Microsporia pathogenesis. Diagnosis and differential diagnosis of microsporia

Childhood is a wonderful, unforgettable time, a time of new discoveries and adventures. Kids enjoy exploring the huge world with everyone possible ways. The children happily dribble in the sand and earth, pet animals, and touch surrounding objects.

Pediatrician, neonatologist

But sometimes such fun plays a cruel joke on little researchers. After all, there are many pathogens of infectious and fungal skin diseases in the environment. The baby’s immune system is not yet ready to cope with the abundance of infections. This is how a disease such as microsporia arises, or ringworm.

It is important for parents to know what microsporia is and how to prevent it. After all, many unpleasant situations may not happen to the baby if mothers and fathers are vigilant and protect their child. You need to understand what the treatment of skin diseases is aimed at, when you can get by traditional medicine, and when you need to sound the alarm and run to the doctor.

Microsporia or ringworm?

Highly contagious is called ringworm fungal disease skin, nails and hair. But it is not entirely correct to call ringworm microsporia, because there are several causative agents of ringworm. If the cause of lichen is caused by fungi of the genus Trichophyton, the disease is called trichophytosis. When infected with Microsporum fungi, microsporia appears.

Microsporia most often occurs in children, because the disease is very contagious, and it is transmitted from domestic animals and from sick people. Trichophytosis can only be contracted from a sick person.

To the culprits of the appearance fungal infection skin in children include Microsporum fungi. Scientists have identified more than 12 species of fungi of this genus, the most common of which is Microsporum canis.

The fungus is highly resistant to external environment and is capable of infecting others for several years. The pathogen is found in hair, animal fur, dust or skin flakes.

Once on the skin, the fungus penetrates and forms its colonies in hair follicles. This occurs both on the surface of the scalp and in the vellus hair follicles throughout the body. Rarely, microsporia appears on the palms, soles and nails, although there are no hair follicles there.

Preschool and preschool children are most susceptible to the disease. school age. In adults, the disease is much less common, which is due to the properties of the immunity of adults.

Although microsporia is a highly contagious disease, not all children become infected with fungi. There are certain risk factors, the combination of which increases the possibility of infection several times.

Risk factors for developing fungal skin diseases are as follows.

1. The disease is more common in children with chronic diseases, weakened immune system.
2. For the development of fungi, sufficient moisture is needed - warm and rainy weather. Therefore, an increase in the incidence of microsporia is observed in spring and summer – in May, June and in autumn – in September and October.
3. Unfavorable sanitary and hygienic living conditions for children contribute to the spread of the pathogen.
4. Increased sweating and moisture in the baby's skin are an excellent environment for fungus to multiply.
5. Hormonal problems - hypothyroidism and diabetes.

How does microsporia become infected?

Microsporia - contagious disease, which is most often spread by sick animals.

Both domestic and wild animals can suffer from fungal disease. Among domestic animals, cats, dogs, rabbits, large cattle, and among the wild ones there are foxes, arctic foxes, and monkeys.

Direct contact with an animal is not necessary to become infected with microsporia. It is enough for hair or scales from surrounding objects to come into contact with human skin, for example, when grooming or feeding a pet.

Children most often catch the disease through contact with infected cats and kittens, and less often through contact with dogs or through infected care items.

A person with microsporia who secretes the pathogen into environment. For children, the source of infection is often a sick child, for example, playing in a sandbox or visiting a children's group.

Infection is possible from sick family members, through contact with household items, or clothing contaminated with fungus. It is dangerous to use the same comb or wear a hat for a person with microsporia.

By following the rules of hygiene and thorough hand washing, the disease can be prevented. The contact of fungal spores on the surface of human skin does not indicate the inevitability of the disease, although the risk of infection remains high.

Incubation period for microsporia in children

Incubation period may vary. It depends on the type of Microsporum fungus and ranges from 5 days to 6 weeks. But most often, the development of the disease occurs 1 - 2 weeks from the moment the fungus gets on the skin.

Classification of microsporia in children

From the type of fungus

Depending on the type of Microsporum fungus, epidemiologists distinguish the following types of microsporia.

1. Zoonotic microsporia. This type of microsporia is caused by fungi, the main host of which is animals. Infection occurs through contact with an animal or while caring for it.
2. Anthroponotic microsporia. They become infected with anthroponotic microsproria from a sick person. This form is typical for children, children's groups, kindergartens, and schools. It is enough to touch things on which hair or scales containing fungal spores remain, and the disease develops.
3. Geophilic microsporia. The causative agent of the disease is the fungus Microsporum, which lives in the soil. A child can become infected by digging in soil contaminated with fungal spores.

From localization

Depending on the location and location of the affected area, the following types of disease are distinguished.

The first symptom of infection is the appearance of a small round or oval spot on the skin. The affected area has clear boundaries and rises slightly above the rest of the skin surface. Doctors call this spot a lesion.

Gradually, the area of ​​the lesion increases, the spot becomes larger and denser to the touch. The outer edge of the lesion swells and transforms into a cushion, which consists of crusts and bubbles. In the center of the lesion, inflammation, on the contrary, decreases, the skin becomes pale pink in color and becomes covered with scales.

It happens that the fungus re-enters the ring and infects the skin again. Then a new round-shaped spot appears in the middle of the lesion, and then a ring. Repeated infections can be repeated, then the shape of the lesion resembles a target and consists of several rings, which is very characteristic of anthroponotic microsporia.

The lesions are located on upper limbs, neck, face, at the site of pathogen penetration. The diameter of the spots varies from 5 mm to 3 cm, but sometimes the lesions reach 5 cm. Adjacent lesions can merge, forming extensive skin lesions.

This infection does not cause significant discomfort in a child and is often painless. There are even abortive forms when clinical manifestations microsporia are not expressed, and the skin remains pale pink, the affected area has no clear boundaries. Severe pain and itching indicate serious inflammatory process at the site of the lesion.

For children under 3 years of age, an erythematous-edematous form of the disease is characteristic. This form is characterized by the appearance of a red, swollen lesion with pronounced signs of inflammation. Peeling and the appearance of scales are not typical for microsporia in children; these manifestations are minimal.

Microsporia of the scalp

If fungi get on a child's hair, microsporia of this area develops. This localization is typical for children from 5 to 12 years old and rarely occurs in adults. This is explained by the peculiarity hair follicles adults.

With the onset of puberty, hair follicles produce acid, which prevents the development of Microsporum fungi. Therefore, there are known cases of spontaneous cure of the disease in children who have reached puberty.

The disease microsporia is very rare in children with red hair, the reasons for this are not yet known.

Damage to the scalp is manifested by the formation of lesions on the crown, crown and temples. On the head you can see round or oval spots with clear edges.

After fungal spores get on the skin of the scalp, a small flaky area forms at the site of the lesion. The hair in this place is surrounded by ring-shaped scales. After a week, it is easy to detect hair damage in this area. Hair loses color and elasticity, breaks easily, leaving only fragments about 5 cm long.

The affected area is an island, a group of hair fragments covered with a grayish coating. A large amount of the pathogen is found in plaque and scales located on the scalp.

The number of affected areas of the scalp usually does not exceed two. But between the lesions small secondary screenings appear, up to 2 cm in diameter.

Involvement of areas devoid of hair follicles, nails, palms or soles is very rare. With nail microsporia, a gray spot forms on the baby’s nail, which grows and increases in size. Over time, the color of the spot changes to white, and the nail plate loses its properties and is destroyed.

From the depth of the lesion

Depending on the depth of skin damage, the following types of pathology are distinguished.

• superficial microsporia;

Damage to the skin in this form is superficial, mainly the upper layers are damaged. Microsporia manifests itself as peeling and redness of the skin. When the fungus spreads to the scalp, hair loss and breakage occurs. Superficial microsporia most often found in children with anthroponotic infection.

• infiltrative-suppurative microsporia.

In severe suppurative form of microsporia, the inflammation process penetrates deep into the tissue. Focal fragments covered with pustules form on the skin. When pressure is applied to the affected areas, purulent exudate is released. The patient’s well-being due to the suppurative form is disturbed.

Diagnosis of microsporia in children

To make a correct diagnosis, a consultation with a dermatologist is necessary. The specialist examines the affected area of ​​the skin and scalp. Then the doctor conducts a survey and establishes the possibility of contact of the child with a patient with microsporia or an infected animal.

The final diagnosis is established after additional research.

1. Dermatoscopy and microscopy. To see the fungus under a microscope, scrapings from the affected skin or pieces of hair are taken. When examining skin flakes, threads of mycelium and fungal bodies are revealed. A large number of fungal spores are detected on damaged hair.
2. Cultural research. Sowing scales or hair on a nutrient medium will help to more accurately diagnose, prescribe treatment and determine prevention. 2 - 3 days after sowing, colonies of fungi appear in the Petri dish. By appearance colonies, you can determine the type of pathogen and select a treatment that will definitely affect this type fungus.
3. Luminescent study. Using a Wood's lamp, you can quickly determine the disease in a child. The affected hair begins to glow during fluorescent examination green. Required condition diagnostics is to cleanse the lesions from ointments and crusts, and conduct research in a dark room.

Thus, only experienced doctor can accurately determine the cause of the disease, correctly diagnose and prescribe effective treatment.

Treatment of microsporia in children. General principles

To quickly cure microsporia in a child, it is necessary to start therapy on time and choose the right antifungal treatment. Long-term ineffective treatment or smoothing of symptoms of the disease folk remedies leads to suppuration of lesions and frequent relapses diseases.

Only a dermatologist can determine how to properly treat microsporia in children.

Therapy for various forms of microsporia has its own characteristics, but the principles of treatment are similar.

1. If the fungus has affected only the skin, and the vellus hairs are untouched, then use local drugs will be sufficient.
2. If affected hairy part scalp or symptoms of infection are visible on vellus hair, treatment is necessary antifungal drugs inside.
3. Treatment with drugs against fungal infection continues at the same dose for a week after the symptoms of the disease disappear. This measure prevents the recurrence of the disease.

Treatment of smooth skin microsporia

Ointments, creams and solutions are widely used for local therapy. The most popular use of ointments containing antifungal drugs. For example, Clotrimazole, Itroconazole, Bifonazole. A widely used antifungal cream is Lamisil, which has a pronounced antifungal effect. It is recommended to treat the affected area 2 - 3 times a day.

If the doctor has detected a pronounced inflammatory process at the site of the lesion, then combined ointments are prescribed. In addition to the antifungal component, such ointments also include hormonal agents, reducing swelling and inflammation, reducing itching. In severe suppurative forms of the disease, ointments containing antibacterial drugs, for example, Triderm.

Treatment of microsporia of the scalp

Therapy for this form of the disease should begin when the first symptoms appear in order to prevent the formation of a cosmetic defect on the child’s head.

You should shave the hair from the affected area daily and treat the lesion with antifungal ointments or apply a Griseofulvin patch. Until the end of treatment, you need to wash your hair 1-2 times a week.

Complex treatment of the disease must necessarily include the use of antifungal drugs; Griseofulvin is most often prescribed. The general course of treatment lasts about 1.5 - 2 months.

The duration of treatment for microsporia, the dosage and frequency of taking drugs is determined by the doctor. Incorrect or prematurely completed treatment often leads to recurrence of the disease.

Prevention of microsporia in children

1. Maintain personal hygiene. The child must be taught to regularly wash his hands, use an individual towel, and a comb. Explain to your child that you should not exchange mittens or hats with other children.
2. Preventing contact with infected animals. Warn your child that stray animals can carry the disease; do not allow children to play with them. Examine your pets carefully and treat them promptly.
3. Medical examinations in preschool institutions. To prevent the disease in children, it is necessary to promptly identify and isolate patients with microsporia. A child with a fungal skin infection must be treated in a hospital, and his things must be disinfected.
4. Quarantine measures. The kindergarten or school the child attends is subject to quarantine for 2 to 3 weeks.

Conclusion

Microsporia in children is a highly contagious, common disease. You can become infected with the disease from pets, cats, or from a sick person. Therefore, the main method of protecting a baby from microsporia and fungal skin infections is to maintain personal hygiene and prevent contact with the source of the disease.

Microsporia is a highly contagious dermatophytosis caused by fungi of the genus Microsporum.

Etiology and epidemiology of microsporia

The most commonly isolated pathogens of microsporia are the fungi Microsporum canis, which are among the most widespread zoophilic fungi in the world, causing dermatophytes in cats (especially kittens), dogs, rabbits, guinea pigs, hamsters, in more rare cases - in monkeys, tigers, lions, wild and domestic pigs, horses, sheep, silver-black foxes, rabbits, rats, mice, hamsters, guinea pigs and other small rodents, as well as domestic birds. Infection occurs mainly through contact with sick animals or through objects contaminated with their fur. Infection between humans and humans is extremely rare, occurring on average in 2% of cases.

Microsporum audouinii is a common anthropophilic pathogen that can cause damage to the scalp and, less commonly, smooth skin in humans. Children get sick more often. The pathogen is transmitted only from a sick person to a healthy person directly through contact or indirectly through contaminated care and household items.

Microsporia is characterized by seasonality. Peaks in the detection of microsporia are observed in May-June and September-November. Various factors can contribute to the occurrence of the disease endogenous factors: sweat chemistry, endocrine and immune systems. In addition, children have insufficient density and compactness of the keratin of epidermal cells and hair, which also contributes to the introduction and development of fungi of the genus Microsporum.

Microsporia is a disease that is the most highly contagious of the entire group of dermatophytosis. Mostly children, often newborns, are affected. Adults get sick less often, while the disease is often registered in young women. The rarity of microsporia in adults is associated with the presence of fungistatic agents in the skin and its appendages. organic acids(in particular, uncylenic acid).

IN last years there has been an increase in the number of patients with chronic course mycosis against the background of severe systemic lesions– lupus erythematosus, chronic glomerulonephritis, immunodeficiency states, intoxications.

Classification of microsporia

• microsporia caused by anthropophilic fungi Microsporum audouinii, M. ferrugineum;
• microsporia caused by zoophilic fungi canis, M. distortum;
• microsporia caused by geophilic fungi gypseum, M. nanum.

According to the depth of the lesion there are:

• superficial microsporia of the scalp;
• superficial microsporia of smooth skin (with damage to vellus hair, without damage to vellus hair);
• deep suppurative microsporia.

Symptoms of microsporia

Microsporum canis affects hair, smooth skin, and very rarely nails; foci of the disease can be located on both open and closed parts of the body. The incubation period of the disease is 5–7 days.
On smooth skin, the lesions look like swollen, raised erythematous spots with clear boundaries, round or oval outlines, covered with grayish scales. Gradually, the spots increase in diameter, and a raised ridge, covered with blisters and serous crusts, forms along their periphery. In 80-85% of patients in infectious process vellus hairs are involved. The eyebrows, eyelids and eyelashes may be affected. For microsporia of smooth skin subjective feelings are absent, sometimes patients may be bothered by moderate itching.

With microsporia of the scalp, the lesions are most often located in the occipital, parietal and temporal areas. IN initial period disease, a focus of peeling appears at the site of introduction of the pathogenic fungus. Subsequently, the formation of one or two large lesions of round or oval shape with clear boundaries, measuring from 3 to 5 cm in diameter, and several small lesions - screenings, ranging in size from 0.3-1.5 cm are characteristic. Hair in the lesions is broken off and protrudes above the level skin by 4-5 mm.

Along with the typical clinical symptoms of zooanthroponotic microsporia, atypical variants have often been observed in recent years. These include infiltrative, suppurative (deep), exudative, rosacea-like, psoriasiform and seboroid (proceeding like asbestos-like lichen), trichophytoid, exudative forms, as well as a “transformed” version of microsporia (with modification clinical picture as a result of the use of topical corticosteroids).

In the infiltrative form of microsporia, the lesion on the scalp rises somewhat above the surrounding skin, is hyperemic, and the hair is often broken off at a level of 3-4 mm. The sheath of fungal spores is weakly visible at the root of broken hair.

In the infiltrative-suppurative form of microsporia, the lesion usually rises significantly above the surface of the skin due to pronounced infiltration and the formation of pustules. When pressing on the affected area, pus is released through the follicular openings. Discharged hair is glued together with purulent and purulent-hemorrhagic crusts. Crusts and melted hair are easily removed, exposing the gaping mouths of the hair follicles, from which, like a honeycomb, light yellow pus is released. The infiltrative-suppurative form is more common than others atypical forms, sometimes occurs in the form of kerion of Celsus - inflammation of the hair follicles, suppuration and the formation of deep painful nodes.

Due to the absorption of fungal decay products and the associated secondary infection, intoxication of the patient’s body is observed, which is manifested by malaise, headaches, fever, enlargement and soreness of regional lymph nodes.

The formation of infiltrative and suppurative forms of microsporia is facilitated by irrational (usually local) therapy, serious accompanying illnesses, and late application for medical help.

The exudative form of microsporia is characterized by severe hyperemia and swelling, with small bubbles located against this background. Due to the constant impregnation of the scales with serous exudate and gluing them together, dense crusts are formed, which, when removed, exposes the moist, eroded surface of the lesion.

microsporia exudative form

With the trichophytoid form of microsporia, the lesion process can cover the entire surface of the scalp. The lesions are numerous, small, with weak pityriasis-like peeling. The boundaries of the lesions are unclear, there are no acute inflammatory phenomena. This form of mycosis can acquire a chronic, sluggish course, lasting from 4-6 months to 2 years. The hair is thin or there are areas of patchy baldness.

trichophytoid form

With the seborrheic form of microsporia of the scalp, sparse hair is mainly noted. The areas of discharge are abundantly covered with yellowish scales, upon removal of which a small amount of broken hair can be found. Inflammatory phenomena in the lesions are minimal, the boundaries of the lesion are unclear.

seborrheic form

Diagnosis of microsporia

The diagnosis of microsporia is based on the clinical picture and the results of laboratory and instrumental studies:

• microscopic examination for fungi (at least 5 times);
• inspection under a fluorescent filter (Wood's lamp) (at least 5 times);
• cultural research to identify the type of pathogen in order to properly carry out anti-epidemic measures;

When prescribing systemic antimycotic drugs, it is necessary to:

• general clinical analysis blood (once every 10 days);
• general clinical urine analysis (once every 10 days);
• biochemical examination of blood serum (before the start of treatment and after 3-4 weeks) (ALT, AST, total bilirubin).

Differential diagnosis of microsporia

Microsporia is differentiated from trichophytosis, pityriasis rosea, seborrhea, and psoriasis.

The superficial form of trichophytosis of the scalp is characterized by small scaly foci of round or irregular shape with very mild inflammatory phenomena and some hair thinning. The lesions are characterized by the presence of short gray hair broken off 1-3 mm above the skin level. Sometimes the hair breaks off above the skin level and looks like so-called “black dots”. At differential diagnosis with microsporia, pay attention to highly broken hair, with muff-like covers covering the hair fragments, asbestos-like peeling. Of decisive importance in diagnosis is emerald fluorescence in the rays of a Wood's lamp of affected hair, detection of elements of a pathogenic fungus and isolation of the pathogen during cultural examination.

For pityriasis rosea Zhiber is characterized by more pronounced inflammation, a pink tint of the lesions, the absence of sharp boundaries, peeling in the form of “crumpled tissue paper”, the absence of the characteristic emerald glow and the identification of elements of a pathogenic fungus during microscopic examination.

Psoriasis is more characterized by clear boundaries, dry lesions, silvery scales, and the absence of muff-like layers of scales on the affected hair.

Treatment of microsporia

Treatment Goals

• clinical cure;
• negative results of microscopic examination for fungi.

General notes on therapy

For microsporia of smooth skin (less than 3 lesions) without damage to vellus hair, external antimycotic agents are used.

Indications for the use of systemic antimycotic drugs are:

• multifocal microsporia of smooth skin (3 or more lesions);
• microsporia with damage to vellus hair.

Treatment of these forms is based on a combination of systemic and local antimycotic drugs.

Hair in the affected areas is shaved once every 5-7 days or epilated.

Indications for hospitalization

• lack of effect from outpatient treatment;
• infiltrative-suppurative form of microsporia;
• multiple lesions with damage to vellus hair;
• severe concomitant pathology;
• according to epidemiological indications: patients from organized groups in the absence of the possibility of isolating them from healthy individuals (for example, in the presence of microsporia in persons living in boarding schools, orphanages, dormitories, children from large and asocial families).

Treatment regimens for microsporia:

• Griseofulvin orally with a teaspoon vegetable oil 12.5 mg per kg body weight per day

Additionally, therapy is carried out with locally active drugs:

• ciclopirox, cream
• ketoconazole cream, ointment
• isoconazole, cream
• bifonazole cream
• 3% salicylic acid and 10% Sulfuric ointment
• sulfur (5%)-tar (10%) ointment

When treating the infiltrative-suppurative form, antiseptics and anti-inflammatory drugs are initially used. medicines(in the form of lotions and ointments):

• Ichthyol, ointment 10%
• potassium permanganate, solution 1:6000
• ethacridine, solution 1: 1000
• furatsilin, solution 1:5000

Then treatment is continued with the above antifungal drugs.

Alternative treatment regimens

• terbinafine 250 mg
• itraconazole 200 mg

Special situations

microsporia - Pregnancy and lactation.

The use of systemic antifungal drugs during pregnancy and lactation is contraindicated.

Treatment of all forms of microsporia during pregnancy is carried out only with locally active drugs.

Treatment of children with microsporia:

Griseofulvin orally with a teaspoon of vegetable oil 21-22 mg per kg body weight per day

Treatment is considered complete when three negative results of the study are carried out at intervals of 5-7 days.

Additionally, therapy is carried out with locally active drugs:

• ciclopirox, cream
• ketoconazole cream, ointment
• isoconazole, cream
• bifonazole cream
• 3% salicylic acid and 10% sulfur ointment, alcohol tincture of iodine
• sulfur (5%)-tar (10%) ointment

Alternative treatment regimens

• terbinafine: children weighing >40 kg - 250 mg 1 time per day orally after meals, children weighing from 20 to 40 kg - 125 mg 1 time per day orally after meals, children with body weight<20 кг — 62,5 мг 1 раз в сутки
• itraconazole: children over 12 years of age - 5 mg per 1 kg of body weight

Requirements for treatment results

• resolution of clinical manifestations;
• lack of hair glow under a fluorescent filter (Wood's lamp);
• three negative control results of a microscopic examination for fungi (microsporia of the scalp - 1 time in 5-7 days; microsporia of smooth skin with damage to vellus hair - 1 time in 5-7 days, microsporia of smooth skin - 1 time in 3-5 days).

Due to the possibility of relapses, after completion of treatment, the patient should be under clinical observation: for microsporia of the scalp and microsporia of smooth skin with damage to vellus hair - 3 months, for microsporia of smooth skin without damage to vellus hair - 1 month.

Control microscopic examinations during dispensary observation must be carried out: for microsporia of the scalp and microsporia of smooth skin involving vellus hair - once a month, for microsporia of smooth skin - once every 10 days.

A conclusion on recovery and admission to an organized team is given by a dermatovenerologist.

Prevention of microsporia

Preventive measures for microsporia include sanitary and hygienic measures, incl. compliance with personal hygiene measures and disinfection measures (preventive and focal disinfection).

Focal (current and final) disinfection is carried out in places where the patient is identified and treated: at home, in children's and medical organizations.

Preventive sanitary-hygienic and disinfection measures are carried out in hairdressing salons, baths, saunas, sanitary checkpoints, swimming pools, sports complexes, hotels, hostels, laundries, etc.

Anti-epidemic measures when microsporia is detected:

• For a patient diagnosed with microsporia for the first time, a notification is submitted within 3 days to the department of accounting and registration of infectious diseases of the Federal Budgetary Institution of Health "Center for Hygiene and Epidemiology" and its branches, to territorial dermatovenerological dispensaries.
• Each new disease should be considered as newly diagnosed.
• When registering a disease in medical organizations, organized groups and other institutions, information about the sick person is entered into the infectious diseases register.
• The journal is kept in all medical organizations, medical offices of schools, preschool institutions and other organized groups. Serves for personal registration of patients with infectious diseases and registration of information exchange between medical organizations and state sanitary and epidemiological surveillance organizations.
• The patient is isolated.

• When a disease is detected in children's institutions, a patient with microsporia is immediately isolated and routine disinfection is carried out before transfer to the hospital or home.
• Until a child with microsporia recovers, he is not allowed to enter a preschool educational institution or school; an adult patient is not allowed to work in children's and communal institutions. The patient is prohibited from visiting the bathhouse or swimming pool.
• For maximum isolation, the patient is allocated a separate room or part of it, personal items (linen, towel, washcloth, comb, etc.).
• In the first 3 days after identifying a patient in preschool educational institutions, schools, higher and secondary specialized educational institutions and other organized groups, medical personnel of these institutions conduct an examination of contact persons. An examination of contact persons in the family is carried out by a dermatovenerologist.

• The inspection is carried out before final disinfection.
• Further medical observation with mandatory examination of the skin and scalp using a fluorescent lamp is carried out 1-2 times a week for 21 days with a note in the documentation (an observation sheet is kept).
• Current disinfection of outbreaks is organized by the medical organization that identified the disease. Routine disinfection before hospitalization and recovery is carried out either by the patient himself or by the person caring for him.
• Responsibility for performing routine disinfection in organized teams and medical organizations rests with its medical personnel. Current disinfection is considered timely organized if the population begins to perform it no later than 3 hours from the moment the patient is identified.
• Final disinfection is carried out in microsporia foci after the patient leaves the foci for hospitalization or after the recovery of a patient who was treated at home, regardless of the length of hospitalization or recovery.

• In some cases, final disinfection is carried out twice (for example, in the case of isolation and treatment of a sick child in the isolation ward of a boarding school: after isolation - in the premises where the patient was and after recovery - in the isolation ward). If a child attending a preschool or school falls ill, final disinfection is carried out at the preschool (or school) and at home. In secondary schools, final disinfection is carried out according to epidemiological indications. The final disinfection in the outbreaks is carried out by a disinfection station. Bedding, outerwear, shoes, hats, carpets, soft toys, books, etc. are subject to chamber disinfection.
• An application for final disinfection in households and isolated cases in organized groups is submitted by a medical worker of a medical organization with a dermatovenerological profile.
• When 3 or more cases of microsporia are registered in organized groups, as well as for epidemiological indications, the exit of a medical worker from a medical organization with a dermatovenerological profile and an epidemiologist from state sanitary and epidemiological surveillance institutions is organized. As directed by the epidemiologist, final disinfection is prescribed and the scope of disinfection is determined.

• The medical worker who has identified the disease is working to identify the source of infection (contact with sick animals). Animals (cats, dogs) are sent to a veterinary hospital for examination and treatment, followed by the submission of a certificate of the place of treatment and observation of the patient with microsporia. If a stray animal is suspected, information is transmitted to the appropriate animal control services.

IF YOU HAVE ANY QUESTIONS ABOUT THIS DISEASE, CONTACT DOCTOR DERMATOVENEROLOGIST KH.M. ADAEV:

EMAIL: [email protected]

INSTAGRAM @DERMATOLOG_95

zooanthroponotic mycosis skin pathogen

Microsporia is a zooanthroponotic anthropurgic mycosis of skin, hair, and sometimes nails caused by various species of fungi of the genus Microsporum, with a contact mechanism of pathogen transmission.

The disease was first described in Paris by the Hungarian scientist Gruby (1843). The causative agents of microsporia are dermatomycetes of the genus Microsporum.

Microsporums are usually divided into three groups - anthropophilic, zoophilic and geophilic. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.76

Anthropophilous: M.audoinii, M.langeroni - common in North Africa and Western Europe; M.ferrugineum is dominant in Eastern Europe, Southwest Asia, and West Africa; M.rivaliery is endemic in the Congo.

Bestiality-. M.canis (felineum, lanosum, equinum) is the most common pathogen of microsporia in humans and animals, distributed everywhere; the natural reservoir is stray cats, dogs, and less commonly other mammals; M.galinae - chickens; M.persicolor - mice and other small rodents; M.distortum - monkeys, cats, dogs; M.papit - monkeys.

Geophilic: M.gypseum, M.racemosum, M.qookey, M.magellanicum. This group of microsporums does not play a significant role in the formation of the epidemic process, but, nevertheless, is described in the literature as the causative agent of “gardeners’ mycosis.”

M.gypseum is found everywhere in soil, especially garden soil. Described as a causative agent of damage to smooth skin, scalp and nail plates, the latter is very rare.

In the epidemic processes of the European part of Russia, the share of the zoophilic fungus M.canis is 99%, the anthropophilic fungus M.ferrugineum is about 1%, and the geophilic fungus M. gypseum is about 0.5%. At the same time, Mcanis is relatively evenly distributed throughout the Eurasian continent; in Central and Southern Europe, M.audoinii makes up a significant proportion, and in Siberia and the Far East, M. ferrugineum is equally widespread.

Microsporia caused by M.canis is the dominant mycosis of smooth skin and scalp in childhood in Europe, the USA and South American countries, Japan, Israel, Qatar, Kuwait, and the United Arab Emirates. This is a kind of cosmopolitan mushroom, as aptly put by one of the leading Russian mycologists, Ph.D. V.M. Rukavishnikova, practically the only pathogen of microsporia in the world, with the exception of African countries. Microsporia predominates in European countries, especially in the Mediterranean, the USA and South America, Japan, Israel, Kuwait, Qatar, and the United Arab Emirates. Khmelnitsky, O.K. Pathomorphology of human mycoses /O.K. Khmelnitsky, N.M. Khmelnitskaya. - SPb.: SPb MALO, 2005, - P. 98.

Epidemiology of microsporia

Infection with anthropophilic fungi occurs through direct contact with a sick person, or indirectly, through household items (hats, combs, clothing, bed, etc.). Currently, anthroponotic microsporia occurs much less frequently than zoonotic microsporia, mainly in the Asian part of Russia and Siberia.

In Russia, the incidence of microsporia averages about 71.6 per 105 people. In Moscow and the Moscow region it accounts for 96.2% of all dermatomycosis involving hair.

The main sources of human infection with zoophilic fungi are cats (80.5%), mostly stray cats, and especially kittens and dogs. Up to 80% of all cases of infection occur through direct contact. Animals that rarely suffer from microsporia, but are a possible source of infection for humans, include monkeys, tigers, lions, wild and domestic pigs (especially piglets), horses, sheep, silver foxes, rabbits, rats, mice, hamsters, guinea pigs and other small rodents, as well as poultry.

Microsporia mainly (up to 65%) affects children, including children in the first year of life; Moreover, the incidence of the latter tends to slowly but steadily increase from year to year. Infection with a zoophilic fungus from person to person is possible, but does not exceed 2-4%. Cases of infection of children after playing with sand (on the beach, in the sandbox) have also been described, because fungi of the genus Microsporum are extremely stable in the external environment.

Thus, most children (and adults) become infected through direct contact with a sick animal. Transmission of the microsporia pathogen from person to person is possible.

The main contingent is children aged 6-14 years. Adults make up 15-25% of patients, but this ratio did not always exist - in the 1970-80s, the proportion of adults among patients with microsporia was only 3-5%.

The peak incidence of microsporia in central Russia occurs in August-October, when the epizootic reaches its peak among stray animals, cats and dogs, and children come into contact with them on vacation or in the city.

Anthroponotic microsporia, caused by rusty microsporum, is transmitted mainly only from a sick person to a healthy person directly through contact with him; indirect infection through care and household items is now rare. This form of microsporia is more contagious than zoonotic. Currently, this mycosis is found relatively rarely in our country.

In recent years, patients with chronic mycosis have begun to be registered against the background of severe systemic lesions - lupus erythematosus, chronic glomerulonephritis, immunodeficiency states, and intoxications. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.79

Pathogenesis

Microsporums have an affinity for structures containing keratin and affect animal fur, human skin and hair. Very rarely, unlike trichophytons, microsporums affect nails.

In the pathogenesis of microsporia, factors of immune and non-immune resistance play a certain role. Non-immune resistance factors include the composition and acidity of sebum, genetically determined structural features of the stratum corneum of the skin and hair. Immune resistance factors include Langerhans cell cytokines, phagocytic activity of macrophages, the antigen-presenting role of immunocompetent cells, etc. Phagocytosis is the main factor of immune resistance in any mycoses; it may not be completed if the patient has certain types of endocrine pathology (diabetes mellitus).

With mycoses of the skin, even infectious immunity is not stable, and is expressed almost only in the presence of allergic sensitization in some patients to these fungi.

On smooth skin, M. canis tends to produce a large number of small lesions, and M. ferrugineum - 1-3 large ones. The rule of greater affinity of anthropophilic fungi for the acid-lipid and antigenic composition of human skin works here. On hairless skin, the acid-lipid composition is different, as a result of which the ratio of the processes of germination and sporulation radically changes. It is known that zoophilic fungi generally cause more pronounced inflammatory phenomena than anthropophilic ones, but it does not at all follow from this that zoophilic fungi are less adapted to life in the human body than anthropophilic ones. The incubation period for zoonotic microsporia is 3-8 days, for anthroponotic microsporia - 4-6 weeks. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.81.

Microsporia is a fungal disease that affects the skin and hair, and in extremely rare cases, the nail plates. The name of this fungal disease comes from the name of its causative agent - a fungus of the genus Microsporum. The disease is also known as “ringworm,” due to the characteristics of its manifestation.

Etiology

Microsporia is the most common fungal infection, not counting foot fungus. The disease occurs everywhere. Microsporia is highly contagious and children are more often affected. Adults rarely get sick - mostly young women. The rarity of the disease with microsporia in adults, especially with damage to the scalp, and usually the onset of independent recovery at the beginning of adolescence is explained by the presence of organic acids in the hair of adults that slow down the growth of the fungus. The main source of the disease is cats (usually kittens), less often dogs. Infection with microsporia occurs through direct contact with a sick animal or objects infected with hair or scales. Once in the soil with an affected hair or scale, the fungus remains viable only for 1–3 months. Thus, soil is only a factor in the transmission of infection and does not serve as its natural source.

Epidemiology

Once on the skin, the fungus penetrates it and begins to multiply. When located near the hair follicles, fungal spores germinate, leading to hair damage. Spreading quite quickly over the surface of the hair, the fungus destroys the cuticle, between the scales of which spores accumulate. Thus, the fungus surrounds the hair, forming a sheath, and tightly fills the bulb.

Clinic

Manifestations of microsporia in animals are characterized by areas of baldness on the face, the outer surfaces of the ears, as well as on the front, less often the hind, paws. Often, apparently healthy cats can be carriers of the fungus. Seasonal fluctuations in incidence are associated with litters in cats, as well as more frequent contact of children with animals in the summer.

The rise in the incidence of microsporia begins in late summer, the peak occurs in October–November, and the decrease to a minimum occurs in March–April. The incubation period for zoonotic microsporia is 5–7 days.

The nature of the manifestations of microsporia is determined by the location of the lesions and the depth of penetration of the pathogen. There are microsporia of smooth skin and microsporia of the scalp.

Microsporia of smooth skin At the site of the fungus, a swollen, raised red spot with clear boundaries appears. Gradually the spot increases in diameter.

A continuous raised ridge is formed along the edge, represented by small nodules, bubbles and crusts. In the central part of the spot, inflammation resolves, as a result of which it acquires a pale pink color, with pityriasis-like peeling on the surface.

Thus, the focus has the appearance of a ring. The number of foci with microsporia of smooth skin is usually small (1–3).

Their diameter ranges from 0.5 to 3 cm. Most often, lesions are located on the skin of the face, neck, forearms and shoulders.

There are no subjective sensations or moderate itching. In newborns and young children, as well as in young women, severe inflammation and minimal peeling are often observed.

In people prone to allergic reactions (in particular, in patients with atopic dermatitis), the fungus is often masked by manifestations of the underlying process and is not always diagnosed in a timely manner. The use of local hormonal drugs only increases the spread of fungal infection.

A rare type of microsporia includes damage to the skin of the palms, soles and nail plates. Nail lesions are characterized by isolated lesions of the nail, usually its outer edge.

Initially, a dull spot is formed, which becomes white over time. The nail in the area of ​​whitening becomes softer and more fragile, and may subsequently collapse.

Microsporia of the scalp Damage to the scalp by microsporia occurs mainly in children 5–12 years old. It is generally accepted that the rarity of this form in adults is explained by the presence of organic acids in their hair, which slow down the growth of the fungus.

This fact indirectly confirms the independent recovery of children during puberty, when the composition of sebum changes. Interestingly, microsporia of the scalp is practically never found in children with red hair.

Foci of microsporia of the scalp are located mainly on the crown, in the parietal and temporal regions. Usually there are 1-2 large lesions ranging from 2 to 5 cm in size, with round or oval outlines and clear boundaries.

Along the edges of large lesions there may be screenings - small lesions with a diameter of 0.5–1.5 cm. At the beginning of the disease, a peeling area forms at the site of infection.

In the first days, the fungus is located only at the mouth of the hair follicle. Upon closer inspection, you will notice a whitish ring-shaped scale surrounding the hair like a cuff.

On the 6th–7th day, microsporia spreads to the hair itself, which becomes brittle, breaks off above the level of the surrounding skin by 4–6 mm and looks as if it has been trimmed (hence the name “ringworm”). The remaining stumps look dull and are covered with a grayish-white sheath, which is the spores of a fungus.

If you “stroke” the stumps, they deviate in one direction and, unlike healthy hair, do not restore their original position. The skin in the affected area is usually slightly reddened, swollen, and its surface is covered with grayish-white small scales.

In the suppurative form of microsporia, against the background of significant inflammation, soft bluish-red nodes form, the surface of which is covered with pustules. When pressed, pus is released through the holes.

The formation of a suppurative form of microsporia is facilitated by irrational (usually local) therapy, the presence of serious concomitant diseases, and late consultation with a doctor.

Prevention

Prevention of microsporia consists of timely identification, isolation and treatment of patients with microsporia. In children's institutions, periodic medical examinations should be carried out. A child diagnosed with microsporia must be isolated from other children and sent for treatment to a specialized hospital. Things belonging to a patient with microsporia must be disinfected. Relatives and people in contact with the patient must be examined. Particular attention should be paid to pets, since they are often the source of infection. Animals with microsporia are either destroyed or given full antifungal treatment.

Diagnostics

Diagnosis is carried out by a dermatologist. To confirm the diagnosis of microsporia, fluorescent, microscopic and cultural studies are used. Luminescent research: the method is based on identifying the bright green glow of hair affected by fungi of the genus Microsporum when examined under a Wood's lamp. The reason for this phenomenon has not yet been established. Luminescence testing must be carried out in a darkened room. The lesions are first cleaned of crusts, ointments, etc. When examining fresh lesions, there may be no glow, which is due to insufficient hair damage. In such situations, the hair should be removed from the suspected site of the fungus, and the glow can be detected in its root part. When the fungus dies, the glow in the hair remains. The luminescent method is used to: determine the pathogen; identifying affected hair; evaluation of therapy results; control over persons in contact with the patient; determining infection or carriage in animals Microscopic examination: to confirm the fungal origin of the disease, scales from lesions of smooth skin lesions are subjected to microscopic examination, and if the scalp is involved in the process, hair fragments are subjected to microscopic examination. In scales from lesions on smooth skin, twisted threads of mycelium are found. A microscopic examination of the affected hair reveals many small spores on its surface. Cultural examination: carrying out cultural diagnostics with positive results of luminescent and microscopic examinations is required to identify the causative fungus. The method allows you to determine the genus and type of pathogen and, therefore, carry out adequate therapy and prevention of the disease. The material (scales, hair) is placed on a nutrient medium. The growth of Microsporum colonies (the main pathogen of microsporia) is observed on the 3rd day after sowing.

Treatment

When treating microsporia of smooth skin without hair damage, external antifungal drugs are used. Apply 2–5% iodine tincture to the affected areas in the morning, and apply antifungal ointment in the evening. Use traditional 10–20% sulfur, 10% sulfur-3% salicylic or 10% sulfur-tar ointments.

Modern ointments are used twice a day: clotrimazole, ciclopirox, isoconazole, bifonazole, etc. The drug terbinafine (Lamisil), produced in the form of 1% cream and spray, has proven itself well.

In case of severe inflammation, it is advisable to prescribe combination drugs containing additional hormones. Similar products include mycozolon ointments and travocort.

When a bacterial infection occurs, Triderm cream is useful. For deep forms of microsporia, preparations containing dimexide are indicated.

In particular, in such situations, a 10% solution of quinosol is widely used (quinosole and salicylic acid 10.0 each, dimexide 72.0, distilled water 8.0). The solution should be applied 2 times a day until the mushrooms disappear.

When vellus hair, and especially long hair, is affected, systemic antifungal therapy for microsporia is necessary. When treating microsporia of the scalp, griseofulvin, an antibiotic produced by a mold, is still the drug of choice.

Griseofulvin, available in the form of 125 mg tablets. The drug is taken daily in 3-4 doses during meals with a teaspoon of vegetable oil, which is necessary to increase the solubility of griseofulvin and increase the duration of its action.

For children under 3 years of age, it is preferable to prescribe griseofulvin in the form of a suspension, 8.3 ml of which corresponds to 1 tablet (125 mg) of the drug. Continuous therapy is carried out until the first negative test result for fungi, after which griseofulvin is taken at the same dose every other day for 2 weeks, and then for another 2 weeks, 2 times a week.

The general course of treatment is 1.5–2 months. During treatment, you need to shave your hair weekly and wash your hair 2 times a week.

It is recommended to simultaneously rub any antifungal ointment into the affected area. In parallel with taking the antifungal drug, manual hair removal can be performed with preliminary application of a 5% griseofulvin patch to the lesion.

Side effects of griseofulvin include headache, allergic rashes, and discomfort in the pancreas. Due to its toxic effect on the liver, griseofulvin is contraindicated in children who have had hepatitis or suffer from liver disease.

The drug is also not prescribed for kidney diseases, gastric and duodenal ulcers, neuritis, blood diseases, and photodermatoses. In recent years, terbinafine (Lamisil) has been used as an alternative to griseofulvin.

In the treatment of microsporia of the scalp, terbinafine is used in the form of tablets, available in doses of 125 and 250 mg. When treating microsporia of the scalp in children, the dose of terbinafine is determined depending on body weight.

Terbinafine is taken once a day. The drug is well tolerated.

Patients may be bothered by a feeling of fullness in the stomach, minor abdominal pain. Following a diet aimed at relieving flatulence relieves patients from unpleasant sensations.

Attention! The described treatment does not guarantee a positive result. For more reliable information, ALWAYS consult a specialist.

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Topic: Microsporia: etiology, epidemiology, classification, clinical characteristics of lesions of the scalp and smooth skin, diagnosis, treatment, prevention

Chelyabinsk 2015

Introduction

4. Treatment of microsporia

Conclusion

Bibliography

Introduction

The intensive growth of patient populations in various age and social groups of the population observed over the past decade has placed the problem of the prevalence of fungal diseases on a par with other acute medical and social problems. Fungal infection is of particular relevance due to a decrease in immunity in the majority of the population, as well as an increase in immunodeficiency states. The further development of mass types of physical education and sports, identified as a priority direction of state policy in the field of public health, the planned expansion of the network of gyms and swimming pools increases the risk of a further increase in morbidity and will require the adoption of preventive measures.

Considering that almost a quarter of the adult population of the Russian Federation suffers from fungal diseases of the feet (skin and nails), an increase in the intensity of communication between patients and healthy people will further complicate the situation, which will also be facilitated by the high prevalence of atypical and erased forms of dermatomycosis. Factors contributing to the development of fungal pathology can be a number of reasons, including overcrowding of the population, non-compliance with sanitary standards, personal hygiene, etc., as well as somatic burden. The effectiveness of preventive measures and timely prescription of antifungal therapy largely determine the timing of resolution of the mycotic process in the lesions and reduce the possibility of infection of others. Dermatomycosis is one of the medical and social problems, and therefore remains the focus of attention of both health care organizers and dermatovenerologists.

All of the above indicates the relevance of the topic of my essay.

Purpose of the work: to study the disease microsporia.

Objectives of the work: -analyze the etiology and epidemiology of microsporia,

Consider the classification and clinical characteristics of the disease;

Study the diagnosis, treatment, and prevention of microsporia.

1. Microsporia: etiology, epidemiology, pathogenesis

zooanthroponotic mycosis skin pathogen

Microsporia is a zooanthroponotic anthropurgic mycosis of skin, hair, and sometimes nails caused by various species of fungi of the genus Microsporum, with a contact mechanism of pathogen transmission.

The disease was first described in Paris by the Hungarian scientist Gruby (1843). The causative agents of microsporia are dermatomycetes of the genus Microsporum.

Microsporums are usually divided into three groups - anthropophilic, zoophilic and geophilic. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.76

Anthropophilous: M.audoinii, M.langeroni - common in North Africa and Western Europe; M.ferrugineum is dominant in Eastern Europe, Southwest Asia, and West Africa; M.rivaliery is endemic in the Congo.

Bestiality-. M.canis (felineum, lanosum, equinum) is the most common pathogen of microsporia in humans and animals, distributed everywhere; the natural reservoir is stray cats, dogs, and less commonly other mammals; M.galinae - chickens; M.persicolor - mice and other small rodents; M.distortum - monkeys, cats, dogs; M.papit - monkeys.

Geophilic: M.gypseum, M.racemosum, M.qookey, M.magellanicum. This group of microsporums does not play a significant role in the formation of the epidemic process, but, nevertheless, is described in the literature as the causative agent of “gardeners’ mycosis.”

M.gypseum is found everywhere in soil, especially garden soil. Described as a causative agent of damage to smooth skin, scalp and nail plates, the latter is very rare.

In the epidemic processes of the European part of Russia, the share of the zoophilic fungus M.canis is 99%, the anthropophilic fungus M.ferrugineum is about 1%, and the geophilic fungus M. gypseum is about 0.5%. At the same time, Mcanis is relatively evenly distributed throughout the Eurasian continent; in Central and Southern Europe, M.audoinii makes up a significant proportion, and in Siberia and the Far East, M. ferrugineum is equally widespread.

Microsporia caused by M.canis is the dominant mycosis of smooth skin and scalp in childhood in Europe, the USA and South American countries, Japan, Israel, Qatar, Kuwait, and the United Arab Emirates. This is a kind of cosmopolitan mushroom, as aptly put by one of the leading Russian mycologists, Ph.D. V.M. Rukavishnikova, practically the only pathogen of microsporia in the world, with the exception of African countries. Microsporia predominates in European countries, especially in the Mediterranean, the USA and South America, Japan, Israel, Kuwait, Qatar, and the United Arab Emirates. Khmelnitsky, O.K. Pathomorphology of human mycoses /O.K. Khmelnitsky, N.M. Khmelnitskaya. - SPb.: SPb MALO, 2005, - P. 98.

Epidemiology of microsporia

Infection with anthropophilic fungi occurs through direct contact with a sick person, or indirectly, through household items (hats, combs, clothing, bed, etc.). Currently, anthroponotic microsporia occurs much less frequently than zoonotic microsporia, mainly in the Asian part of Russia and Siberia.

In Russia, the incidence of microsporia averages about 71.6 per 105 people. In Moscow and the Moscow region it accounts for 96.2% of all dermatomycosis involving hair.

The main sources of human infection with zoophilic fungi are cats (80.5%), mostly stray cats, and especially kittens and dogs. Up to 80% of all cases of infection occur through direct contact. Animals that rarely suffer from microsporia, but are a possible source of infection for humans, include monkeys, tigers, lions, wild and domestic pigs (especially piglets), horses, sheep, silver foxes, rabbits, rats, mice, hamsters, guinea pigs and other small rodents, as well as poultry.

Microsporia mainly (up to 65%) affects children, including children in the first year of life; Moreover, the incidence of the latter tends to slowly but steadily increase from year to year. Infection with a zoophilic fungus from person to person is possible, but does not exceed 2-4%. Cases of infection of children after playing with sand (on the beach, in the sandbox) have also been described, because fungi of the genus Microsporum are extremely stable in the external environment.

Thus, most children (and adults) become infected through direct contact with a sick animal. Transmission of the microsporia pathogen from person to person is possible.

The main contingent is children aged 6-14 years. Adults make up 15-25% of patients, but this ratio did not always exist - in the 1970-80s, the proportion of adults among patients with microsporia was only 3-5%.

The peak incidence of microsporia in central Russia occurs in August-October, when the epizootic reaches its peak among stray animals, cats and dogs, and children come into contact with them on vacation or in the city.

Anthroponotic microsporia, caused by rusty microsporum, is transmitted mainly only from a sick person to a healthy person directly through contact with him; indirect infection through care and household items is now rare. This form of microsporia is more contagious than zoonotic. Currently, this mycosis is found relatively rarely in our country.

In recent years, patients with chronic mycosis have begun to be registered against the background of severe systemic lesions - lupus erythematosus, chronic glomerulonephritis, immunodeficiency states, and intoxications. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.79

Pathogenesis

Microsporums have an affinity for structures containing keratin and affect animal fur, human skin and hair. Very rarely, unlike trichophytons, microsporums affect nails.

In the pathogenesis of microsporia, factors of immune and non-immune resistance play a certain role. Non-immune resistance factors include the composition and acidity of sebum, genetically determined structural features of the stratum corneum of the skin and hair. Immune resistance factors include Langerhans cell cytokines, phagocytic activity of macrophages, the antigen-presenting role of immunocompetent cells, etc. Phagocytosis is the main factor of immune resistance in any mycoses; it may not be completed if the patient has certain types of endocrine pathology (diabetes mellitus).

With mycoses of the skin, even infectious immunity is not stable, and is expressed almost only in the presence of allergic sensitization in some patients to these fungi.

On smooth skin, M. canis tends to produce a large number of small lesions, and M. ferrugineum - 1-3 large ones. The rule of greater affinity of anthropophilic fungi for the acid-lipid and antigenic composition of human skin works here. On hairless skin, the acid-lipid composition is different, as a result of which the ratio of the processes of germination and sporulation radically changes. It is known that zoophilic fungi generally cause more pronounced inflammatory phenomena than anthropophilic ones, but it does not at all follow from this that zoophilic fungi are less adapted to life in the human body than anthropophilic ones. The incubation period for zoonotic microsporia is 3-8 days, for anthroponotic microsporia - 4-6 weeks. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - P.81.

2. Classification and clinical manifestations of microsporia

The severity of the inflammatory process depends on the “anthropophilicity” or “zoophilicity” of the fungus - anthropophilic mushrooms generally cause a less pronounced inflammatory reaction than zoophilic ones.

Zoophilic microsporums generally cause more severe allergic reactions than anthropophilic microsporums.

The primary morphological element of a rash in microsporia in a typical case is an inflammatory spot or papule. On the scalp within the spot, peeling and minimal infiltration quickly occur, and the spot turns into a papule associated with the hair follicle. On smooth skin, lesions form as the fungus grows from a number of miliary papules that form a border; with a pronounced exudative component, papules alternate with vesicles, the exudate shrinks into crusts, the border of the lesion is formed from small papules, vesicles and crusts. In the center, the process can be completed for a while due to lysis of part of the colony, and then begin again due to autoinoculation, thus forming foci of the “iris” type, “ring in a ring”.

Anthroponotic microsporia of smooth skin: in lesions, the primary elements can be vesicles or nodules (depending on the reactivity of the body and the formation of allergies), and the secondary elements can be crusts. More often, 1-2 large lesions are observed, in the classic version in the form of an iris.

Anthroponotic microsporia of the scalp: lesions are often small, multiple, usually located in the marginal zones; inflammatory phenomena in the foci are slightly expressed, fine-plate peeling; Not all hair breaks off and at different levels - from 5 to 8 mm above the skin. It usually takes 4-5 days from the moment the follicular papule is finally formed until the hair breaks off, so the lesion is often hidden under the hair.

Zoonotic microsporia of smooth skin: lesions are small, often multiple, 1-2 cm in size, visually difficult to distinguish from lesions with superficial trichophytosis, although with microsporia there are usually more lesions, eyebrows and eyelashes are more often affected, vellus hair is involved in the process in 80-85% cases. Microsporidae are often recorded - allergic rashes in the form of erythematous-squamous or lichenoid nodules, rarely - with a violation of the general condition, an increase in temperature.

Zoonotic microsporia of the scalp, 2 large rounded lesions are formed, up to 3-5 cm in size, with clear boundaries and pityriasis-like peeling on the surface. The hair in the lesions is broken off at the same level - 6-8 mm, and there are more broken hairs than with anthroponotic microsporia.

Lesions of eyebrows and eyelashes should be treated as microsporia of pilar skin and adequate treatment methods should be used.

Microsporia of the facial skin has its own characteristics. Both zoonotic and anthroponotic forms, when localized on the face, often do not have clinically pronounced differences; foci of the “iris” type, “ring in a ring”, are rarely observed. The peripheral ridge is clearly expressed, continuous, and there is almost always an exudative component in the form of vesicles and crusts along the periphery. Vellus hair is always affected. Small lesions, up to 5 mm in size, may not show pityriasis-like peeling, but be covered with 1-2 scales, and only later, after 4-5 days, they acquire a typical appearance. In men with a beard and mustache, microsporia in these areas of the skin acquires features characteristic of hairy skin: a less pronounced peripheral ridge (and sometimes unclear boundaries), pityriasis-like peeling, hair broken off at a level of 6-8 mm; the development of trichophytoid or seborrheic forms is possible.

With all forms of microsporia, and especially with zoonotic ones, there is a possibility of allergic rashes - microsporidae; These are erythematous spots or lichenoid nodules, often located close to the main lesions. No pathogenic fungi are found in these foci.

Variants of a typical form of microsporia:

Infiltrative - occurs as a result of the high pathogenicity of a particular strain of the fungus, an infiltrate quickly forms in the foci, they rise above the skin, and if there are a large number of them, localized on the head, there may be a violation of the general condition, an increase in regional lymph nodes, an increase in temperature;

Table 1 - Clinical features of microsporia of the scalp caused by M.canis and M.ferrugineum

Table 2. Clinical features of smooth skin microsporia caused by M.canis and M.ferrugineum

Pathogen	Number and size of lesions	Form of lesions	Color of lesions	Damage to vellus hair
	Small, 1-2 cm, multiple, can merge	Round or oval, with clear boundaries, along the periphery, in the center there are bubbles, crusts	From pink to bright red
	Single	Round, less often oval, or “ring in a ring” (“iris”).	Pale pink in the center, hyperemic ridge along the periphery

Suppurative (deep) - occurs as the next stage of the infiltrative form, when treatment is not started in a timely manner - a fluctuation appears in the infiltrative foci, pus begins to be released from the mouths of the hair follicles, and after the completion of the pathological process, small scars remain at the site of suppuration, persistent hair thinning, patches baldness. Dermatovenereology / ed. A.A. Kubanova. - M.: DEX-Press, 2010. - P.145

Atypical forms of microsporia:

Atypical localization - a form that is not identified by all authors, but apparently has a right to exist, since the localization of the lesion is in the groin area, perineum, intergluteal fold, in the border zone of hair growth on the head, inside the auricle, in the area of ​​the eyelid with hair damage to eyelashes requires a special approach to treatment, special tactics and even caution;

Psoriasiform - lesions on smooth skin strongly resemble psoriatic ones, they can be distinguished only by close examination: usually such a lesion is formed as a result of the fusion of several small ones, acquires polycyclic shapes, infiltrates and is covered with silvery scales, more often this picture is observed on smooth skin at the superficial stage of INT, than with microsporia;

According to the type of asbestos-like lichen, it is a variant of exudative mycorosporia of the scalp, with a large number of scales sticking together, which can mask not only broken hair, but even glow;

Rosacea-like - a form, most often caused by zoophilic fungi, usually occurring on smooth skin and characterized by a predominance of erythema and superficial skin atrophy, relatively weak peeling;

Seborrheic (seborrheic) - forms on the scalp or face (beard), lesions without clear boundaries, with fine lamellar peeling on an erythematous background, resemble seborrheic dermatitis; with a long course, a large surface can be affected without the formation of a clearly limited area of ​​broken hair;

Trichophytoid - is described as a form of anthroponous microsporia, when the process is clinically similar to anthroponous trichophytosis: lesions on the head without clear boundaries, with pityriasis-like peeling without a pronounced infiltrate and inflammatory component, with relatively short broken hair (at the level of 2-4 mm);

Follicular - small-focal form caused by an actively sporulating strain of the fungus, is observed more often in individuals prone to liquid seborrhea when infected with M. ferrugineum: foci are often multiple, but very small, the glow is dim;

Exudative (exudative-inflammatory) - occurs from the very beginning with a vesicular component, especially on smooth skin, often accompanied by dissemination of the process, when the patient can have up to 60, and even up to 120 very small vesicular foci, consisting of 3-5 grouped vesicles ; later, from these foci, classic ring-shaped lesions are formed, but still having a vesicular component. Dermatovenereology / ed. A.A. Kubanova. - M.: DEX-Press, 2010. - P. 147.

Clinical manifestations of microsporia caused by geophilic microsporums (rare, sporadic cases) are indistinguishable from those with zoonotic microsporia, but the process is more often localized on the hands and occurs in people who deal with the soil (“gardeners’ mycosis”). Some authors, however, point to a more frequent occurrence of infiltrative and suppurative forms in microsporia of “geophilic” etiology.

Onychomycosis with microsporia. Nail damage in both anthroponotic and zoonotic microsporia rarely develops. Most often, nail damage is caused by a widespread, long-term and, most importantly, unrecognized process on the skin, and almost always with damage to the scalp.

The clinical picture of microsporic onychomycosis is dominated by forms without pronounced hyperkeratosis of the nail bed, most often occurring as a white superficial form. Changes in the nails with this mycosis are usually nonspecific: changes in the color of the nail in yellowish-gray shades are observed. In the rays of a Wood's lamp, such lesions give a green glow, completely similar to that in the affected hair.

3. Diagnosis and differential diagnosis of microsporia

The diagnosis of microsporia is based on the clinical picture and the results of additional studies:

Microscopic examination for fungi (at least 5 times);

Inspection under a fluorescent filter (Wood's lamp) (at least 5 times);

Cultural research to identify the type of pathogen in order to properly carry out anti-epidemic measures;

Clinical blood test (if there is a deviation from the norm, the test is repeated once every 10 days);

Clinical urine analysis (if there is a deviation from the norm, the test is repeated once every 10 days);

Biochemical examination of blood serum (before the start of treatment and after 3-4 weeks).

Luminescent diagnostics. In the ultraviolet rays of a Wood lamp, with a wavelength of 320-380 nm, hair affected by microsporum glows greenish. The intensity of this glow depends on a number of factors: the life activity of the mushroom - the glow is more intense; the presence of an exudative component in the lesions, the glow is dim; Treatment is carried out with systemic antimycotics, and the hair gradually grows back - not the entire hair shaft glows dimly, sometimes even only the ends of the hair.

Hair with microsporia of the scalp in the absence of treatment begins to glow on the 3-4th day of the disease, counting from the moment of final formation of the plaque due to the fusion of many papules. On smooth skin, the glow of vellus hair begins 1-2 days later. If the patient, before coming to the doctor, used various antifungal drugs, especially colored ones (iodine, Fukortsin), then the glow of vellus hair on smooth skin can be either strongly masked or actually absent. On the scalp and face (areas with a large number of vellus hairs), the glow is noticeable even despite the use of any antifungal agents by the patient - many times we observed glow of hair in the lesions, which was clearly noticeable even against the background of the use of quinozole, and he, is known to give off an intense greenish glow.

The detection of even a dim glow always clearly indicates the presence of a viable fungus in the lesion, actively producing pigment. After complete treatment, the establishment of cure criteria can begin only in the complete absence of hair glow in the lesion. Yakovlev, A.B. Microsporia, trichophytosis, favus. A manual for doctors / A.B. Yakovlev. - M.:Novik, 2013. - P.72-73

Differential diagnosis of microsporia

The spectrum of nosologies proposed for the differential diagnosis of microsporia of hairy and smooth skin differs somewhat.

When lesions are localized on the scalp, hairy skin of the beard, mustache, armpits, pubis, etc., differential diagnosis is carried out mainly with the following nosologies: other mycoses (trichophytia, favus), seborrheic dermatitis and seborrheic eczema, eczematids, psoriasis of the scalp scalp, alopecia areata, atrophic alopecia (pseudopelada), trichotillomania. Severe focal or diffuse desquamation on the scalp may mask hair debris.

It is important to distinguish microsporia from trichophytosis, favus, imbricated mycosis, since the sensitivity of microsporum and trichophyton to antimycotics may be different. The presence of a green glow in the rays of a Wood's lamp in the lesion clearly indicates microsporia. With microsporia, hair breaks off much higher above the skin level than with trichophytosis. Microscopy of lesions during infection with anthropophilic trichophytons (which includes the causative agent of favus) reveals a picture of hair damage of the “endothrix” type.

Seborrheic dermatitis or eczema is characterized by the location of lesions in seborrheic areas (head, face, neck, pubic area). Lesions without clear boundaries, with fine-plate peeling, both false and true polymorphism of elements, microvesiculation, weeping during a sharp exacerbation. Isolated damage to the scalp is rare; there are usually manifestations in other seborrheic areas.

In seborrheic dermatitis, the predominant symptom is erythema, and in eczema, follicular miliary yellowish-pink papules. A symptom that can cause difficulty in differential diagnosis with mycosis is resolution of the lesion in the center with the formation of a ring-shaped figure. During a prolonged inflammatory process, hair often thins, especially in the crown area, but never breaks off.

Eczematids are inflammatory, usually not numerous, scaly patchy elements, without a favorite localization, apparently representing a kind of hypersensitivity reaction to the microbial flora of the skin. On smooth skin they can strongly resemble foci of microsporia and trichophytosis. In most cases, within such foci, microscopy reveals fungi of the genus Malassezia, which are commensals of human skin.

Psoriasis on the scalp manifests itself as typical papules and plaques. Their location is also typical, in the form of a “crown” in the border zone of hair growth with a transition to the skin of the forehead. There is also a positive symptom of “palpability” of a psoriatic papule (Kartamyshev’s symptom). The hair within such plaques does not change and does not fall out.

When localizing lesions on smooth skin, one should keep in mind Gibert's pityriasis rosea, granuloma annulare, imbricated mycosis, and Malassezia-associated dermatoses.

Zhiber's pityriasis rosea is a hyperergic reaction to an adenoviral infection and often appears after influenza. Characteristic signs are the presence of a “maternal plaque,” ​​a larger element than the rest. The latter are lenticular spots or papules located along Langer's skin tension lines. There is almost no itching.

Granuloma annulare is a delayed-type hyperergic reaction of not always clear etiology. Injuries, autoimmune diseases, lung diseases, and diabetes may play a certain role in its occurrence. The skin process is not inflammatory, it can be represented by nodules, gradually turning into rings 3-4 cm in size, with a sunken and atrophic center; peeling is rare.

The lesions on smooth skin in Malassezia-associated dermatoses, which include Gougerot-Cartot reticular papillomatosis and certain forms of porokeratosis, are very similar to fungal lesions.

Reticular papillomatosis of Gougerot-Cartot refers to erythrokeratoderma, with autosomal dominant inheritance of a peculiar reactivity towards Malassezia fungi - foci are formed on the skin of seborrheic areas, reminiscent of a geographical map, consisting of hyperkeratotic semi-arcs and rings, sometimes inscribed one into the other. Dermatoscopically, such an arc or ridge appears to consist of small keratinized nodules. The center of the lesions is covered with scales resembling seborrheic ones.

Foci of porokeratosis are even more reminiscent of fungal lesions. The primary morphological element in this dermatosis is a small nodule confined to the mouth of the sweat gland. During development, the nodules quickly become keratinized; an umbilical depression appears in the center of the papule, filled with a horny plug; they merge into arcs and semirings, and the lesion begins to take on the appearance of a peripheral ridge with a fungal infection. The color of the papules ranges from grayish to reddish-brown. In total, up to 9 forms of porokeratosis have been described, including actinic, Mibelli, eosinophilic, three palmoplantar variants, unilateral linear nonviform, reticular, and punctate.

Elastosis peripheral serpiginating Miescher-Lutz (Lutz-Miescher) is a rare hereditary connective tissue disease of unknown etiology with an unknown type of inheritance, belonging to the group of perforating dermatoses and characterized by brownish hyperkeratotic papular rashes, which are then grouped into rings or semi-arcs with a diameter of up to 5-7 cm; in the center there is regression of rashes. The combination of areas of atrophy in the central part of the lesions with peripheral semi-arches and rings can strongly resemble the polycyclic outlines of the lesion in trichophytosis. Within the lesions, the biocenosis of the skin may change, and Malassezia fungi may be detected. This creates additional difficulties in the differential diagnosis of trichophytosis.

In general, any ring-shaped element on the skin is suspicious of a fungal disease, and is an indication for laboratory testing for the presence of a pathogenic fungus.

An additional difficulty is presented by lesions on smooth skin and on the scalp, which contain a large number of elements of the Malassezia fungus. For example, in a patient with alopecia areata, the laboratory, upon microscopic examination, detects elements of a fungus in the lesion. This fungus has nothing to do with the etiology or pathogenesis of alopecia areata, but such a situation can provoke a diagnostic error, and the patient with alopecia will be prescribed antifungal treatment. A similar situation is possible with regard to asbestos lichen, syphilitic alopecia, and atrophic alopecia. Yakovlev, A.B. Microsporia, trichophytosis, favus. A manual for doctors / A.B. Yakovlev. - M.:Novik, 2013. - P.75-76

4. Treatment of microsporia

Treatment goals: clinical cure; negative results of microscopic examination for fungi.

For microsporia of smooth skin (less than 3 lesions) without damage to vellus hair, external antimycotic agents are used.

Indications for the use of systemic antimycotic drugs are: microsporia of the scalp; multifocal microsporia of smooth skin (3 or more lesions); microsporia with damage to vellus hair.

Treatment of these forms is based on a combination of systemic and local antimycotic drugs. Hair in the affected areas is shaved once every 5-7 days or epilated.

Griseofulvin (A) orally with a teaspoon of vegetable oil 12.5 mg per kg body weight per day (but not more than 1 g per day) in 3 doses daily until the first negative analysis on mushrooms, then every other day for 2 weeks, then 2 times a week until the end of treatment.

Additionally, therapy is carried out with local drugs: ciclopirox, cream (B) 2 times a day externally for 4-6 weeks, or ketoconazole cream, ointment (B) 1-2 times a day externally for 4-6 weeks, or 10% sulfur 3% salicylic ointment (D) externally in the evening + iodine 2% alcohol tincture externally in the morning.

When treating the infiltrative-suppurative form, at the beginning of therapy, antiseptics and anti-inflammatory drugs are used in the form of lotions (D): ichthammol, solution 10% 2-3 times a day externally for 2-3 days, or potassium permanganate, solution 1:6000 2- 3 times daily externally for 1-2 days, or rivanol, solution 1: 1000 2-3 times daily externally for 1-2 days, or furatsilin, solution 1:5000 2-3 times daily externally for 1 -2 days.

Then treatment is continued with the above antifungal drugs.

Alternative treatment regimens: terbinafine tablets (B) 250 mg once daily orally after meals (adults and children weighing >40 kg) daily for 3-4 months, or itraconazole capsules (C) 200 mg once daily 24 hours orally after meals daily for 4-6 weeks. Dermatovenerology. National leadership/ ed. Yu.K. Skripkina, Yu.S. Butova, O.L. Ivanova. - M.: GEOTAR-Media, 2011. - P.530-531.

Special situations

Griseofulvin (A) orally with a teaspoon of vegetable oil 18 mg per kg body weight per day in 3 doses daily until the first negative test for fungi, then every other day for 2 weeks, then 2 times a week until the end of treatment.

Alternative treatment regimens: terbinafine tablets (B): children weighing >40 kg - 250 mg once daily orally after meals, children weighing 20 to 40 kg - 125 mg once daily orally after meals, children with body weight<20 кг - 62,5 мг 1 раз в сутки перорально после еды ежедневно в течение 5-6 недель, или итраконазол, капсулы (С): детям в возрасте старше 12 лет - 5 мг на 1 кг массы тела 1 раз в сутки перорально после еды ежедневно в течение 4-6 недель.

Pregnancy and lactation.

The use of systemic antifungal drugs and griseofulvin during pregnancy and lactation is contraindicated. Treatment of all forms of microsporia during pregnancy is carried out only with topical drugs.

Requirements for treatment results

Resolution of clinical manifestations;

Lack of hair glow under a fluorescent filter (Wood's lamp);

Three negative control results of microscopic examination (microsporia of the scalp - 1 time in 7-10 days; microsporia of smooth skin with damage to vellus hair - 1 time in 5-7 days, microsporia of smooth skin 1 time in 5-7 days).

In view of the possibility of relapses, after completion of treatment, the patient should be under clinical observation: for microsporia of the scalp and microsporia of smooth skin with damage to vellus hair - 3 months, for microsporia of smooth skin without damage to vellus hair - 1 month.

Control microscopic examinations during dispensary observation must be carried out: for microsporia of the scalp and microsporia of smooth skin involving vellus hair - once a month, for microsporia of smooth skin - once every 10 days.

A certificate of recovery and admission to an organized team is given by a dermatovenerologist.

Indications for hospitalization are:

Lack of effect from outpatient treatment;

Infiltrative-suppurative form;

Multiple lesions with damage to vellus hair;

Severe concomitant pathology;

Microsporia of the scalp

According to epidemiological indications: patients from organized groups in the absence of the possibility of isolating them from healthy individuals (for example, in the presence of microsporia in persons living in boarding schools, orphanages, dormitories, children from large and asocial families). Dermatovenerology. National leadership / ed. Yu.K. Skripkina, Yu.S. Butova, O.L. Ivanova. - M.: GEOTAR-Media, 2011. - P.532.

5. Preventive measures

Preventive measures for microsporia include sanitary and hygienic measures, incl. compliance with personal hygiene measures and disinfection measures (preventive and focal disinfection).

Focal (current and final) disinfection is carried out in places where the patient is identified and treated: at home, in children's and healthcare institutions.

Preventive sanitary-hygienic and disinfection measures are carried out in hairdressing salons, baths, saunas, sanitary checkpoints, swimming pools, sports complexes, hotels, hostels, laundries, etc.

Anti-epidemic measures

1. For a patient with microsporia identified for the first time, a notification is submitted within 3 days to the department of registration and registration of infectious diseases of the Federal Budgetary Institution of Health "Center for Hygiene and Epidemiology" and its branches, to the territorial dermatovenerological dispensaries (No. 089/u-kv). Each new disease should be treated as if it were newly diagnosed and notified.

2. When registering a disease in healthcare institutions, organized groups and other institutions, information about the sick person is entered into the infectious diseases register (form No. 060/u). The journal is kept in all healthcare institutions, medical offices of schools, preschool institutions and other organized groups. Serves for personal registration of patients with infectious diseases and registration of information exchange between healthcare institutions and state sanitary and epidemiological surveillance.

3. The patient is isolated. If a patient with microsporia is identified in children's institutions, they are immediately isolated and routine disinfection is carried out before transfer to the hospital or home. Until a child with microsporia recovers, he is not allowed to enter a preschool educational institution or school; an adult patient is not allowed to work in children's and communal institutions. The patient is prohibited from visiting the bathhouse or swimming pool. For maximum isolation, the patient is allocated a separate room or part of it, personal items (linen, towel, washcloth, comb, etc.). Limit the number of objects it can come into contact with.

4. In the first 3 days after identifying a patient in preschool educational institutions, schools, higher and secondary specialized educational institutions and other organized groups, the medical personnel of these institutions conduct an examination of contact persons. An examination of contact persons in the family is carried out by a dermatovenerologist or a doctor who is entrusted with the responsibility of a dermatovenereologist. The inspection is carried out before final disinfection. Further medical observation with mandatory examination of the skin and scalp is carried out 1-2 times a week for 21 days with a note in the documentation (an observation sheet is kept) using a fluorescent lamp.

5. Routine disinfection in outbreaks is organized by the health care institution that has identified the disease. Routine disinfection before hospitalization and recovery is carried out either by the patient himself or by the person caring for him. Responsibility for performing routine disinfection in organized teams and healthcare institutions rests with its medical staff. Current disinfection is considered timely organized if the population begins to perform it no later than 3 hours from the moment the patient is identified.

6. Final disinfection is carried out in microsporia foci after the patient leaves the foci for hospitalization or after the recovery of a patient who was treated at home, regardless of the length of hospitalization or recovery. In some cases, final disinfection is carried out twice (for example, in the case of isolation and treatment of a sick child in the isolation ward of a boarding school: after isolation - in the premises where the patient was and after recovery - in the isolation ward). If a child attending a preschool or school falls ill, final disinfection is carried out at the preschool (or school) and at home. In secondary schools, final disinfection is carried out according to epidemiological indications. The final disinfection in the outbreaks is carried out by a disinfection station. Bedding, outerwear, shoes, hats, carpets, soft toys, books, etc. are subject to chamber disinfection.

7. An application for final disinfection in households and isolated cases in organized groups is submitted by a medical worker of a medical organization with a dermatovenerological profile.

8. When 3 or more cases of microsporia are registered in organized groups, as well as for epidemiological indications, the exit of a medical worker from a medical organization with a dermatovenerological profile and an epidemiologist from state sanitary and epidemiological surveillance institutions is organized. As directed by the epidemiologist, final disinfection is prescribed and the scope of disinfection is determined.

9. The medical worker who has identified the disease is working to identify the source of infection (contact with sick animals). Animals (cats, dogs) are sent to a veterinary hospital for examination and treatment, followed by the submission of a certificate of the place of treatment and observation of the patient with microsporia. If a stray animal is suspected, information is transmitted to the appropriate animal control services. Medical mycology. Guide for doctors / ed. prof. V.B. Sboychakova. - M.: GEOTAR-Media, 2008. - P.201-202.

Conclusion

The problem of ringworm will apparently always be relevant. The issues of predicting morbidity, the strength and degree of correlation of these rises with solar activity cycles, reducing the duration of treatment, finding new methods of external therapy to avoid the occurrence of irritant dermatitis remain unresolved... The list of questions can be continued for quite a long time.

One of the most pressing problems in the search for new methods of therapy is the study of the dynamics of the emergence of fungal resistance to antifungal agents, including the so-called xenobiotics - substances synthesized by humans that are not found in nature. Antifungal agents include all azole compounds (itraconazole, clotrimazole, fluconazole, etc.). Another problem of superficial dermatomycosis of the skin is finding ways to form specific resistance of the body against the fungal agent. Thus, the development of immunotropic drugs for the treatment of skin mycoses continues, although it is only of an adjuvant nature in microsporia treatment programs.

The third modern problem concerns the organization of secondary medical and social prevention of skin mycoses among all age groups of the population. This problem lies mainly in the organization of interaction between medical and veterinary services, which in our time are significantly separated.

The solution to these problems should serve as the key to successful treatment of dermatomycosis, reducing morbidity, and increasing mycological safety. It is the term “mycological safety” that best characterizes the entire complex of measures for the identification, treatment, medical examination and prevention of mycoses, and not only of the skin.

Bibliography

1. Arabian, R.A., Diagnosis of mycoses / R.A. Arabian, N.N. Klimko, N.V. Vasilyeva - St. Petersburg: SPbMAPO, 2004. - 186 p.

2. Dermatovenereology / ed. A.A. Kubanova. - M.: DEX-Press, 2010. - 500 p.

3. Dermatovenerology. National leadership / ed. Yu.K. Skripkina, Yu.S. Butova, O.L. Ivanova. - M.: GEOTAR-Media, 2011. - 630 p.

4. Blinov, N.P. A short mycological dictionary (for doctors and biologists) / NyuPyu Blinov - St. Petersburg: MEDEM, 2004 - 174 p.

5. Klimko, N.N. Mycoses: diagnosis and treatment. Guide for doctors / N.N. Klimko - M.: Premier MT, 2007. - 336 p.

6. Korotky, N.G. Modern external and physical therapy of dermatoses / N.G. Korotky, A.A. Tikhomirov, O.A. Sidorenko - M.: Exam, 2007. - 350 p.

7. Korsunskaya, I.M. Dermatophytosis with hair damage in children / I.M. Korsunskaya, O.B. Tamrazova - M.: RMAPO, 2004. - 32 p.

8. Medical mycology. Guide for doctors / ed. prof. V.B. Sboychakova. - M.: GEOTAR-Media, 2008. - 208 p.

9. Raznatovsky, K.I. Dermatomycoses. Guide for doctors / K.I. Raznatovsky, A.N. Rodionov, L.P. Kotrekhova - St. Petersburg, 2006. - 184 p.

10. Rational pharmacotherapy of skin diseases and sexually transmitted infections: A guide for practitioners. doctors / under general ed. A.A. Kubanova, V.I. Kisina. - M.: Litera, 2005. - P.312 - 346.

11. Rukavishnikova, V.M. Mycoses of the feet / V.M. Rukvishnikova - M.: EliksKom, 2003. - 332 p.

12. Guide to laboratory diagnosis of onychomycosis / Ed. A.Yu. Sergeeva. - M.: GEOTAR Medicine, 2000. - 154 p.

13. Sergeev, A.Yu. Fungal infections: a guide for doctors / A.Yu. Sergeev, Yu.V. Sergeev - M., 2003 - 300 p.

14. Modern external and physical therapy of dermatoses / ed. N.G. Short. - M.: “Exam”, 2007. - P. 249-255.

15. Sokolova, T.V., The role of topical antimycotics in the treatment of patients with microbial eczema associated with candidiasis of the skin and mucous membranes / T.V. Sokolova, S.A. Grigoryan, M.A. Mokronosova // Problems of medical mycology. - 2006. - Volume 8, No. 4. - P. 23-31.

16. Stepanova, Zh.V. Fungal diseases: diagnosis and treatment / Zh.V. Stepanova. - M.: Miklos, 2011. - 124 p.

17. Therapy and prevention of zooanthroponotic microsporia. Methodical instructions / T.M. Budumyan, Zh.V. Stepanova, E.O. Panova, N.N. Potekaev. - Ekaterinburg, 2001. - 17 p.

18. Khmelnitsky, O.K. Pathomorphology of human mycoses /O.K. Khmelnitsky, N.M. Khmelnitskaya. - St. Petersburg: SPb MALO, 2005. - P. 98 - 115.

19. Yakovlev, A.B. Microsporia, trichophytosis, favus. A manual for doctors / A.B. Yakovlev. - M.: Novik, 2013. - 136 p.

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