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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

Observable last decade intensive growth of patient populations in various age and social groups population put 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. Further development mass species physical education and sports, identified as a priority area public 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 Russian Federation suffers from fungal diseases of the feet (skin and nails), increasing 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 - caused various types fungi of the genus Microsporum is a zooanthroponotic anthropurgic mycosis of the skin, hair, and sometimes nails, 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 predominates in Eastern Europe, South-West 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 don't play 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 a significant proportion is M.audoinii, and in Siberia and 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, USA and South American countries, in Japan, Israel, Qatar, Kuwait, 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, USA and South America, Japan, Israel, Kuwait, Qatar, 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-black 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%.

Peak incidence of microsporia in middle lane Russia falls in August-October, when the epizootic among stray animals, cats and dogs reaches its peak, and children come into contact with them on vacation or already 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 last years Patients with a chronic course of mycosis against the background of severe systemic lesions - lupus erythematosus, chronic glomerulonephritis, immunodeficiency states, and intoxications began to be registered. 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 foci, 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 foci are observed, in classic version in the form of 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. From the moment final formation Follicular papule usually takes 4-5 days before 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) - formed on the scalp or face (beard), lesions without clear boundaries, with fine lamellar peeling on an erythematous background, reminiscent of seborrheic dermatitis, with long term a wide surface may 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 for the purpose of correct implementation 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 ultraviolet rays Wood's lamp, with a wavelength of 320-380 nm, hair affected by microsporum glows with a greenish light. 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 when complete absence glow of hair in the hearth. 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 peculiar reaction hypersensitivity 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 features 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 Gougerot-Cartot refers to erythrokeratoderma, with autosomal dominant inheritance of a peculiar reactivity towards Malassezia fungi - foci resembling 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 disease connective tissue of unclear 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 divided doses daily until the first negative test for fungi, then every other day for 2 weeks, then 2 once 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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Central Research Institute of Dermatovenerology, Ministry of Health of the Russian Federation, Moscow

M icrosporia- a fungal disease from the group of dermatophytosis, which affects the skin and hair, and in extremely rare cases, the nail plates. The name of this mycosis comes from the name of its causative agent - a fungus of the genus Microsporum related to dermatophytes. The disease is also known as “ringworm” (the term combines microsporia and trichophytosis), which is due to the peculiarities of its clinical picture.

Etiology

The causative agent of microsporia was first described by Gruby in 1843. The scientist discovered a sheath of small spores on the surface of the affected hair and gave the fungus its name Microsporum audouinii in honor of the late Dr. Audouin. However, the author’s discovery was not appreciated, and highly respected dermatologists (in particular, Bazin) identified microsporia with trichophytosis. Sabouraud managed to restore the truth in 1893, who, having carefully studied the biology of the microsporia pathogen, indicated the signs that distinguish this mycosis from trichophytosis. In Russia, microsporia was first described by S.L. Bogrov in 1912.

Currently, more than twenty species of fungus are known Microsporum. Of these, the following are identified as pathogens:

. Anthropophilic group - M. ferrugineum, M. audouinii, M. distorum, M. rivalieri, M. langeronii.

. Zoophilic group - M. canis, M. nanum, M. persicolor.

. Geophilic group - M. gypseum, M. cookeii, Keratynomyces ajelloii.

Of the listed types, only M.canis (seu lanosum) in recent years it has become almost the only causative agent of microsporia. It is no coincidence that it is called a cosmopolitan mushroom.

Once on the skin, the pathogen penetrates it and begins to multiply. When located near the mouths of hair follicles, fungal spores germinate, leading to hair damage. Quite quickly spreading over the surface of the latter, the mycelial hyphae destroy the cuticle, between the scales of which spores accumulate. Thus, the fungus surrounds the hair, forming a sheath, and tightly fills the follicular apparatus.

Epidemiology

Microsporia is the most common mycotic infection among dermatophytoses, not counting mycoses of the feet. The disease occurs everywhere. In Russia, up to 100 thousand patients with microsporia are registered annually. Mycosis is highly contagious, children are more often affected. In the last two decades, there has been an increase in the incidence of microsporia in newborns. Adults rarely get sick - mostly young women. The rarity of the disease with microsporia in adults, especially with damage to the scalp, and the usually occurring spontaneous recovery at the beginning of puberty is explained by the presence of fungistatic organic acids (in particular, undicylenic acid) in the hair of adults. Patients with lesions of the scalp pose a particular danger in epidemiological terms. This is due to the fact that this form of mycosis, firstly, is most often diagnosed untimely, and, secondly, its therapy is associated with certain difficulties. Unfortunately, data from recent epidemiological studies conducted in Russia indicate an increase in the number of patients with hair damage.

As already stated, The most common causative agent of microsporia is Microsporum canis - a zoophilic fungus, which is found in 90-97% of patients. The main source of the disease is cats (usually kittens), less often dogs. Infection occurs through direct contact with a sick animal or objects contaminated with fur or scales. Once in the soil with an affected hair or scale, M.canis 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 reservoir. Intrafamily spread of infection is common. In this case, infection usually occurs from one animal. Transmission of zoonotic microsporia from sick family members is possible, but this is quite rare. There are isolated observations of families in which three generations were sick with this mycosis. It should be emphasized that in such situations, women and children of younger age groups, including newborns, are at greatest risk of infection.

Clinical manifestations 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, legs. Under Wood's lamp a green glow is detected. Often, clinically healthy cats can be mycocarriers, and then only a luminescent study helps to identify the fungus. However, situations are possible when the fact of carriage cannot be confirmed either by clinical or luminescent examination. In such cases, and they are observed in 2-3% of carriers, wool is sown from various areas.

The incidence of zoonotic microsporia varies throughout the year. Seasonal fluctuations are associated with litters in cats, as well as more frequent contact of children with animals in the summer. The rise in incidence begins at the end of summer, the peak occurs in October-November, and the decrease to a minimum occurs in March-April. The emergence of epizootics of microsporia in cats and kittens in a number of regions and cities leads to the formation of epidemic foci among children.

Clinic

Since the main causative agent of microsporia in our time is Microsporum canis, then when describing the clinical picture of the disease, more attention will be paid to the zoonotic form rather than the anthroponotic one.

The incubation period for zoonotic microsporia is 5-7 days . The nature of the clinical picture of the disease is determined by the localization 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 introduction of the fungus appears swollen, raised erythematous patch with clear borders . Gradually the spot increases in diameter and infiltrates. A continuous raised ridge is formed along the periphery, represented by small nodules, bubbles and crusts. In the central part, the inflammatory phenomena resolve, as a result of which it acquires a pale pink color, with pityriasis-like peeling on the surface (Fig. 1a). Thus, the focus has the appearance of a ring. As a result of autoinoculation of the fungus in the central part and repeated development of the inflammatory process, bizarre foci of the “ring in a ring” type are formed (Fig. 1b). Such iris-like figures are more common with anthroponotic microsporia. Vellus hair is often involved in the process, which complicates the treatment of the disease. The number of foci with microsporia of smooth skin is usually small (1-3). Their diameter ranges from 0.5 to 3 cm. The rash can be located on both open and closed areas of the skin, since a sick animal is often warmed under clothes and taken to bed. However, the most common lesions are located on the skin of the face (Fig. 1c), neck, forearms and shoulders. There are no subjective sensations or moderate itching.

In newborns and young children, as well as in young women, due to a hyperergic reaction, erythematous-edematous form microsporia, in which pronounced inflammatory phenomena and minimal peeling are noted.

Papular-squamous the form occurs when microsporia is localized in seborrheic areas of the skin - on the face, chest and back. The lesions are characterized by infiltration and lichenification, accompanied by significant peeling and itching. Since this form of microsporia is usually observed in individuals with signs of atopy (in particular, in patients with atopic dermatitis), mycosis is often masked by manifestations of the underlying process and is not always diagnosed in a timely manner. The use of local corticosteroid drugs only increases the spread of mycotic infection.

In young women with hypertrichosis, follicular nodular elements with a diameter of 2-3 cm may appear in the lower leg area - the so-called deep form microsporia of smooth skin.

Localization of single foci of microsporia in places atypical for it can sometimes lead to difficulties in diagnosing the disease. T.I. Meerzon, in particular, described an isolated focus of zoonotic microsporia on the skin of the shaft of the penis in an 18-year-old patient.

A rare type of microsporia includes damage to the skin of the palms, soles and nail plates. On the palms, and less often on the soles, dyshidrotic and/or squamous-keratotic rashes are observed. Microsporic onychomycosis is characterized by isolated lesions of the nail, usually its proximal part. Initially, a dull spot is formed, which becomes white over time. The nail in the area of ​​leukonychia becomes softer and more fragile, and subsequently can collapse as onycholysis. When examining the affected nail under a Wood's lamp, a bright green glow is detected. Microsporic onychomycosis not diagnosed in time can cause reinfection and further spread of the disease among others.

Microsporia of the scalp

Damage to the scalp occurs mainly in children 5-12 years old . Over the past 20 years, there has been a 20-fold increase in the incidence of this form of microsporia in newborns. It is generally accepted that the rarity of this form in adults is explained by the presence of fungistatic organic acids in their hair and water-lipid mantle of the skin. This fact indirectly confirms the spontaneous recovery of children during puberty, when the composition of sebum changes. Perhaps the difference in hair thickness between children and adults matters. It is noteworthy that microsporia of the scalp practically does not occur in children with red hair.

Foci of microsporia of the scalp are located mainly on the crown, in the parietal and temporal regions (Fig. 2). 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 periphery 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 localized 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 6-7th day the process spreads to the hair that becomes brittle breaks off 4-6 mm above the level of the surrounding skin and look as if they have 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 intact hair, do not restore their original position. The skin in the lesion, as a rule, is slightly hyperemic, edematous and moderately infiltrated, its surface is covered with grayish-white small scales.

For microsporia of the scalp caused by anthropophilic fungi, numerous small foci with minimal inflammation and unclear boundaries are observed. A characteristic feature of anthropophilic microsporia is its localization in the marginal zone of hair growth, when one part of the lesion is located on the scalp, and the other on smooth skin.

To atypical, rare variants of microsporia of the scalp include infiltrative, suppurative (deep), exudative, trichophytoid and seborrheic forms.

At infiltrative In the 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. It should be especially emphasized that with this type of microsporia, the sheath of fungal spores at the root of broken hair is weakly expressed.

At suppurative form against the background of significant inflammation and infiltration, soft nodes of a bluish-red color are formed, the surface of which is covered with pustules. When pressed, pus is released through the follicular openings. Such clinical manifestations correspond to the picture of kerion Celsi (Celsius honeycomb) - infiltrative-suppurative trichophytosis. The formation of infiltrative and suppurative forms of microsporia is facilitated by irrational (usually local) therapy, the presence of serious concomitant diseases, and late consultation with a doctor.

Exudative microsporia of the scalp 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.

The listed three forms of microsporia of the scalp are often complicated by regional lymphadenitis, and patients with suppurative microsporia may also experience symptoms of intoxication.

At trichophytoid form of microsporia, numerous small foci with weak pityriasis-like peeling are scattered on the scalp. The boundaries of the lesions are unclear, there are no acute inflammatory phenomena, the hair is broken off at a level of 1-2 mm above the surrounding skin. Along with broken hair, there are healthy hairs. Trichophytoid microsporia is more common in older age groups with serious concomitant diseases.

At seborrheic Microsporia of the scalp is mainly characterized by thinning of the hair. The areas of rarefaction are abundantly covered with yellowish scales, upon removal of which a small amount of broken hair can be found.

Late diagnosis and inadequate treatment of atypical forms of microsporia lead to further changes in clinical symptoms, dissemination of rashes and chronicity of the process, irreversible alopecia in the patient and dissemination of infection in the environment.

Diagnostics

To confirm the clinical diagnosis of microsporia, fluorescent, microscopic and cultural studies are used.

Luminescent study

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. At the same time, both long and vellus hair glows. 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 epilated from the suspected site of fungal penetration, 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 for:

Pathogen identification;

Definitions of affected hair;

Evaluation of therapy results;

Monitoring persons in contact with the patient;

Definitions of infection or mycocarriage in animals.

Microscopic examination

To confirm the fungal etiology 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. Immediately before collecting pathological material, the lesion on smooth skin must be treated with 960 alcohol. Then, using a blunt scalpel, carefully scrape off the scales from the periphery of the lesion. On the scalp, using tweezers, hair fragments are also removed from the marginal zones of the lesion. Then the pathological material is placed on a glass slide in a drop of 20% potassium hydroxide solution. Microscopic examination is carried out after 30-40 minutes.

In scales from lesions on smooth skin, twisted threads of septate mycelium are found. Microscopic examination of the affected hair reveals many small spores (2-3 microns) on its surface (ectothrix-type lesion). In this regard, the boundaries of the hair appear blurred. The spores surrounding the hair are arranged chaotically, like a mosaic.

Cultural examination

Carrying out cultural diagnostics with positive results of luminescent and microscopic studies 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. Pathological material (scales, hair) is placed on Sabouraud's medium. Growth of Colonies Microsporum canis(the main causative agent of microsporia) is noted on the 3rd day after sowing. By the 10th day, the colony reaches a diameter of 4-5 cm and is represented by a flat disk covered with a whitish, delicate fluff, which spreads like rays along the walls of the test tube. The reverse side of the colony is yellow in color.

Treatment

In the treatment of microsporia of smooth skin without damage to vellus hair external antimycotic drugs are used. Apply 2-5% iodine tincture to the foci of mycosis 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 allylamine drug has proven itself well terbinafine (Lamisil) , produced in the form of 1% cream and spray.

Terbinafine has a fungicidal effect (i.e., it leads to the death of the fungus) and is the most active antimycotic agent against dermatophyte fungi. The drug inhibits the functions of svalene epoxidase, resulting in disruption of the synthesis of ergosterol, the main component of the fungal cell membrane. At the same time, the amount of squalene, a high molecular weight hydrocarbon, increases inside the cell. These disturbances lead to the death of the fungal cell. The sensitivity of svalene epoxidase in fungi is 10,000 times higher than in humans, which explains the selectivity and specificity of the action of terbinafine in relation to the fungal cell. The drug can be used once a day. It should be emphasized that, having a keratophilic ability, Lamisil accumulates in the stratum corneum of the epidermis and is present here for a long time in fungicidal concentrations. This circumstance explains the persistence of a pronounced antifungal effect even after discontinuation of the drug. The convenient dosage form of terbinafine spray ensures contactless application of the drug to large areas of affected skin. Terbinafine cream and spray are quickly absorbed and do not leave marks on clothing.

In case of severe inflammatory reaction It is advisable to prescribe combination drugs containing additional corticosteroid hormones. Similar products include ointments mycozolon And travocort .

When a secondary bacterial infection occurs useful cream triderm . With severe infiltration lesion, as well as for deep forms of microsporia, preparations containing dimexide , which is known to have conductive properties. 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 clinical manifestations resolve and the fungi disappear.

When vellus hair, and especially long hair, is affected, systemic antimycotic therapy for microsporia is necessary.

In the treatment of microsporia of the scalp, the drug of choice still remains griseofulvin - a chlorine-containing antibiotic produced by mold Penicillium nigricans. Griseofulvin, available in the form of 125 mg tablets, is prescribed at the rate of 22 mg per 1 kg of patient body weight. 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 (a-tocopherol contained in oils delays the metabolism of griseofulvin in the liver). 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 therapy, it is necessary 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 oral administration of the antimycotic, 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 epigastrium; Granulocytopenia and leukopenia are less common. Unfortunately, due to hepatotoxicity, 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, a worthy alternative to griseofulvin has been terbinafine (Lamisil) . Local forms of the drug have already been mentioned earlier. In the treatment of microsporia of the scalp, terbinafine is used in the form of tablets, available in doses of 125 and 250 mg. The drug has a high safety profile, which is largely due to the peculiarities of its mechanism of action. Squalene epoxidase, which is inhibited by terbinafine, is not associated with the cytochrome P-450 system, so the drug does not affect the metabolism of hormones and other drugs. Since terbinofine is lipophilic, after oral administration it quickly reaches the dermal layer of the skin, overcomes it and accumulates in the lipids of the stratum corneum of the epidermis, hair follicles and hair.

When treating microsporia of the scalp in children, the dose of terbinafine is determined depending on body weight. The manufacturer recommends prescribing the drug for a child weighing less than 20 kg at a dose of 62.5 mg per day; children weighing from 20 to 40 kg - 125 mg; more than 40 kg - 250 mg. However, our experience shows that these doses are often insufficient, since we obtained the maximum therapeutic effect by changing the officially recommended treatment regimens. In this regard, the doses of terbinafine we offer are 50% higher than those recommended by the manufacturer: 94 mg/day (3/4 tablets of 125 mg) for children weighing 10-20 kg and 187 mg/day (1.5 tablets at 125 mg) - 20-40 kg. For body weight over 40 kg, terbinafine is prescribed at a dose of 250 mg/day. For adults, terbinafine is prescribed at a dose of 7 mg per 1 kg, but not more than 500 mg per day.

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.

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 mycological hospital. For each sick person, a notification is filled out according to registration form 281. Things belonging to a patient with microsporia are subject to disinfection. 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. An important role in the fight against microsporia is assigned to health education authorities, as well as veterinary supervision of stray animals.

Literature

1. Mohammad Yusuf. Clinical and epidemiological features of microsporia in modern conditions and the development of treatment with new medications. Author's abstract. diss...candidate of sciences. M., 1996

2. Fakhretdinova Kh.S. Clinical and epidemiological features of modern microsporia. Author's abstract. diss... doc. med. sc. M., 1999.

3. Sheklakov N.D., Andriasyan S.G. Some ecological features of Microsporum canis and the incidence of zooanthroponotic microsporia. Vestn dermatol. 1979; 2: 18-23.

4. Stepanova Zh.V., Davydov V.I. On the carriage of fluffy microsporum by clinically healthy animals. Vestn dermatol. 1970; 3:42-6.

5. Esteves J. Acromia parasitaria devida ao M. Felineum. Trab. Soc. Derm. Vener. 1957; 15:43.

6. Meerson T.I. Atypical localization of smooth skin microsporia caused by Microsporum canis. Vestn dermatol. 1985; 5:70.

7. Stepanova Zh.V., Klimova I.Ya., Shapovalova F.S. Onychomycosis caused by fluffy microsporum. Vestn dermatol. 1997; 4:37-9.

8. Feyer E., Olah D., Szatmari S. et al. Medical mycology and fungal diseases. Budapest. 1966.

9. Potekaev N.S., Kurdina M.I., Potekaev N.N. Lamisil for microsporia. Vestn. Dermatol. 1997; 5: 69-71.

Terbinafine -

Lamisil (trade name)

(Novartis Consumer Health)

Joke . Hare in the pharmacy: “Tell me, do you have contraceptives?”

Thank you

Microsporia is a highly contagious (highly contagious) infectious disease of smooth skin, scalp and nails caused by pathogenic fungi genus Microsporum. It was on the basis of the Latin name of the infectious agent (Microsporum) that the name of the disease itself (microsporia) was adopted. Microsporia appears as round, red, flaky patches on the skin, bald spots on the scalp, or white and dull circles on the nails.

Microsporia and ringworm (microsporia and trichophytosis)

In addition to the medical name, this fungal disease has another common name - ringworm. lichen. The term "ringworm" is the traditional designation for a group of diseases of the skin and scalp in which the hair is affected and breaks off, resulting in the formation of bald spots. And since 100 years ago doctors were not able to identify infectious agents due to the lack of appropriate techniques, all diseases were classified, described and named mainly by external manifestations. That is why microsporia was called ringworm.

However, with the development of science and technological progress, doctors were able to identify not only signs of diseases, but also isolate their causative agents, which was literally a breakthrough. During this period, it was possible to establish that the disease, which has always been called ringworm, can be caused by two types of pathogenic fungi - Trichophyton and Microsporum. And then the type of ringworm caused by fungi of the genus Trichophyton began to be called trichophytosis, and Microsporum - accordingly, microsporia. But since the external signs and course of trichophytosis and microsporia are the same, these two infections retain the same common name - ringworm.

Thus, according to modern concepts, microsporia is a fungal infection ( mycosis), affecting the skin, hair and nails, and at the same time is considered one of the varieties of ringworm.

The causative agent of infection

Among the fungi of the genus Microsporum, there are about 20 species that can provoke microsporia of smooth skin, scalp and nails. Microsporia is most often caused by the following types of fungi of the genus Microsporum:

• M. distorum;
• M. rivalieri;
• M. langeronii;
• M. canis;
• M. nanum;
• M. persicolor;
• M. gypseum;
• M. cookii;
• Keratynomyces ajelloii.

Moreover, in 90% of cases, the causative agent of microsporia is a fungus of the species Microsporum canis, and the remaining listed varieties of pathogenic microorganisms cause infection in only 10% of cases.

Methods of transmission of microsporia (how you can get infected)

Infection with microsporia occurs through contact, that is, by touching any objects, substances, animals or people who are sick with the infection, are its carriers, or have fungal spores on their surface. To clearly understand the mechanisms and routes of transmission of microsporia in the population, it is necessary to know the varieties of this fungus, which affect the way they spread among people.

So, depending on the main host, all types of Microsporum fungi are divided into three varieties:
1. Zoophilic fungi – the main hosts are animals (most often kittens, less often dogs);
2. Anthropophilic fungi – the main owners are people;
3. Geophilic fungi – the main habitat is soil.

Zoophilic, atropophilic and geophilic fungi, when they come into contact with human skin, cause the same infectious disease - microsporia, but the routes of their transmission and, accordingly, the methods of infection are different.

Yes, transfer zoophilic fungi genus Microsporum occurs through direct household contact with infected cats or dogs. And since kittens are most often carriers of microsporia, there are two seasonal peaks in the incidence of this infection - in mid-summer and autumn, when cats give birth. To become infected with microsporia, it is enough to pet a cat or dog that has the infection or is an asymptomatic carrier. People usually become infected from their pet cats or dogs, which are constantly in contact with their owners, sitting on laps, crawling under blankets, etc.

However, zoophilic fungi of the genus Microsporum can be transmitted to humans not only as a result of direct contact with a sick animal, but also indirectly through pieces of its fur. The fact is that cats and dogs that suffer from microsporia or are carriers of the fungus can leave small and unnoticeable pieces of hair on various household items (furniture, carpets, beds, sofas, armchairs, clothes, shoes, etc.), in which contains fungal spores. A person touching such pieces of wool containing fungal spores also becomes infected with microsporia.

Thus, transmission of zoophilic microsporia can occur both through direct contact with a sick animal, and through touching objects that have fur and skin flakes of an infected animal.

Anthropophilic fungi genus Microsporum are transmitted from a sick person to a healthy person through direct close contact (hugs, kisses, etc.) or through the use of various objects on which there are skin flakes of an infected person (for example, when using a comb, hat, hair scissors belonging to a person with microsporia). That is, anthropophilic fungi are transmitted in the same way as zoophilic fungi, but from person to person, and not from animals.

Infection geophilic fungi genus Microsporum occurs through direct contact with soil contaminated with these microbes.

When a person becomes infected with any type of Microsporum fungus (zoophilic, anthropophilic or geophilic), then in the future he becomes a source of infection for others who can be infected with microsporia from him. However, despite the hypothetical possibility of infecting other people, family members of patients with microsporia very rarely become infected.

The routes of transmission of microsporia described above do not fully reflect the picture of how a fungal infection occurs. Thus, if a fungus simply gets on the skin, a person will not get sick with microsporia, since the pathogenic microbe will be destroyed by normal microflora and the immune system or simply washed away during hygiene measures. This means that for the disease microsporia it is necessary not only for the fungus to get on the skin, but also for the presence of certain predisposing factors that will allow it to penetrate the skin and provoke an infection.

To such predisposing factors include the following:
1. Traumatic skin injuries;
2. Skin maceration;
3. Reduced immunity.

Thus, microsporia is transmitted from an animal or person to another person only if he has the specified predisposing factors.

Microsporia in children

Microsporia in children is much more common than in adults, which is explained by two main factors. Firstly, children are more likely to come into contact with sick animals, and accordingly, they have a higher risk of contracting an infection. And secondly, the sebaceous glands of the skin of children do not produce acids that have a destructive effect on fungi. That is, a fungus that gets on the skin of a child is much more likely to provoke microsporia than in an adult in a similar situation, since after puberty the glands begin to produce acids that have a detrimental effect on microsporia pathogens.

The clinical manifestations, course and principles of treatment of microsporia in children do not differ from those for adults. Therefore, it is inappropriate to consider separately the characteristics of microsporia in childhood.

Types of microsporia (classification)

Depending on the leading factor underlying the classification, there are several options for dividing microsporia into different types.

So, depending on the predominant area of ​​damage, microsporia is divided into three main types:
1. Microsporia of smooth skin;
2. Microsporia of the scalp;
3. Microsporia of nails.

In addition, medical specialists distinguish three forms of microsporia, depending on what type of pathogen caused the infection:
1. Zoonotic microsporia - caused by species of fungi Microsporum, which are zoophilic (the main hosts are animals);
2. Anthroponotic microsporia - caused by species of Microsporum fungi, which are classified as anthropophilic (the main host is humans);
3. Geophilic microsporia - caused by species of Microsporum fungi, which are classified as geophilic (the main habitat is soil).

The divisions into zoonotic, anthroponotic and geophilic microsporia have no clinical significance, since they all have the same symptoms, a similar course and are treated according to the same principles. This classification is important for epidemiologists because it allows them to identify the primary sources of infection and carry out appropriate anti-epidemic measures if necessary.

Clinically important is also the classification of microsporia according to the type of course, the depth of tissue damage and the response of the immune system to infection. According to these criteria, the following types of microsporia are distinguished:

• Surface form (the lesions are located on the surface of smooth skin or under the hair);
• Exudative form (foci are located on any part of the body and liquid discharge oozes from them);
• Infiltrative-suppurative form (the lesions penetrate deep into the tissues, at the site of the lesion there is severe swelling with the addition of a secondary bacterial infection, which causes suppuration);
• Nail shape(foci are located on the nails);
• Chronic form (a variant of a long-existing surface form).

Incubation period of the disease

The duration of the incubation period depends on the type of fungus that provoked microsporia. Thus, when infected with zoophilic and geophilic species of Microsporum fungi, the incubation period lasts 5–14 days. And when infected with anthropophilic forms, the incubation period of microsporia lasts much longer - from 4 to 6 weeks. But since microsporia is most often provoked by a fungus of the Microsporumcanis species, which belongs to the zoophilic species, in most cases the incubation period of the infection is 1 - 2 weeks.

Symptoms (signs) of microsporia

All types of microsporia are characterized by both general signs, symptoms and features of the clinical course, and certain nuances that distinguish the forms from each other. Therefore, for general orientation in the problem, first of all we will consider those symptoms that are inherent in all forms of microsporia. And only after this we separately focus on the features inherent in various forms of microsporia.

The very first symptoms of incipient microsporia are red spots that form on the scalp or body. If microsporia affects the scalp, then spots may appear not only under the hair, but also in the area of ​​the eyebrows and eyelashes. With microsporia of smooth skin, spots form on any part of the body.

A few days after their appearance, the spots become pink and rather pale, and their surface is covered with whitish scales. At the same time, the hair loses its color and breaks off at a height of several millimeters from the surface of the skin, creating the effect of a short haircut. Because of this, characteristic and clearly visible bald spots are formed on the scalp, on which scaly skin and short hair resembling stiff stubble are visible. In some cases, black spots form on bald spots.

Sometimes microsporia of the scalp does not cause the formation of bald spots due to hair breaking, but provokes the formation of a large number of scales, which people mistake for profuse dandruff, which appeared completely unexpectedly for them. Also, in rare cases, microsporia appears as a gray spot on the scalp, in the area of ​​which there is intense hair loss.

If lichen affects smooth skin, then the initial spots simply turn pale, acquire a grayish color and become covered with scales. Outside the spot, a clearly visible ridge is formed, raised above the surface of the skin, as if delimiting the affected area from healthy areas. Inside the spot, another spot may form, smaller in size, but exactly the same in structure, which is why the affected area takes on the appearance of a target.

Over time, foci of microsporia on smooth skin and scalp increase in size and take on the shape of a regular circle or oval. The size of the lesions can reach 10 cm in diameter. At the same time, their surface is covered with a dense layer of gray scales, which give them the appropriate color. As a result, the edge of the spot looks like a red rim, and the inside is painted a pale gray-pinkish color.

If two or more foci of microsporia are located nearby, they can merge into a spot. Scaly spots peel off with varying degrees of intensity. Sometimes peeling is accompanied by severe itching, and in other cases the spot does not cause any discomfort at all.

In children and adults, when foci of microsporia are localized on the scalp, face, neck or upper half of the body, body temperature may rise and the cervical lymph nodes may enlarge.

In severe cases of microsporia, severe inflammation of the skin develops in the affected area with swelling, exudation and suppuration, which is called scab.

In general, microsporia in children and adults occurs as described. Let's consider the features and more precise characteristics of spots characteristic of various forms of fungal infection.

Skin microsporia (smooth skin microsporia) in adults and children

As a rule, the infection occurs in a superficial form, which begins with the appearance of a red spot of a round or oval shape, which has clear boundaries and rises above the rest of the surface of the skin. It is this spot that is the focus of the lesion. Gradually, the spot increases in size, becomes dense and swollen. The outer border of the spot transforms into a roller, rising above the surface of the skin, consisting of bubbles and crusts. In the center of the spot, inflammation decreases and the entire area limited by the outer ridge becomes covered with flaky scales and acquires a pale pink color.

However, the fungus can re-infect an area that is already inside the outer ring. In this case, another ring is formed inside the ring, as a result of which the lesion takes on the bizarre appearance of a target. Such affected areas of the “ring in a ring” type are characteristic mainly of anthroponotic microsporia.

The total number of microsporia foci on smooth skin is usually small and amounts to 1–3 spots. The diameter of the spots is most often 0.5 - 3 cm, but sometimes the lesions can increase up to 5 cm in radius. Closely located spots can merge into one. Lesions can be located on any part of the body, but most often they are located on the face, neck, forearms and shoulders.

Non-inflamed microsporia spots, as a rule, do not cause any unpleasant sensations. Sometimes they may be mildly itchy. If there is severe inflammation in the lesions, they are very itchy and painful.

In people who have reduced delayed sensitivity reactions, microsporia can occur in the so-called abortive form. In this case, the lesion looks like a pale pink spot without clear boundaries and bubbles forming a peripheral ridge.

In newborns and children under 3 years of age, microsporia occurs in an erythematous-edematous form, in which the lesion is red, inflamed and swollen with a minimal amount of scales and peeling.

In people prone to atopy (for example, those suffering from atopic dermatitis), microsporia occurs in a papular-squamous form. In this case, spots appear on areas of the skin characterized by the production of large amounts of sebum, such as the face, chest and back. The lesions are abundantly infiltrated (dense, swollen) and lichenified (the skin on them is dense and thickened, with a pronounced pattern and impaired pigmentation).

In young women (under 30 years of age) who suffer from increased hair growth on the legs, microsporia lesions usually appear in the form of red and inflamed nodules with a diameter of 2–3 cm. This is a deep form of microsporia.

Microsporia capitis (microsporia of the scalp)

Most often, foci of microsporia are located on the scalp in children aged 5–12 years. In adults, this localization of lesions is rare, since with the onset of puberty, hair follicles begin to produce acid, which has a detrimental effect on the causative agent of microsporia. And therefore, after the onset of puberty, microsporia in children heals spontaneously.

A characteristic feature of childhood microsporia is that the infection almost never occurs in children with red hair.

Microsporia of the scalp is a round or oval lesion with a clear border, most often located on the crown, crown or temples. Usually there are 1 - 2 lesions on the head with a diameter of 2 - 5 cm. At the borders of the lesions, small secondary lesions with a diameter of 0.5 - 1.5 cm, which are screenings, may appear.

At the initial stages of the disease, a flaky patch of skin forms in the affected area. In this area at the roots of the hair, you can see ring-shaped scales surrounding the hairs along the entire perimeter. After a week, the hair itself is affected, losing color, becoming dull, brittle and fragile, and as a result breaks off at a distance of 5 mm from the surface of the skin. The short “brush” remaining in place of the broken hairs, dull and covered with a grayish coating, is an accumulation of fungal spores. If the roots of broken hair are smoothed in any direction, they will remain in the position they were given. The skin under the hair fragments is moderately reddish, dense and covered with a large number of grayish scales.

In the anthroponotic form of microsporia, a characteristic feature is the location of the lesions at the border of hair growth, when one half of the spot is on the scalp, and the second on the smooth skin.

The picture described above is a typical course of microsporia. However, in rare cases, the infection occurs in atypical forms, such as:

• Infiltrative form Microsporia of the head is characterized by an elevation of the lesion above the rest of the skin. The skin of the lesion is red and swollen, and the hair is broken off at a level of 4 mm.
• Suppurative form microsporia is characterized by a strong inflammatory process, as well as thickening and compaction of the skin in the affected area. In this case, bluish-red nodes with pustules on the surface are formed, through which pus comes out when pressing on the affected area.
• Exudative form microsporia is characterized by severe redness, swelling and small blisters in the affected area. Due to the secreted inflammatory fluid, the skin scales stick together and form a dense crust covering the lesion.
• Trichophytoid form microsporia is characterized by multiple small lesions with mild peeling. The lesions are vague, without clear boundaries and signs of inflammation, and the hair is broken off at a level of 1 - 2 mm.
• Seborrheic form microsporia is characterized by thinning of hair in some areas of the head. In the area of ​​such hair thinning, skin is visible, covered with a large number of yellowish scales. If the scales are removed, fragments of a small amount of hair become visible underneath them.

These rare forms of microsporia of the scalp are almost always associated with increased body temperature, inflammation of the lymph nodes of the neck and symptoms of intoxication (headache, weakness, lethargy, etc.).

Anthroponotic microsporia

Anthroponotic microsporia most often develops in children. On smooth skin it appears as round or oval lesions with a clear boundary, within which numerous scales are visible. The border of the lesion is formed by bubbles and nodules.

On the scalp, lesions are located at the border of hair growth in the area of ​​the back of the head, crown and temples. As a rule, part of the lesion is located in the hair growth area, and part is on smooth skin. Such lesions are small, vague, with clear boundaries and peeling inside the spot. When located close to each other, the lesions can merge, forming one large, bizarrely shaped lesion area. In the area of ​​the lesions, the hair breaks off at a level of 4–6 mm and looks short-cut.

Zoonotic and geophilic microsporia

Multiple small (0.5 - 3 mm in diameter) reddish-pink scaly spots of round or oval shape with clear boundaries appear on smooth skin. The inner surface of the spots is covered with flaky scales. Over time, new ones appear right within the perimeter of old lesions, forming a characteristic “ring within a ring” pattern, which is a hallmark of microsporia.

When the scalp is damaged, large lesions are formed, located strictly in the hair growth zone. The lesions are round or oval in shape, have clear boundaries and are covered with whitish scales. The hair in the lesion is broken off at a height of 6–8 mm, and the protruding fragments are covered with a white sheath of fungal spores.

Nail microsporia

Nail microsporia is extremely rare. This form includes lesions on the palms, soles and nails. When a nail is damaged, a dull spot forms on it in the area of ​​the growth crescent. Over time, the spot becomes white, and the nail in this part becomes fragile, soft and thinned. Quite often the affected part of the nail is destroyed.

Microsporia - photo

This photograph shows numerous lesions of smooth skin microsporia.

This photograph shows a microsporia lesion in a child.

This photograph shows a focus of microsporia on the scalp.

Diagnosis of microsporia

Diagnosis of microsporia is based on examining the lesions, first with the naked eye, and then through a fluorescent lamp. After this, if necessary, microscopic or cultural examinations are performed to confirm the diagnosis and accurately determine the type of fungal infection.

The method for diagnosing microsporia through a fluorescent lamp (Wood's lamp) is very simple - a doctor in a darkened room examines the affected area illuminated by such a device. Skin and hair affected by fungus in the light of a Wood's lamp flicker bright green. The reason for this phenomenon is not clear, but it allows you to quickly and accurately diagnose microsporia.

If necessary, the doctor can carefully scrape off a small amount of scales from the affected area with a blunt scalpel and examine them under a microscope, conducting a microscopic examination accordingly. Before scraping off the scales, the skin in the affected area is wiped with 96% alcohol. After this, only scales are scraped off from smooth skin, and hair fragments from the scalp. All collected material is placed on a glass slide, filled with a drop of 20% potassium hydroxide solution and examined under a microscope after 30 minutes.

With microsporia, twisted threads of mycelium are visible in the scales, and on the surface of the hair there are numerous spores attached to it like small balls along the entire outer perimeter. Due to the spores, the border of the hair is not clear, but blurred.

The cultural method for diagnosing microsporia is used when microscopic and luminescent results are positive in order to identify the type of fungus that causes it. Sometimes this is necessary to determine the optimal treatment strategy. For the cultural method, scales are removed from the affected area and placed on a nutrient medium. In the presence of microsporia, a colony grows on the medium in the form of a flat disk with a fluff on the surface.

In most cases, to diagnose microsporia, it is sufficient to examine the affected area through a Wood's lamp and subsequent microscopic examination.

Microsporia - treatment

General principles of therapy

If only smooth skin is affected by microsporia, and the vellus hair on it remains intact, then treatment with local antifungal drugs (ointments, lotions, sprays), which are applied daily until the lesions disappear, is sufficient.

If foci of microsporia are located on the scalp or vellus hairs of smooth skin are involved in the process, then treatment consists of taking antifungal drugs internally and applying them externally to the affected areas.

Most effective for oral administration for the treatment of microsporia, antifungal drugs containing the following active substances:

• Griseofulvin;
• Terbinafine (Terbizil, Lamisil, etc.);
• Itraconazole (Orungal, Irunin, etc.).

For external processing smooth skin and scalp, the following agents with antifungal activity are used:

• Ointments with terbinafine (Lamisil, Terbizil, etc.), clotrimazole, isoconazole and bifonazole;
• Tincture of iodine 2 – 5%;
• Sulfuric ointment 10 – 20%;
• Sulfur-salicylic ointment;
• Sulfur-tar ointment.

Taking antifungal drugs orally and applying them externally to the affected skin continues for a week after the symptoms of microsporia disappear to avoid a possible relapse of the infection.

During the entire period of therapy, the sick person should use separate towels, sponges, combs and other personal hygiene and household items, and not share them with other people. All things worn by a person suffering from microsporia should be washed with ordinary powder at a water temperature of 60 o C, which is sufficient to kill the fungal spores. Boil all the items he used for 15 minutes in water. Drawers, cartons and other containers where things of a person suffering from microsporia were stored should be treated with the antifungal disinfectant Terralin.

Microsporia of smooth skin and scalp - treatment

If vellus hair on smooth skin is affected, then treatment consists of taking antifungal drugs internally and applying them externally to the lesions. If vellus hair is not affected, then only local treatment is carried out, which consists of external application of antifungal agents. Treatment of microsporia of the scalp is always carried out by a combination of taking antifungal agents internally and applying them externally to the lesions.

So, the following drugs should be taken orally to treat microsporia:

• Griseofulvin. The dosage is calculated individually from the ratio of 22 mg per 1 kg of body weight. The calculated amount is divided by 3 and taken 3 times a day with a spoonful of oil for 2 to 6 weeks. Once a week, a scraping from the affected area is submitted for analysis. After the scraping result for fungi is negative, Griseofulvin is taken for another 2 weeks at the same dose every other day. Then for another 2 weeks at the same dose the tablets are taken every 3 days.
• Terbinafine. Take 250–500 mg once a day for 4–6 weeks.
• Itraconazole. Take 100–200 mg 1 time per day for 4 weeks.

In parallel with taking the above medications internally, foci of microsporia should be treated daily with external agents. It is preferable to use different means for external treatment of microsporia foci in the morning and evening. For example, in the morning, tincture of iodine, and in the evening - Lamisil, or in the morning - sulfur ointment, and in the evening - Isoconazole, etc.

If there is severe inflammation on the skin, then in the first 3 to 5 days of therapy it is necessary to treat them once a day with Travocort ointment, which contains a hormone with a powerful anti-inflammatory effect. When the inflammation decreases, you should switch to using any other antifungal ointment (Travogen, Zalain, Lamisil, Terbizil, Terbinafine, etc.).

Hair from smooth skin should be shaved once a week or epilated with a special patch containing griseofulvin. For microsporia of the scalp, before starting treatment, you should shave the hair from the affected area, and do this 1-2 times a week until the end of the course of therapy. You should also wash your hair 1-2 times a week with tar soap or pharmaceutical shampoo containing selenium sulfide, ketoconazole or povidone-iodine.

Treatment of microsporia in children

In children, microsporia is treated according to the same schemes and principles as in adults. However, the optimal drug for oral administration is Terbinafine (Lamisil, Terbizil, etc.), which should be used in the absence of any contraindications. Pediatric Terbinafine oral dosages are determined by their body weight:

• Children weighing 10 – 20 kg – take 3/4 tablets (94 mg) of Terbinafine 125 mg 1 time per day;
• Children weighing 20 – 40 kg – take 1.5 tablets (187 mg) of Terbinafine 125 mg once a day;
• Children weighing over 40 kg – take 2 tablets (250 mg) of Terbinafine once a day.

These dosages are 50% higher than those recommended by the manufacturer, however, they turned out to be the most effective in the treatment of microsporia according to clinical observations and use in children's hospitals.

Itraconazole and Griseofulvin are not recommended for use in children due to their high toxicity.

External treatment of affected areas in the treatment of microsporia in children is carried out with the same drugs as in adults. The optimal ointment for children is Clotrimazole or Lamisil.

Disease prevention

Prevention of microsporia consists of timely identification and treatment of sick people, as well as limiting contact with animals. When microsporia is detected in someone's family, then all other people who are in close contact with him should undergo a preventive examination using a Wood's lamp. All pets should also be examined and treated if necessary.

Microsporia: pathogens, routes of infection, signs (symptoms), treatment and prevention - video

A person is constantly surrounded by a huge number of microorganisms that can cause various pathologies. Microsporia in children or ringworm is a pathology that affects the scalp or smooth skin of an adult or child. The disease is contagious, so it is necessary to isolate the person and begin immediate treatment. Therapy has a positive prognosis if the rules and medication regimen are followed.

What is microsporia in children

This pathology is better known to the general public as ringworm. This term has become the traditional name for a whole group of ailments that affect the skin and scalp. Skin microsporia affects the hair, it breaks off and bald spots appear. The disease belongs to the group of infectious fungal pathologies; the pathogen (Microsporium) penetrates the skin and begins to reproduce, which leads to the appearance of typical symptoms.

Routes of infection

Penetration of the infection occurs through contact with a carrier, which can be another person, object, or animals that are already infected with the fungus. There are several types of spores, which determines how they spread among people. There are three main species of Microsporum depending on the main host:

• Zoophilic fungi. The main carriers are cats, dogs and other animals.
• Anthropophilic. People become the main carriers.
• Geophilic. The main habitat is soil, where they remain viable for several months

Incubation period in children

The duration of this stage depends on the type of fungus that caused microscopy. For example, geophilic and zoophilic spores develop over 5-14 days. If anthropophilic forms of the fungus get under the skin, the incubation period will take longer - 4-6 weeks. As a rule, infection occurs from sick animals, so the disease manifests itself in humans after 1-2 weeks.

Symptoms

There is a general clinical picture for all types of microscopy, but there are also individual signs of each type of disease, which become characteristic features of the disease. Common symptoms include the following:

1. Red spots. One of the first signs of the development of pathology is the appearance of lesions on the scalp and body. When localized on the scalp, spots may also appear in the area of ​​the eyebrows and eyelashes. When they appear on smooth skin, lesions can be found on any part of the body.
2. Whitish small scales. After a few days, the spots become pink and fade. Whitish scales begin to form on the surface, and there are many of them. They can be mistakenly taken on the scalp for dandruff, and on the body as the first signs of psoriasis in a child.
3. Severe itching. In some cases, areas of peeling are accompanied by this symptom. When a child scratches his head, parents at first think that it is lice. Microscopy is often confused with eczema or another type of dermatitis. This is not a mandatory sign; the disease can proceed without it.
4. Increase in body temperature. It is not observed in all patients, but may be present.
5. Enlarged lymph nodes. This symptom is observed only in some babies on the neck.

Skin microsporia

Depending on the type and stage of the pathology, certain symptoms may develop, which simplify the diagnosis of the disease. Microsporia of smooth skin in children and newborns most often occurs in a superficial form. Signs include the following manifestations (see photo):

1. The first to appear is a red spot (focus) of a round or oval shape. It has clear boundaries and rises slightly above the skin.
2. Then the lesion begins to increase in size, becoming even denser and slightly swollen. A roller appears along the radius of the spot, which consists of bubbles and crusts.
3. In the center of the lesion, the inflammatory process decreases. The area limited by the roller becomes pink and covered with scales.
4. Sometimes microsporia re-enters the site of primary infection. Another lesion appears inside the old ring. This form is often found in anthroponotic microsporia.
5. As a rule, 1-3 such lesions form on the surface of smooth skin. If the spots are close together, they may merge. Lesions without an active infectious process do not cause discomfort in most cases. If an inflammatory process is observed, the child experiences itching and pain.
6. In newborns and children under 3 years of age, the disease often has an erythematous-edematous form. The lesions are swollen, red and with obvious inflammation, with very few scales.

Microsporia of the head

Ringworm on the scalp most often appears between the ages of 5 and 12 years. In older adults, this pathology is very rarely observed, because the hair follicles are capable of producing acid that kills the causative agent of the disease. Fungal infection is more often diagnosed in children with red hair; the disease occurs with the following symptoms:

1. Areas of peeling appear on the dermis, ring-shaped scales form at the roots of the hair, they surround the hairs along the entire perimeter.
2. After 1 week, hair loss occurs. Loss of pigmentation occurs, hair becomes brittle, brittle and very dull. As a result, they break off, leaving only a short “hedgehog” of about 5 mm.
3. The remaining fragments of hairs are covered with a fungal coating of spores. The skin in these places is dense and moderately red, covered with numerous grayish scales.

These are common symptoms that appear in this form of pathology, but there are also atypical options. The following types of disease are distinguished:

1. Infiltrative form. The lesion rises above the rest of the skin. It has a red appearance, swollen, hair breaks at the level of 4 mm.
2. Suppurative form. There is a strong inflammatory process, the spot is dense and thick. Bluish-red nodules with pustules form on the surface, which release pus when pressed.
3. Exudative. There is severe swelling. Redness, small blisters at the site of infection. The scales stick together due to the inflammatory fluid, and a crust forms that covers the spot.
4. Trichophytoid. A large number of small lesions appear on the skin, they peel slightly. The spots do not have clear contours, obvious inflammation, hair breaks at the level of 2 mm.
5. Seborrheic. Hair thinning is observed in some areas of the head. In these places, the scalp with yellowish scales is visible. If you peel them off, you will end up with broken hair roots.

Causes

The main source of infection are dogs and cats. Penetration of spores occurs not only through direct contact of a child with a sick animal, but when touching objects that have fur or scales on them. The fungus continues to live in the soil for another 1-3 months. Infection can only occur through contact; probable sources of microsporia can be:

• objects touched by the patient (person or animal);
• sick people;
• sick animals;
• the soil.

Classification

There are two main options for dividing this pathology. The first classification is based on the area affected by the fungus. The disease is divided into three variants according to this type:

• microsporia of smooth skin;
• scalp;
• damage to the nail plates (extremely rare).

Doctors identify 3 more forms of pathology, which are classified according to the type of pathogen that provoked the development of the disease:

Ringworm does not pose any danger to the life of a child or adult. With adequate and timely therapy, the hair and skin are completely restored. However, there are situations in which complications of the disease arise if the wrong treatment regimen was prescribed or the doctor was consulted late. The consequences may appear in the following form:

• inflammation, suppuration of the skin (as in the photo);
• Bald spots appear on the head.
• Irreversible hair loss develops.

Diagnostics

The diagnosis is based on a visual examination of the affected areas by a doctor, then a fluorescent lamp is used. If the specialist is not sure, then to confirm and accurately determine the type of pathogen, examination under a microscope and cultural examination are prescribed. Using a Wood's lamp in a dark room, the doctor examines the lesion. Areas that are affected by the disease begin to flicker bright green.

This phenomenon has not been fully studied, but it is one of the fastest ways to diagnose microsporia. For laboratory testing, the doctor carefully scrapes off the scales with a scalpel and transfers the material for examination under a microscope. Before the procedure, it is necessary to treat the affected area with 96% alcohol. Only scales are taken from smooth skin, and hair fragments are also needed from the scalp.

The collected material is placed under a glass slide, 20% potassium hydroxide is dripped, after 30 minutes the result can be examined under a microscope. You can see filaments of mycelium in the scales, and on the surface of the hair there are a large number of spores, which, like small balls, are attached to it along the entire outer perimeter. This causes the hair to not have a clear boundary; it is more blurred.

A cultural diagnostic method is necessary if the result is positive after luminescent and microscopic examination to determine the type of fungus. This will help determine the most effective treatment tactics. The scales collected from the affected area are placed in a nutrient medium. If the fungus is present, the colony grows in the shape of a disk with a fluff.

Treatment of microsporia in children

Determining treatment tactics for a child is possible only after seeing a doctor and diagnosing the disease. If only smooth skin is affected, then local antifungal drugs (solutions, ointments, creams, sprays) will suffice. These medications are used until the lesions completely disappear. If the pathology affects the scalp, then the treatment tactics change. Systemic therapy with antifungal agents and the application of local medications are required. The following points can be highlighted from general recommendations:

1. On smooth skin, it is necessary to shave the hair once a week; you can use patches with griseofulvin.
2. If localized on the scalp, before treatment, you need to shave the hair from the affected area. Repeat this procedure 2 times a week until complete recovery.
3. It is better to wash your hair with a special pharmaceutical shampoo containing ketoconazole, povidone-iodine, selenium sulfide or tar soap

Preparations for internal administration to children

There are different types of medications to treat this disease. The appropriateness of their use should be determined by the doctor based on the type of disease, stage and individual characteristics of the child. The following options are considered the most optimal:

• terbinafine preparations;
• Lamisil;
• Trebizil.

If there are no contraindications, then the first option is considered preferable. The dosage is determined by the doctor depending on the child’s body weight. The following dosage recommendations for taking terbinafine are available:

• 10-20 kg – ¾ of 125 mg tablets of medication;
• 20-40 kg – 1.5 tablets 125 mg;
• over 40 kg – 2 tablets.

Drugs for local therapy

Medicines for external (local) use must be used. External treatment is necessary for both smooth skin and scalp. As a rule, the following drugs are prescribed:

• Zalain;
• Travogen;
• Isoconazole;
• Travocort;
• Terbizil;
• sulfur-tar ointment;

In addition to antifungal ointments, you can use iodine and folk recipes. The affected areas must be treated every day, morning and evening. For example, after waking up, lubricate with iodine tincture, and before going to bed, apply a layer of Lamisil ointment. If the disease has reached the stage of severe inflammation, then local hormonal ointment Travocort is prescribed for 3-5 days for initial therapy, which has a powerful effect on the pathogen. Apply the product 1 time per day.

Treatment of microsporia of the scalp

To treat this form of pathology, griseofulvin is often prescribed. This is an antibiotic that produces mold. The product is available in the form of tablets (125 mg) and the medication is taken every day in 3-4 doses after or during meals along with a teaspoon of vegetable oil. This measure is necessary to increase the solubility of the product and increase its duration of action. Microsporia of the scalp in children under 3 years of age is preferably treated with a griseofulvin suspension.

Therapy must be carried out continuously until tests show a negative result for fungi. After this, the same dosage of the drug is maintained for another 2 weeks, and then taken 2 times a week for another 14 days. The course of treatment lasts from 1 to 2 months, you need to shave your hair every 7 days, wash your hair 2 times a week. Additionally, it is necessary to use any antifungal ointment (rub into the surface of the head). Griseofulvin has some side effects:

• allergic rashes;
• headache;
• discomfort in the pancreas;

This medication should not be prescribed to a child if he has suffered from hepatitis, suffers from liver pathology, kidney disease, peptic ulcers, blood diseases and neuritis. If necessary, you can use an alternative to griseofulvin - Lamisil (terbinafine). The medication is used in the form of tablets in dosages of 125 and 150 g. The dosage of the drug is set in accordance with body weight, the medicine must be taken once a day.

Folk remedies

In consultation with your doctor, home recipes may be used as additional therapy. Folk remedies can only help in the initial stages of pathology or be used for prevention. The following recipes can be used:

• squeeze the juice from the onions, moisten the napkins and apply to the affected areas every day;
• tincture of lilac flowers: add 2 tbsp to 100 ml of 70% alcohol. l. dried flowers, then strain and lubricate the inflamed areas;
• wash the affected areas with a decoction of celandine: 1 tbsp. l. dry herbs, take a glass of boiling water and hold on low heat for 10 minutes, then cool, strain.

Prevention

The main preventive area should be the child’s personal hygiene, which is monitored by parents. Avoid contact with unfamiliar animals or people who have obvious signs of ringworm. If the playground looks dirty and there are dogs and cats walking around, do not let your child play in the sand or walk on it barefoot. If a sick person appears in the family, he is isolated from other members until complete recovery, and the apartment is disinfected.

Microsporia is a disease caused by a fungus. This disease is characterized by damage to the skin and hair; in more rare cases, the fungus also affects the nail plates. This disease was named after the name of the causative agent of the disease - a fungus of the genus Microsporum. This disease is also known as “ringworm” due to a number of characteristic features of its manifestation.

After contact with human skin, the fungus penetrates the skin, after which its active reproduction begins. If there are hair follicles near the place where the fungus has entered, then the spores of the fungus germinate, and eventually the hair is affected. The fungus spreads very quickly throughout the hair, as a result of which the cuticle is destroyed and spores accumulate between its scales. As a result, the fungus completely surrounds the hair and fills the bulb.

How can you get infected?

Microsporia is caused by fungi of the genus Microsporum. There are several types of them, but only two of them pose a danger to humans - canine and rusty microsporum. A person can encounter these pathogens in the following situations.

1. Contacting a person with microsporia. In this situation, most often the causative agent of the disease is rusty microsporum, which is considered anthropophilic, that is, living on human skin. It is the anthropophilic form of microsporia that can cause collective outbreaks of the disease.
2. Contacting objects with fungal spores. In this way, you can become infected with both zoophilic and anthropophilic microsporia.
3. By contact with sick animals, mainly cats, although infection from dogs, pigs, and sheep is possible. In such cases, zoophilic microsporia develops. It is also transmitted from person to person, but with less probability, so collective outbreaks of ringworm caused by canine microsporum practically do not occur.

It should also be noted that contact of the pathogen with human skin does not always lead to the development of the disease, especially in adults. The likelihood of infection is influenced by the number of fungi, the state of the body’s defenses, and the presence of predisposing factors.

The causative agent of the disease

As a result, it follows that microsporia is transmitted through contact with a sick person or animal, as well as through contact with contaminated soil.

Symptoms of microsporia, photo

The duration of the incubation period depends on the type of fungus that provoked microsporia (see photo).

Thus, when infected with zoophilic and geophilic species of Microsporum fungi, the incubation period lasts 5–14 days. And when infected with anthropophilic forms, the incubation period of microsporia lasts much longer - from 4 to 6 weeks.

But since microsporia is most often provoked by a fungus of the Microsporumcanis species, which belongs to the zoophilic species, in most cases the incubation period of the infection is 1 - 2 weeks.

Microsporia of smooth skin

At the site where the fungus has invaded, 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 plate, 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

Most often it occurs in the area of ​​the crown and temples, as well as on the top of the head. A fungal colony looks like this: a central large spot, reaching 5 cm, and smaller (up to 1.5 cm) screenings around the circumference. As the central spot grows, it can absorb nearby small lesions.

Microsporia on the human head in the initial stage forms focal peeling. Upon closer inspection, you can see a whitish "cuff" around the hairs growing inside the spot. This indicates the growth of fungus in the mouth of the hair, which after a week leads to hair breakage. Outwardly, it looks like a spot trimmed at a level of 4-6 cm. Broken hairs with a grayish coating are a haven for fungal spores. The changed position of the hair stumps when stroking is preserved, unlike healthy hair.

The scalp itself in the affected areas is somewhat hyperemic, swollen and covered with small white or grayish scales.

Diagnostics

To make an accurate diagnosis and choose the right treatment, you must:

• Undergo laboratory diagnostic testing. Includes a microscopic examination for fungi, a cultural examination to determine the type of pathogen, and examination under a fluorescent lamp (damaged hair is passed through ultraviolet light).
• Take a clinical (standard) blood test and urine test.
• Do a biochemical study of liver functions.

A differentiated study is also necessary, which allows us to finally confirm the diagnosis. In this study, microsporia is compared with other dermatoses (pityriasis rosea, trichophytosis, seboreids, etc.)

How to treat microsporia in humans?

If only smooth skin is affected by microsporia, and the vellus hair on it remains intact, then treatment with local antifungal drugs (ointments, lotions, sprays), which are applied daily until the lesions disappear, is sufficient. If foci of microsporia are located on the scalp or vellus hairs of smooth skin are involved in the process, then treatment consists of taking antifungal drugs internally and applying them externally to the affected areas.

The most effective antifungal drugs for oral administration to treat microsporia are those containing the following active substances:

• Griseofulvin;
• Terbinafine (Terbizil, Lamisil, etc.);
• Itraconazole (Orungal, Irunin, etc.).

For external treatment of smooth skin and scalp, the following agents with antifungal activity are used:

• Ointments with terbinafine (Lamisil, Terbizil, etc.), clotrimazole, isoconazole and bifonazole;
• Tincture of iodine 2 – 5%;
• Sulfuric ointment 10 – 20%;
• Sulfur-salicylic ointment;
• Sulfur-tar ointment.

Taking antifungal drugs orally and applying them externally to the affected skin continues for a week after the symptoms of microsporia disappear to avoid a possible relapse of the infection.

Mandatory measures when identifying microsporia in humans:

• Removal of damaged hair (epilation, daily shaving).
• Wash your hair twice a week.
• Regular change of linen.
• Limiting contact with a sick person. Isolation of a child from a preschool educational institution or school during the treatment of microsporia in children.
• Examination of people who have been in contact with a sick person.
• Examination of pets by a veterinarian.
• Disinfection of care items (towels, combs), clothes, children's toys using disinfectants. Spring-cleaning.

The entire treatment takes 3-6 weeks. Recovery is confirmed by a negative analysis of scrapings from the site of injury.

Folk remedies

Currently, doctors have a significant arsenal of medications that can quickly and reliably relieve patients from microsporia, even in its advanced forms. Therefore, traditional methods of treating this disease are used extremely rarely today, as a rule, as part of complex therapy prescribed by a dermatologist.

The main folk remedies for fighting ringworm are:

1. Garlic vinegar. This remedy is widely used in the treatment of many dermatological diseases. To prepare it, chop a few cloves of garlic and pour in 0.5 liters of apple cider vinegar. The resulting mixture should be infused for 1 - 2 weeks, shaking occasionally. After preparation, rub the affected area of ​​skin with vinegar. To enhance the therapeutic effect, you can add a few drops of camphor oil to the infusion before use.
2. Garlic juice. Cut a clove of garlic lengthwise and rub its juice on the affected area of ​​the skin. This procedure is performed once a day (preferably in the morning). After this, during the day the lichen can be lubricated with birch charcoal or plantain.
3. Ointment based on sea fish broth. To prepare the ointment, you will need about 400 ml of rich broth, 100 g of butter and a paste of several heads of grated garlic. This mixture is carefully applied to the affected area of ​​skin 2 - 3 times a day, wrapped with a clean bandage for 30 - 60 minutes.
4. Sophora japonica. To prepare this product you need 50 g of fruits or flowers of this plant. In the absence of contraindications, it is recommended to make an alcohol infusion. For 50 g of herb you need 0.5 liters of vodka (at least 35 degrees strength). Infusion lasts 3 – 4 weeks in a dark place. After preparation, the infusion is filtered and taken orally, 3 teaspoons per day. Regular brewing of tea with the addition of Japanese Sophora can also provide a certain therapeutic effect for microsporia.

As you can see, most of the above recipes use garlic. The fact is that this plant contains a large number of substances that have a beneficial effect on biochemical processes in the skin. It also has some disinfecting properties (which, however, are ineffective against the pathogen microsporia).

Prevention

As a preventive measure for microsporia, timely detection and effective treatment of patients is very important. To do this, children's institutions need to conduct regular medical examinations. If a sick child is discovered, he should be isolated from other children and emergency treatment measures for microsporia should be taken.

It is also important to promptly and efficiently disinfect the belongings of sick people. A thorough examination of everyone who came into contact with a person with microsporia is carried out. It is also important to periodically examine pets to identify foci of disease and take measures to treat them.

Forecast

With timely treatment, the prognosis for microsporia is favorable, the disease ends in complete recovery. After completing the course of treatment, the patient remains under the dispensary supervision of a dermatologist for 12 months. Deregistration is carried out only after receiving negative tests for fungi.