, and knees. By external signs the disease resembles lupus erythematosus, erythema nodosum, vasculitis.

Preparatory stage of treatment of rubromycosis

The first stage of treatment for rubrophytosis is preparatory. At this time, it is necessary to peel off the skin.

For skin detachment, Arievich ointment is used. This ointment is prescribed for contraindications to the use of systemic antifungal drugs based on ketoconazole and to improve the effect of local treatment. The drug contains 6 g of lactic acid, 12 g of salicylic acid and another 82 g of petroleum jelly as an excipient. Removal of the stratum corneum is carried out as follows:

1. Immerse your feet in a bath of 5% soda solution and steam for 5-10 minutes.
2. Apply a sufficient amount of ointment to the affected area and wrap with cellophane film or parchment paper. Leave the ointment on for 24 hours.
3. Remove the top layer of the epidermis. If the procedure was carried out successfully, then there will be no difficulties in removing the stratum corneum.
4. If the procedure was not successful, it is recommended to apply the ointment for another 24 hours, but in double concentration.

To consolidate the result or as an alternative, it is recommended to use lactic-salicylic colloid. This is a mixture of 10 g of lactic and salicylic acid and 80 g of colloid. The affected area is lubricated 2 times a day for 8 days. When the course of treatment is completed, baths with a solution of soap and soda are used. Exfoliated skin is carefully cleaned off with pumice.

Treatment of rubrophytia

Rubrophytia should be treated comprehensively and include etiotropic, symptomatic and pathogenetic therapy. First aid should be external. The following tools and methods are used for this:

• with pronounced inflammatory processes lotions (compresses) are used from a solution of resorcinol (25%), silver nitrate (0.25%), boric acid;
• If blisters form on the skin, carefully prick them with a sterile needle. After this, treat the area where the blisters used to be with diamond polish. green solution, Castellani paint (Fukortsin) or other aniline dye;
• etiotropic (antibacterial) treatment is carried out using antimycotic ointments. These include: Zalain, Lamisil, Travogen;
• if severe inflammation is accompanied by a secondary infection, the doctor prescribes corticosteroid ointments and creams. Complex therapy includes antimycotic drugs: Travocort, Triderm, Gentriderm;
• for “wet” skin, Nitrofungin-Neo is prescribed. This medicine is available in the form of a spray or solution and is aimed at drying out the lesions.

When using products, be careful, follow the instructions and do not overdose. Otherwise you can call allergic reactions or dry out your skin.

Systemic therapy

Rubromycosis of the feet, skin and hands is treated with antimycotic (antifungal) drugs. These include: Mycozonol, Lamisil, Clotrimazole, Castellani liquids, Nitrofungin and other agents. If the nail plates are damaged, treatment should be comprehensive and include taking medications (tablets and capsules):

• Lamisil. Taken once a day (250 mg). The course of treatment is 6-12 weeks and up to 30 weeks if the patient is diagnosed with rubrophytosis of the nails in the foot area. Auxiliary treatment in the form of local medicines not required - just taking Lamisil;
• Orungal. Prescribe 400 mg of the drug orally once every 24 hours. The duration of therapy is 7 days, after which a break is taken for 3 weeks. After the break, taking the pills must be repeated: for fungus on the hands - 1 time, on the feet - 2 times;
• Griseovulvin. In the first month, take 6-8 tablets per day, in the second month - 6-8 tablets every other day. Then, it is recommended to take medications twice a week as maintenance therapy. This must be done until the nail is finally replaced by a healthy one;
• Nizoral. Take 1 tablet (200 mg) per day. The course of treatment is 6-8 months. It is recommended to combine the drug with the use of local medications.

Before using any medications, consult your doctor.