What are the causes of black spots on feet. How to identify tinea nigra symptoms. What are the most effective treatments for fungal infections on feet. How to prevent dark patches on palms and soles.

Understanding Tinea Nigra: A Rare Fungal Infection

Tinea nigra is an uncommon fungal infection that manifests as brown or black patches on the soles of feet, palms of hands, and rarely on the torso. This condition is primarily caused by a yeast called Hortaea werneckii, which enters the body through small wounds. Despite its alarming appearance, tinea nigra is generally harmless and confined to the superficial layers of the skin.

Key Characteristics of Tinea Nigra

• Slow-growing brown or black patches
• Usually affects a single area
• More common in people under 20 years old
• Prevalent in tropical and subtropical regions
• Does not spread to deeper layers of skin

Recognizing Tinea Nigra Symptoms

Identifying tinea nigra can be challenging due to its resemblance to other skin conditions. However, certain symptoms can help distinguish this fungal infection from other ailments.

Common Symptoms of Tinea Nigra

• A single round, linear, or irregularly shaped patch
• Slow-growing brown or black discoloration
• Patches that may or may not itch
• Resemblance to a growing mole or freckle
• Occasionally, multiple lesions if exposed to multiple entry points

Can tinea nigra be mistaken for other conditions. Yes, tinea nigra can be confused with melanoma or other types of skin cancer, which is why proper diagnosis by a healthcare professional is crucial.

Risk Factors and Causes of Tinea Nigra

Understanding the risk factors and causes of tinea nigra can help in prevention and early detection of this fungal infection.

Primary Causes of Tinea Nigra

The main culprit behind tinea nigra is the yeast Hortaea werneckii, formerly known by various scientific names such as Cladosporium werneckii, Exophiala werneckii, or Phaeoannellomyces werneckii. In some cases, another yeast called Stenella araguata may be responsible for the infection.

Risk Factors for Developing Tinea Nigra

• Living in or traveling to tropical or subtropical regions
• History of hyperhidrosis (excessive sweating)
• Recent injuries or wounds on hands or feet
• Contact with wood, soil, or compost without protective gear
• Frequent exposure to moist or humid environments

Is tinea nigra more common in certain age groups. Yes, tinea nigra is more likely to affect young people under the age of 20 years, although it can occur in individuals of any age.

Diagnosing Tinea Nigra: Importance of Accurate Assessment

Given the similarity of tinea nigra to other skin conditions, accurate diagnosis is crucial for proper treatment and peace of mind.

Diagnostic Procedures for Tinea Nigra

1. Clinical examination and patient history
2. Skin culture to identify Hortaea werneckii
3. Skin biopsy to rule out skin cancer

During the diagnostic process, healthcare providers may inquire about recent travel history, injuries, and exposure to potential sources of the fungus. A positive diagnosis is confirmed when Hortaea werneckii grows in a lab culture within a week.

Treatment Options for Tinea Nigra

While tinea nigra is generally harmless, many people seek treatment for cosmetic reasons or peace of mind. Various treatment options are available, ranging from home remedies to prescribed medications.

Home Remedies for Tinea Nigra

For those who prefer to try home treatments, keratolytic agents may prove effective. These chemicals help remove excess skin and can include:

• Wart creams
• Salicylic acid
• Whitfield’s ointment

It’s important to note that these remedies may not be safe during pregnancy, and women who are pregnant or trying to conceive should consult a healthcare provider before attempting any home treatments.

Medical Treatments for Tinea Nigra

If home remedies prove ineffective or if the infection is severe, medical treatments may be necessary. These typically include:

• Topical antifungal creams (most common)
• Oral antifungal drugs (for large lesions or resistant cases)

How long does tinea nigra treatment typically last. While the optimal duration of treatment is not definitively established, some reports suggest that a one-month course of treatment is often sufficient for most cases of tinea nigra.

Preventing Tinea Nigra: Practical Strategies

Prevention is key when it comes to tinea nigra, especially for those living in or traveling to tropical regions. By adopting certain habits and precautions, individuals can significantly reduce their risk of developing this fungal infection.

Effective Prevention Techniques

• Practice frequent handwashing, especially after outdoor activities
• Wear gloves when gardening or working with soil and compost
• Avoid walking barefoot outdoors
• Wear socks or shoes in public places
• Change socks regularly, particularly in humid conditions

These strategies are particularly important for individuals residing in or visiting tropical areas where the Hortaea werneckii fungus is more prevalent.

Distinguishing Tinea Nigra from Other Skin Conditions

While tinea nigra has distinct characteristics, it can be mistaken for other skin conditions. Understanding these differences is crucial for proper diagnosis and treatment.

Conditions Often Confused with Tinea Nigra

• Melanoma
• Junctional nevi
• Acral lentiginous melanoma
• Drug-induced hyperpigmentation

How can one differentiate tinea nigra from melanoma. Unlike melanoma, tinea nigra typically has a uniform color, does not change rapidly, and does not have irregular borders. However, a professional diagnosis is always recommended to rule out more serious conditions.

The Impact of Climate and Geography on Tinea Nigra Prevalence

The prevalence of tinea nigra is closely tied to climate and geographical location. Understanding this relationship can help individuals assess their risk and take appropriate precautions.

Geographical Distribution of Tinea Nigra

• More common in tropical and subtropical regions
• Rare in temperate climates
• Often associated with coastal areas

Why is tinea nigra more prevalent in tropical regions. The fungus responsible for tinea nigra thrives in warm, humid environments, which are characteristic of tropical and subtropical climates. These conditions provide an ideal habitat for the growth and spread of Hortaea werneckii.

Climate Factors Influencing Tinea Nigra

• High humidity
• Warm temperatures
• Abundant rainfall

These climatic factors contribute to the creation of environments where the fungus can flourish, increasing the likelihood of human contact and subsequent infection.

Tinea Nigra in Special Populations

While tinea nigra can affect anyone, certain groups may be at higher risk or require special considerations when it comes to treatment and prevention.

Tinea Nigra in Children

Children under 20 are more susceptible to tinea nigra infections. This increased vulnerability may be due to factors such as:

• More frequent outdoor play and exposure to soil
• Less rigorous hygiene practices
• Potentially more sensitive skin

Parents and caregivers should be particularly vigilant in encouraging good hygiene habits and protecting children’s skin when in high-risk environments.

Tinea Nigra During Pregnancy

Pregnant women face unique challenges when dealing with tinea nigra. Many common treatments, including some over-the-counter remedies, may not be safe during pregnancy. Expectant mothers should always consult with their healthcare provider before attempting any treatment for tinea nigra.

Tinea Nigra in Immunocompromised Individuals

People with weakened immune systems may be more susceptible to fungal infections, including tinea nigra. While the infection typically remains superficial, immunocompromised individuals should seek prompt medical attention if they notice any unusual skin changes.

Long-term Outlook and Complications of Tinea Nigra

Understanding the long-term prognosis and potential complications of tinea nigra can help alleviate concerns and guide treatment decisions.

Prognosis of Tinea Nigra

The outlook for tinea nigra is generally excellent. With proper treatment, the infection typically resolves completely without leaving any permanent marks or scars. In some cases, the infection may even clear up on its own without intervention.

Potential Complications

Complications from tinea nigra are rare, but may include:

• Persistent discoloration if left untreated
• Emotional distress due to the appearance of the lesions
• Misdiagnosis leading to unnecessary procedures or treatments

Can tinea nigra recur after treatment. While recurrence is possible, especially if risk factors persist, it is relatively uncommon. Maintaining good hygiene practices and avoiding high-risk environments can help prevent reinfection.

Emerging Research and Future Directions in Tinea Nigra Management

As medical science advances, new insights into tinea nigra are emerging, potentially leading to improved diagnostic and treatment methods.

Advances in Diagnosis

Recent developments in diagnostic techniques for tinea nigra include:

• Advanced imaging technologies for more accurate differentiation from other skin conditions
• Molecular diagnostic methods for faster and more precise identification of the causative fungi
• Improved culture techniques for better detection of Hortaea werneckii

Novel Treatment Approaches

Researchers are exploring new treatment options for tinea nigra, including:

• Natural antifungal compounds derived from plants
• Nanotechnology-based treatments for more effective drug delivery
• Combination therapies to enhance treatment efficacy and reduce duration

What role might probiotics play in preventing or treating tinea nigra. While research is still in its early stages, some scientists are investigating the potential of probiotic treatments to enhance skin immunity and prevent fungal infections like tinea nigra.

Environmental and Climate Change Considerations

As global climate patterns shift, researchers are studying how these changes might affect the prevalence and distribution of tinea nigra. Areas previously unaffected by the fungus may see an increase in cases as temperatures rise and humidity levels change.

Living with Tinea Nigra: Coping Strategies and Support

While tinea nigra is generally harmless, the visible nature of the infection can cause distress for some individuals. Understanding how to cope with the condition and where to find support can be crucial for maintaining emotional well-being.

Emotional Impact of Tinea Nigra

Some individuals may experience:

• Self-consciousness about the appearance of the lesions
• Anxiety about potential misdiagnosis
• Frustration with treatment duration or effectiveness

Coping Strategies

To manage the emotional aspects of tinea nigra, consider:

• Educating yourself about the condition to alleviate fears
• Discussing concerns openly with healthcare providers
• Joining support groups or online communities for individuals with skin conditions
• Practicing stress-reduction techniques such as meditation or yoga

How can one maintain a positive body image while dealing with tinea nigra. Focus on overall health and well-being, remember that the condition is temporary, and consider using makeup or clothing to cover the affected areas if it helps boost confidence.

Support Resources

Various resources are available for individuals dealing with tinea nigra:

• Dermatology associations and foundations
• Online forums and support groups
• Patient education materials from reputable medical sources
• Mental health professionals specializing in body image issues

By understanding tinea nigra, its causes, symptoms, and treatment options, individuals can approach this condition with confidence and take proactive steps towards prevention and management. While the appearance of dark spots on feet or hands can be alarming, knowing that tinea nigra is generally harmless and treatable can provide reassurance. Always consult with a healthcare professional for proper diagnosis and treatment, especially if you have concerns about unusual skin changes or persistent discoloration.

Tinea nigra: Diagnosis, treatment, and remedies

Tinea nigra is a very rare fungal infection. It causes brown or black patches to develop on the soles of the feet, the palms of the hand, or, on rare occasions, the torso.

A type of yeast called Hortaea werneckii causes most tinea nigra infections. A person can get the infection when the yeast gets into their body, often through a small wound.

Keep reading to learn more about a tinea nigra infection, including the symptoms, diagnosis, and treatment options.

Tinea nigra causes brown or black patches to appear on the soles of the feet or the palms of the hand. The patches may be so small and faint that a person does not notice them. They also tend to grow slowly. The most common symptoms include:

• a patch on the foot or hand following an injury
• a single round, linear, or irregularly shaped patch that grows slowly
• growing patches that either cause no symptoms or itch
• patches that resemble a growing mole or freckle
• a slow growing brown patch on the torso

The infection affects people who live in tropical regions and those who have recently traveled to these areas.

Most people with tinea nigra have just one lesion. However, if the fungus comes into contact with multiple points of entry, such as wounds on both hands, a person may have several patches.

In healthy people, tinea nigra lives only on the superficial layers of the skin. It does not spread, cause serious infections, or present major health risks. It is more likely to affect young people under the age of 20 years.

Tinea nigra is a fungal infection, which means that a person gets it when they come into contact with a fungus that can cause the infection.

Scientists used to call Hortaea werneckii either Cladosporium werneckii, Exophiala werneckii, or Phaeoannellomyces werneckii. Another yeast called Stenella araguata may cause some cases of tinea nigra.

As with many other fungi, Hortaea werneckii thrives in moist or humid environments. It lives on dead and decaying organic material, such as soil and wood. It can get into the human body when it comes into contact with the skin, usually through a wound. It is most likely to live on parts of the body with many sweat glands, such as the hands and feet.

Certain risk factors increase a person’s likelihood of developing this infection. They include:

• living in a tropical or subtropical region
• recent travel to a subtropical or tropical region
• a history of hyperhidrosis, a condition that causes excessive sweating
• a recent injury
• contact with wood, soil, or compost, such as from gardening without gloves or woodworking in a tropical or subtropical region

In many cases, a person’s symptoms may lead a doctor to suspect tinea nigra. However, as tinea nigra can resemble the symptoms of several other conditions, it is important to get an accurate diagnosis.

The doctor may ask the individual about their recent travel, injury history, and exposure to wood, compost, or soil. They will also usually take a culture of the skin and send it to a lab to see whether Hortaea werneckii grows within a week. If it does, this means that the test is positive for tinea nigra.

Sometimes, a doctor may also perform a skin biopsy to test for skin cancer, as certain types of skin cancer can look similar to tinea nigra.

People who wish to try home remedies may see improvements with keratolytic agents. A keratolytic is a chemical that helps remove excess skin. Some potentially effective keratolytics include:

• wart cream
• salicylic acid
• Whitfield’s ointment

These drugs may not be safe during pregnancy, so women who are pregnant or trying to become pregnant should see a doctor instead of trying home remedies.

If home treatment fails, it is best to see a doctor. There are other possible causes of brown lesions on the skin.

Doctors usually prescribe topical antifungal creams to treat tinea nigra. People should apply the cream directly to the patch exactly as a doctor advises.

In some cases, a person may also need to take oral antifungal drugs, especially if the lesions are very large or if antifungal creams have not worked. However, oral drugs may not be effective.

Doctors do not know what treatment duration is optimal, but the authors of one report suggest that 1 month of treatment is sufficient.

People can reduce the risk of tinea nigra infections by protecting the skin from exposure to soil, compost, and other materials in which the Hortaea werneckii fungus likes to grow. Following this advice is especially important for people who travel to or live in tropical regions.

These strategies can help:

• practicing frequent handwashing, especially after spending time outside
• wearing gloves or other protective gear in the garden
• refraining from walking outside with bare feet
• wearing socks or shoes in public places
• changing socks frequently, especially if they get wet
• covering any wounds on the hands or feet before spending time outside

Several other skin conditions may look similar to tinea nigra. Other fungal infections, such as athlete’s foot, may also cause skin lesions, but they are not usually brown.

Melanoma, a type of skin cancer, can be deadly. It may also look very similar to tinea nigra in the early stages. Similarly to tinea nigra, melanoma is not typically painful at first. Therefore, people who do not get relief from home or medical treatment should see a dermatologist and request a biopsy.

Some other medical conditions and factors that may cause brown patches include:

• skin staining from henna
• skin hyperpigmentation from pregnancy or Addison’s disease
• complications of syphilis
• exposure to certain chemicals, such as silver nitrate

Tinea nigra is not a serious medical condition. Most people do not notice any symptoms other than brown spots on the skin.

However, as tinea nigra looks similar to several other conditions, it is important to see a doctor for an accurate diagnosis.

Prompt treatment can prevent serious skin-related conditions from getting worse.

Tinea nigra: Diagnosis, treatment, and remedies

Tinea nigra is a very rare fungal infection. It causes brown or black patches to develop on the soles of the feet, the palms of the hand, or, on rare occasions, the torso.

A type of yeast called Hortaea werneckii causes most tinea nigra infections. A person can get the infection when the yeast gets into their body, often through a small wound.

Keep reading to learn more about a tinea nigra infection, including the symptoms, diagnosis, and treatment options.

Tinea nigra causes brown or black patches to appear on the soles of the feet or the palms of the hand. The patches may be so small and faint that a person does not notice them. They also tend to grow slowly. The most common symptoms include:

• a patch on the foot or hand following an injury
• a single round, linear, or irregularly shaped patch that grows slowly
• growing patches that either cause no symptoms or itch
• patches that resemble a growing mole or freckle
• a slow growing brown patch on the torso

The infection affects people who live in tropical regions and those who have recently traveled to these areas.

Most people with tinea nigra have just one lesion. However, if the fungus comes into contact with multiple points of entry, such as wounds on both hands, a person may have several patches.

In healthy people, tinea nigra lives only on the superficial layers of the skin. It does not spread, cause serious infections, or present major health risks. It is more likely to affect young people under the age of 20 years.

Tinea nigra is a fungal infection, which means that a person gets it when they come into contact with a fungus that can cause the infection.

Scientists used to call Hortaea werneckii either Cladosporium werneckii, Exophiala werneckii, or Phaeoannellomyces werneckii. Another yeast called Stenella araguata may cause some cases of tinea nigra.

As with many other fungi, Hortaea werneckii thrives in moist or humid environments. It lives on dead and decaying organic material, such as soil and wood. It can get into the human body when it comes into contact with the skin, usually through a wound. It is most likely to live on parts of the body with many sweat glands, such as the hands and feet.

Certain risk factors increase a person’s likelihood of developing this infection. They include:

• living in a tropical or subtropical region
• recent travel to a subtropical or tropical region
• a history of hyperhidrosis, a condition that causes excessive sweating
• a recent injury
• contact with wood, soil, or compost, such as from gardening without gloves or woodworking in a tropical or subtropical region

In many cases, a person’s symptoms may lead a doctor to suspect tinea nigra. However, as tinea nigra can resemble the symptoms of several other conditions, it is important to get an accurate diagnosis.

The doctor may ask the individual about their recent travel, injury history, and exposure to wood, compost, or soil. They will also usually take a culture of the skin and send it to a lab to see whether Hortaea werneckii grows within a week. If it does, this means that the test is positive for tinea nigra.

Sometimes, a doctor may also perform a skin biopsy to test for skin cancer, as certain types of skin cancer can look similar to tinea nigra.

People who wish to try home remedies may see improvements with keratolytic agents. A keratolytic is a chemical that helps remove excess skin. Some potentially effective keratolytics include:

• wart cream
• salicylic acid
• Whitfield’s ointment

These drugs may not be safe during pregnancy, so women who are pregnant or trying to become pregnant should see a doctor instead of trying home remedies.

If home treatment fails, it is best to see a doctor. There are other possible causes of brown lesions on the skin.

Doctors usually prescribe topical antifungal creams to treat tinea nigra. People should apply the cream directly to the patch exactly as a doctor advises.

In some cases, a person may also need to take oral antifungal drugs, especially if the lesions are very large or if antifungal creams have not worked. However, oral drugs may not be effective.

Doctors do not know what treatment duration is optimal, but the authors of one report suggest that 1 month of treatment is sufficient.

People can reduce the risk of tinea nigra infections by protecting the skin from exposure to soil, compost, and other materials in which the Hortaea werneckii fungus likes to grow. Following this advice is especially important for people who travel to or live in tropical regions.

These strategies can help:

• practicing frequent handwashing, especially after spending time outside
• wearing gloves or other protective gear in the garden
• refraining from walking outside with bare feet
• wearing socks or shoes in public places
• changing socks frequently, especially if they get wet
• covering any wounds on the hands or feet before spending time outside

Several other skin conditions may look similar to tinea nigra. Other fungal infections, such as athlete’s foot, may also cause skin lesions, but they are not usually brown.

Melanoma, a type of skin cancer, can be deadly. It may also look very similar to tinea nigra in the early stages. Similarly to tinea nigra, melanoma is not typically painful at first. Therefore, people who do not get relief from home or medical treatment should see a dermatologist and request a biopsy.

Some other medical conditions and factors that may cause brown patches include:

• skin staining from henna
• skin hyperpigmentation from pregnancy or Addison’s disease
• complications of syphilis
• exposure to certain chemicals, such as silver nitrate

Tinea nigra is not a serious medical condition. Most people do not notice any symptoms other than brown spots on the skin.

However, as tinea nigra looks similar to several other conditions, it is important to see a doctor for an accurate diagnosis.

Prompt treatment can prevent serious skin-related conditions from getting worse.

Not Found (#404)

Paracelsus Medical Center

Page not found.

The above error occurred while the Web server was processing your request.

Please contact us if you think this is a server error. thank you.

Leave feedback

Write to management

Jobs

Please wait, download may take time

Loading…

You know which doctor you want to book

You know the service you want to book

Service selection

A second consultation is considered to be a consultation of one specialist within 30 days from the date of the previous appointment. On the 31st day from the previous visit to a specialist of this profile, the consultation will be primary.

The choice of a specialist

Service selected:

Choosing a specialist service

A second consultation is considered to be a consultation of one specialist within 30 days from the date of the previous appointment. On the 31st day from the previous visit to a specialist of this profile, the consultation will be primary.

Address selection:

st. Vikulova, 33, building 2

st. Bolshakova, d. 68

Date selection:

Time of receipt:

Password

Password

Register
Can’t login?
account activation

To gain access to your personal account, enter the e-mail that was specified during registration, we will send instructions for password recovery

To gain access to your personal account, enter the e-mail that was specified during registration, we will send instructions for reactivating your account

Your application has been accepted, our specialists will answer your question as soon as possible!

Telephone

Commentary

By clicking on the confirmation button, I agree with
personal data processing policy

Dear patients!
Multidisciplinary Clinic and Maternity Hospital “Paracelsus” informs you, according to the Letter of the Ministry of Finance of the Russian Federation to the Federal Tax Service dated March 25, 2022. N BS-4-11 / 3605, that subparagraph 3 of paragraph 1 of Article 219 of the Tax Code of the Russian Federation provides for the taxpayer’s right to receive a social tax deduction in the amount paid by him in the tax period for medical services provided by medical organizations engaged in medical activities , him, his spouse, parents, children (including adopted children) under the age of 18, wards under the age of 18 (in accordance with the list of medical services approved by the Government of the Russian Federation).

Joint order of the Ministry of Taxation of Russia and the Ministry of Health of Russia of July 25, 2001 N 289 / BG-3-04 / 256 (hereinafter – the order of July 25, 2001) approved the form of the Certificate of payment for medical services for submission to the tax authorities of the Russian Federation (hereinafter – the Certificate payment for medical services).

This certificate certifies the fact of receiving a medical service and its payment through the cash desk of a healthcare institution at the expense of the taxpayer.

Thus, if the taxpayer submits to the tax authority a Certificate of payment for medical services, the taxpayer’s failure to submit the relevant contract for the provision of medical services and (or) documents confirming payment cannot be grounds for refusing to provide such a deduction.

The amounts are based on payment data. Therefore, checks, an agreement and a clinic license are not needed to make a deduction.

Sample certificate attached.

Help Sample

Your application has been accepted, our specialists will contact you shortly!

Telephone

Comment

By clicking on the confirmation button, I agree with
personal data processing policy

Deputy Director for Medical Activities of the Multidisciplinary Clinic “Paracelsus”

Makeev Alexander Anatolyevich

Telephone

Comment

By clicking on the confirmation button, I agree with
personal data processing policy

Black lichen, a description of the disease on the portal Medihost.

ru

Black lichen is a fungal skin infection, an infectious disease that is characterized by the appearance of specific black spots on the skin of a certain localization. Usually, black lichen affects the surfaces of the palms and feet.

Dark spots that appear on the palms and soles of the feet do not cause any discomfort to the patient. Sometimes spots appear on other parts of the body.

Etiology and pathogenesis

Black lichen occurs as a result of penetration into the body of certain mold fungi – Stenella arguata, Cladosporium, Exophiala wemeckii.

The predominant localization of these types of fungi is the USA, Africa, Asia, Central and South America, therefore, the disease itself is more typical for this area.

In the environment, the fungus can be found in soil, wood from fallen trees, compost, and also in sewage. Fungi penetrate through microdamages in the skin.

These fungi are characterized by damage to smooth skin, that is, devoid of hair and sebaceous glands. Of course, cases of skin lesions on the body in atypical places are not excluded, but such cases are very rare.

Predisposing factors and causes of black lichen development

• Endemicity. Individuals living in endemic areas are more at risk than others. Persons in non-endemic zones become infected with a similar disease most often during tourism to tropical and subtropical countries.
• Comorbidities affecting the skin.

Symptoms of black lichen

The main manifestation of the disease is the appearance of spots of various sizes and shapes on the skin of the palms and soles. The spots acquire a characteristic color – from dark brown to pronounced black.

The heel is absolutely painless, does not cause any discomfort, except for a visual non-aesthetic defect. Rashes are located on all surfaces of the palms, between the fingers, on the hands and feet. Usually, at first, small elements tend to increase and merge into large spots, reaching a diameter of up to several centimeters.

Lesions can be both unilateral and bilateral, as well as simultaneous lesions of the soles and palms.

Despite the fact that the disease seems harmless, its contagiousness is quite high. The incubation period for black lichen is up to 7 weeks, but on average lasts no more than two weeks.

Most stains have jagged, scalloped edges. Extensive spots can still cause slight discomfort in the form of itching, often the spots are covered with scaly scales.

In some cases, the patient may mistake black lichen as melanoma (skin cancer) and seek advice from an oncologist.

Diagnosis of black lichen

The physician should perform a visual examination. Large spots, as a rule, have a greater color intensity towards the periphery. Also, the doctor should conduct a differential diagnosis with oncological diseases by conducting a cytology of scrapings from altered skin areas.

Black lichen treatment

To successfully cure this disease, you should follow certain rules:

1. Thorough disinfection, removal of keratinized layers from the affected areas.