What is tinea versicolor. How does it manifest on the skin. What causes this fungal infection. How is tinea versicolor diagnosed. What treatment options are available for tinea versicolor. How can lifestyle changes help manage tinea versicolor. Are there ways to prevent tinea versicolor recurrence.

What is Tinea Versicolor and How Does It Affect the Skin?

Tinea versicolor, also known as pityriasis versicolor, is a common fungal infection that causes small, discolored patches on the skin. This condition occurs when a type of yeast naturally present on the skin, called Malassezia, grows out of control. The overgrowth of this yeast leads to the production of an acidic bleach, which results in the characteristic skin discoloration.

The appearance of tinea versicolor can vary depending on the individual’s skin tone and the severity of the infection. Common manifestations include:

• Patches that may be white, pink, red, or brown
• Spots that are lighter or darker than the surrounding skin
• Areas that don’t tan uniformly with the rest of the skin
• Dry and scaly patches that may occasionally itch or cause discomfort

While tinea versicolor can appear anywhere on the body, it most frequently affects the neck, chest, back, and arms. The condition tends to be more noticeable during warm and humid weather, often becoming less apparent in cooler seasons.

Identifying the Root Causes of Tinea Versicolor

Understanding the factors that contribute to the development of tinea versicolor is crucial for effective management and prevention. While the Malassezia yeast is a normal part of the skin’s microbiome, certain conditions can trigger its overgrowth:

1. Oily skin
2. Hot and humid climates
3. Excessive sweating
4. Hormonal changes
5. Weakened immune system

It’s important to note that tinea versicolor is not contagious, as the yeast responsible for the infection is already present on everyone’s skin. However, some individuals may be more susceptible to developing the condition due to genetic factors or environmental influences.

Who is Most at Risk for Tinea Versicolor?

While tinea versicolor can affect people of all ages and skin types, certain groups are more prone to developing the infection:

• Teenagers and young adults
• Individuals living in tropical or subtropical climates
• People with compromised immune systems
• Those with naturally oily skin
• Individuals who frequently engage in activities that cause excessive sweating

Diagnostic Approaches for Tinea Versicolor

Accurate diagnosis of tinea versicolor is essential for appropriate treatment. Healthcare providers typically employ several methods to confirm the presence of the infection:

Visual Examination

In many cases, a dermatologist can diagnose tinea versicolor based on the characteristic appearance of the skin lesions. The distinctive pattern and coloration of the patches often provide sufficient evidence for a clinical diagnosis.

Wood’s Lamp Examination

This diagnostic tool uses ultraviolet light to examine the affected skin areas. Under the Wood’s lamp, tinea versicolor patches may appear as a fluorescent coppery-orange color, helping to differentiate it from other skin conditions.

Microscopic Analysis

For a more definitive diagnosis, a healthcare provider may perform a potassium hydroxide (KOH) preparation. This involves scraping cells from the affected skin and examining them under a microscope after treating them with potassium hydroxide. The presence of characteristic yeast forms confirms the diagnosis.

Skin Biopsy

In rare cases, particularly with children or when the diagnosis is uncertain, a skin biopsy may be performed. This involves removing a small sample of skin for microscopic examination, allowing for a detailed analysis of the tissue structure and the presence of fungal elements.

Effective Treatment Strategies for Tinea Versicolor

Once diagnosed, tinea versicolor can be effectively treated using a variety of approaches. The choice of treatment depends on factors such as the extent of the infection, its location, and the individual’s overall health status.

Topical Antifungal Medications

Over-the-counter and prescription topical antifungal products are often the first line of treatment for tinea versicolor. These may include:

• Clotrimazole
• Ketoconazole
• Miconazole
• Selenium sulfide
• Terbinafine

These medications come in various forms, including lotions, creams, shampoos, and foams, allowing for easy application to the affected areas.

Oral Antifungal Medications

In more severe or persistent cases, oral antifungal medications may be prescribed. These systemic treatments can effectively address widespread infections or cases that have not responded to topical therapies. Common oral antifungals used for tinea versicolor include:

• Fluconazole
• Itraconazole
• Ketoconazole (in some countries)

It’s important to note that oral antifungals may have side effects and require careful monitoring by a healthcare provider.

Managing Tinea Versicolor: Lifestyle Modifications and Prevention

While treatment can effectively clear tinea versicolor, the infection has a tendency to recur. Implementing certain lifestyle changes and preventive measures can help reduce the frequency and severity of outbreaks:

Skincare Habits

• Avoid using oily skin products that may promote yeast growth
• Use non-comedogenic and oil-free moisturizers and sunscreens
• Regularly cleanse the skin, especially after sweating

Sun Protection

Sun exposure can exacerbate tinea versicolor and make the discolored patches more noticeable. To minimize this effect:

• Limit time spent in direct sunlight
• Apply a broad-spectrum sunscreen with an SPF of 30 or higher daily
• Wear protective clothing when outdoors

Preventive Antifungal Regimens

For individuals prone to recurrent tinea versicolor, healthcare providers may recommend periodic use of antifungal products as a preventive measure. This might include:

• Using medicated cleansers once a week for 10 minutes
• Applying antifungal shampoos or lotions before anticipated sun exposure or during humid seasons

The Psychological Impact of Tinea Versicolor

While tinea versicolor is not a serious medical condition, its visible nature can have significant psychological effects on those affected. The discolored patches may lead to:

• Decreased self-esteem
• Social anxiety
• Emotional distress
• Self-consciousness, especially in situations where the affected skin is visible

It’s important for healthcare providers to address these psychological aspects when managing tinea versicolor. Providing reassurance about the benign nature of the condition and discussing effective treatment options can help alleviate patient concerns.

Differentiating Tinea Versicolor from Similar Skin Conditions

Several skin conditions can present with symptoms similar to tinea versicolor, making accurate diagnosis crucial. Two common conditions that may be mistaken for tinea versicolor include:

Vitiligo

Vitiligo is an autoimmune disorder that causes loss of skin pigmentation, resulting in white patches on the skin. Unlike tinea versicolor, vitiligo:

• Produces more defined, often symmetrical patches
• Does not have the fine, scaly texture associated with tinea versicolor
• Is not influenced by environmental factors like heat and humidity

Pityriasis Rosea

This skin condition causes a distinctive rash that can be confused with tinea versicolor. Key differences include:

• Pityriasis rosea often begins with a single, large “herald patch” before spreading
• The rash typically follows a “Christmas tree” pattern on the back
• It usually resolves on its own within 6-8 weeks

Healthcare providers use specific diagnostic criteria and tests to differentiate these conditions from tinea versicolor, ensuring appropriate treatment is provided.

Long-term Management and Prognosis of Tinea Versicolor

While tinea versicolor is a chronic condition with a tendency to recur, proper management can significantly reduce its impact on an individual’s life. Long-term strategies for managing tinea versicolor include:

Maintenance Therapy

For individuals with frequent recurrences, healthcare providers may recommend a maintenance regimen involving periodic use of antifungal products, even when the skin appears clear. This proactive approach can help prevent new outbreaks.

Environmental Modifications

Making changes to one’s environment and daily routines can help minimize factors that promote yeast overgrowth:

• Using air conditioning to reduce ambient humidity
• Wearing breathable, moisture-wicking fabrics
• Showering promptly after exercise or activities that cause sweating

Regular Monitoring

Establishing a routine for self-examination and regular check-ups with a dermatologist can help catch and address new outbreaks early, preventing them from becoming widespread.

It’s important to note that while the active infection can be quickly treated, the skin discoloration may take several months to completely resolve. Patients should be counseled on this aspect to manage expectations and reduce anxiety about the healing process.

With proper treatment and management, most individuals with tinea versicolor can effectively control the condition and minimize its impact on their quality of life. The prognosis is generally excellent, although ongoing vigilance and preventive measures may be necessary to keep the infection at bay.

Tinea Versicolor: Cause, Symptoms, and Treatments

Written by WebMD Editorial Contributors

• What Is Tinea Versicolor?
• Signs and Symptoms of Tinea Versicolor
• Tinea Versicolor Causes
• Tinea Versicolor Diagnosis
• Tinea Versicolor Treatment
• Lifestyle Tips for Managing Tinea Versicolor
• More

Tinea versicolor is a fungal infection that causes small patches of discolored spots on your skin. It’s also called pityriasis versicolor. It results from a type of yeast that naturally lives on your skin. When the yeast grows out of control, the skin disease, which appears as a rash, is the result.

Acidic bleach from the growing yeast causes areas of skin to be a different color than the skin around them. These can be individual spots or patches. Specific signs and symptoms of the infection include:

• Patches that are white, pink, red, or brown and may be lighter or darker than the skin around them.

• Spots that don’t tan the way the rest of your skin does.
• Spots that show up more boldly when you do tan.
• Spots that may occur anywhere on your body but are most commonly seen on your neck, chest, back, and arms.
• Spots that are dry and scaly and may itch or hurt, although this is rare.

The spots may disappear during cool weather and get worse during warm and humid weather.

Similar conditions

Some skin problems have symptoms that look like tinea versicolor, including:

• Vitiligo: a disease that makes you lose your skin color
• Pityriasis rosea: a rash that causes small spots that fan out on your body in the shape of a tree

These conditions have features that clue your doctor in to what you have, such as texture and rash pattern.

The yeast that causes tinea versicolor, Malassezia, grows on normal, healthy skin. But these things can trigger an overgrowth that causes the infection:

• Oily skin
• Living in a hot climate
• Sweating a lot
• Hormonal changes
• A weakened immune system

Because the yeast grows naturally on your skin, tinea versicolor isn’t contagious. The condition can affect people of any skin color. It’s more likely to affect teens and young adults. For some people, it can cause emotional distress and feelings of self-consciousness.

Your doctor can diagnose tinea versicolor by what the rash looks like.

If they need more information, these tests can help:

• Wood lamp (black light) examination. The doctor uses ultraviolet light, which may make the affected areas appear a fluorescent coppery orange color if they’re the result of tinea versicolor.
• Microscopy using potassium hydroxide (KOH). Your doctor removes cells from your skin, soaks them in potassium hydroxide, then looks at them under a microscope.
• Skin biopsy. The doctor takes a skin sample by scraping some skin and scales from the affected area to look at under a microscope. With children, the doctor may lift off skin cells by first firmly attaching clear tape to the affected area then removing it. The sample then can be stuck directly onto a slide to look at with a microscope.

Treatment of tinea versicolor can consist of creams, lotions, or shampoos that you put on your skin. It can also include medication given as pills. The type of treatment will depend on the size, location, and thickness of the infected area.

Treatment options include:

• Topical antifungals. You put these directly to your skin. They may be in the form of lotion, shampoo, cream, foam, or soap. They keep yeast growth under control. Over-the-counter anti-fungal topical products containing ingredients such as clotrimazole, ketoconazole, miconazole, zinc-pyrithione, selenium sulfide, and terbinafine are available. Prescription products are available too.
• Antifungal pills. These may be used to treat more serious or recurrent cases of tinea versicolor. Sometimes doctors use them because they clear up the infection faster. You’ll need a prescription for these medicines. They can have side effects. Your doctor will keep an eye on you while you’re taking antifungal pills.

Treatment usually gets rid of the fungal infection. But skin discoloration may take several months to resolve.
 

Episodes are very common because the yeast that causes the infection is a normal fungus that lives on your skin. You might use medicated cleansers once a week for 10 minutes at a time for a few months to help prevent tinea versicolor from coming back. You may need to use these cleansers if the infection keeps returning, especially if you live in a warm and humid area.

To help you manage tinea versicolor you can:

• Avoid using oily skin products.
• Reduce the time you spend in the sun. It may trigger or worsen an episode, and a tan makes the rash more visible.
• Use an anti-fungal shampoo daily for a couple of days prior to sun exposure if you do have to go out.
• Put on sunscreen every day. Use a broad spectrum, nongreasy formula with a minimum sun protection factor (SPF) of 30.
• Try a dandruff shampoo with selenium sulfide.
• Wear loose clothing.
• Choose breathable fabrics, like cotton, to decrease sweating.

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Tinea Versicolor: Cause, Symptoms, and Treatments

Written by WebMD Editorial Contributors

• What Is Tinea Versicolor?
• Signs and Symptoms of Tinea Versicolor
• Tinea Versicolor Causes
• Tinea Versicolor Diagnosis
• Tinea Versicolor Treatment
• Lifestyle Tips for Managing Tinea Versicolor
• More

Tinea versicolor is a fungal infection that causes small patches of discolored spots on your skin. It’s also called pityriasis versicolor. It results from a type of yeast that naturally lives on your skin. When the yeast grows out of control, the skin disease, which appears as a rash, is the result.

Acidic bleach from the growing yeast causes areas of skin to be a different color than the skin around them. These can be individual spots or patches. Specific signs and symptoms of the infection include:

• Patches that are white, pink, red, or brown and may be lighter or darker than the skin around them.

• Spots that don’t tan the way the rest of your skin does.
• Spots that show up more boldly when you do tan.
• Spots that may occur anywhere on your body but are most commonly seen on your neck, chest, back, and arms.
• Spots that are dry and scaly and may itch or hurt, although this is rare.

The spots may disappear during cool weather and get worse during warm and humid weather.

Similar conditions

Some skin problems have symptoms that look like tinea versicolor, including:

• Vitiligo: a disease that makes you lose your skin color
• Pityriasis rosea: a rash that causes small spots that fan out on your body in the shape of a tree

These conditions have features that clue your doctor in to what you have, such as texture and rash pattern.

The yeast that causes tinea versicolor, Malassezia, grows on normal, healthy skin. But these things can trigger an overgrowth that causes the infection:

• Oily skin
• Living in a hot climate
• Sweating a lot
• Hormonal changes
• A weakened immune system

Because the yeast grows naturally on your skin, tinea versicolor isn’t contagious. The condition can affect people of any skin color. It’s more likely to affect teens and young adults. For some people, it can cause emotional distress and feelings of self-consciousness.

Your doctor can diagnose tinea versicolor by what the rash looks like.

If they need more information, these tests can help:

• Wood lamp (black light) examination. The doctor uses ultraviolet light, which may make the affected areas appear a fluorescent coppery orange color if they’re the result of tinea versicolor.
• Microscopy using potassium hydroxide (KOH). Your doctor removes cells from your skin, soaks them in potassium hydroxide, then looks at them under a microscope.
• Skin biopsy. The doctor takes a skin sample by scraping some skin and scales from the affected area to look at under a microscope. With children, the doctor may lift off skin cells by first firmly attaching clear tape to the affected area then removing it. The sample then can be stuck directly onto a slide to look at with a microscope.

Treatment of tinea versicolor can consist of creams, lotions, or shampoos that you put on your skin. It can also include medication given as pills. The type of treatment will depend on the size, location, and thickness of the infected area.

Treatment options include:

• Topical antifungals. You put these directly to your skin. They may be in the form of lotion, shampoo, cream, foam, or soap. They keep yeast growth under control. Over-the-counter anti-fungal topical products containing ingredients such as clotrimazole, ketoconazole, miconazole, zinc-pyrithione, selenium sulfide, and terbinafine are available. Prescription products are available too.
• Antifungal pills. These may be used to treat more serious or recurrent cases of tinea versicolor. Sometimes doctors use them because they clear up the infection faster. You’ll need a prescription for these medicines. They can have side effects. Your doctor will keep an eye on you while you’re taking antifungal pills.

Treatment usually gets rid of the fungal infection. But skin discoloration may take several months to resolve.
 

Episodes are very common because the yeast that causes the infection is a normal fungus that lives on your skin. You might use medicated cleansers once a week for 10 minutes at a time for a few months to help prevent tinea versicolor from coming back. You may need to use these cleansers if the infection keeps returning, especially if you live in a warm and humid area.

To help you manage tinea versicolor you can:

• Avoid using oily skin products.
• Reduce the time you spend in the sun. It may trigger or worsen an episode, and a tan makes the rash more visible.
• Use an anti-fungal shampoo daily for a couple of days prior to sun exposure if you do have to go out.
• Put on sunscreen every day. Use a broad spectrum, nongreasy formula with a minimum sun protection factor (SPF) of 30.
• Try a dandruff shampoo with selenium sulfide.
• Wear loose clothing.
• Choose breathable fabrics, like cotton, to decrease sweating.

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Fungal skin infections | #05/09

Fungal lesions of the skin and its appendages have been known since ancient times. Doctors gave separate designations (for example, favus) to skin diseases with different symptoms from others, not yet knowing that fungi were the cause of their occurrence. The history of the science of dermatophytes began with the discovery in 1839 by Schonlein J. L. of the causative agent of favus Achorion schoenleinii . Schonlein found fungal mycelium in the skin lesions of a patient whom he mistakenly diagnosed as impetigo. In 1841, Grubi D. established the relationship between skin diseases and fungi. He described the clinical picture of microsporia and the morphological features of the fungus that causes this disease. As a result of the use of the special nutrient medium proposed by Sabouraud R. for the cultivation of fungi, favorable conditions were created for research mycologists. Appropriate clinical and laboratory studies began to be carried out, the era of discovery of new types of pathogens began. In the field of medical mycology, significant advances have taken place in various directions: dermatophytes, molds, yeast-like fungi, the pathogenesis of mycotic infection have been studied and described in detail, the nature of actinomycosis has been determined, the treatment of fungal diseases has improved, etc. Russian scientists have also made a significant contribution to the development of medical mycology , among which the most famous are P. N. Kashkin, A. M. Arievich, N. D. Sheklakov, O. K. Khmelnitsky, A. N. Arabian, Z. G. Stepanishcheva, N. A. Krasilnikov, G. O Suteev, V. M. Leshchenko and many others.

Fungal diseases have long gone beyond the specialty of a dermatologist, but as before, dermatologists-mycologists are doing a lot of work to combat ringworm, which ranks first in prevalence in all countries.

Superficial mycoses (dermatomycoses) include infections that affect the skin, nails and hair. The main pathogens are dermatophytes, fungi that can absorb keratin. These include fungi of the genera Microsporum, Trichophyton and Epidermophyton , which, depending on the source of infection, are divided into anthropophilic, zoophilic and geophilic. The habitat of zoophilic dermatophytes ( Trichophyton mentagrophytes v. gypseum, T. verrucosum, Microsporum canis and others . ) are anthropophilic animals ( Trichophyton rubrum, T. mentagrophytes v. interdigitale, Microsporum ferrugineum, Epidermophyton floccosum and others 90 004 .) – man , geophilic species ( Microsporum gypseum ) live in the soil. Dermatophytes are highly contagious and can be transmitted to humans from humans, animals, or soil, causing disease. The main “distributors” of the infection are anthropophilic species.

Superficial mycoses also include keratomycosis: versicolor and piedra, in which the most superficial areas of the stratum corneum and hair cuticle are affected. The causative agent of multi-colored (pityriasis) lichen and seborrheic dermatitis – a yeast-like fungus Malassezia furfur – lives on the skin of humans and animals and, under favorable conditions, can affect the stratum corneum of the epidermis and the mouth of the follicles. The disease is not contagious in most cases. White and black piedra are commonly found in countries with hot and humid climates. Diseases are not contagious. Black piedra causative agent, Piedraia hortae , only found on hair. Trichosporon beigelii is widely distributed in the environment and, in addition to white piedra, can also cause skin and nail lesions.

In addition to true dermatophytes, which infect only the skin and its appendages, other fungi isolated from a wide variety of localizations in systemic mycoses can also cause superficial mycoses. Candida spp. . – the second most common discharge in dermatomycosis and onychomycosis after dermatophytes. Up to 40% of cases of onychomycosis of the hands are caused by Candida . The lesions of the scalp with a clinical picture of seborrheic eczema were noted with yeast-like fungi. Superficial forms of candidiasis also include lesions of the mucous membranes of the oral cavity and genital organs.

In cases of onychomycosis caused by mold fungi, there is still doubt about the ability of these opportunistic pathogens to independently infect nails due to their weak proteinase and keratinase activity. It is known that mold fungi can manifest themselves as a secondary infection, penetrating into tissues already affected by dermatophytes. However, as a result of many years of research, it has been proven that some mold fungi can penetrate into the intercellular nail space with the help of perforated organs. The most common causative agents of mold lesions of the skin and nails are Scopulariopsis brevicaulis, Pyrenochaeta unguis-hominis, Aspergillus spp., Fusarium spp., Alternaria spp., Cladosporium spp. . and etc.

There are numerous options for the classification of fungal infections, which to a greater or lesser extent take into account the etiology, pathogenesis, clinical picture and features of the epidemiology of diseases. In domestic dermatology, the classification of N. D. Sheklakov is most often used:

1. Keratomycosis (versus versicolor, piedra, mycosis imbricate).
2. Dermatophytosis (epidermophytosis, trichophytosis, microsporia, rubromycosis, favus, etc. ).
3. Candidiasis (superficial candidiasis of the skin and mucous membranes, visceral, etc.).
4. Deep mycoses (chromomycosis, sporotrichosis, etc.).
5. Pseudomycosis (erythrasma, actinomycosis, nocardiosis, etc.).

However, in many countries of the world, a classification of fungal diseases according to the localization of the pathological process has been adopted:

• Tinea pedis – athlete’s foot.
• Tinea corporis – mycosis of the smooth skin of the body.
• Tinea cruris – inguinal mycosis.
• Tinea capitis – mycosis of the scalp.
• Tinea unguim – onychomycosis.
• Tinea manum – mycosis of the hands.
• Tinea barbae – mycosis of the face.

This classification is convenient from a practical point of view, but does not take into account the etiological features of dermatophytosis, which can determine the nature of epidemiological measures and treatment features.

Main clinical features of fungal infections

Mycoses of the feet (Fig. 1). The interdigital folds and soles are mainly affected. In the interdigital folds, slight peeling with minor inflammation, moderate maceration, cracks, and vesicles are observed. On the sole – thickening of the stratum corneum, flour-like peeling in the skin furrows, small cracks on a slightly hyperemic background. In the dyshidrotic form, numerous blisters form on the skin of the arch and inferolateral surface of the foot, which then merge to form large blisters. In place of the opened bubbles, erosions with an uneven edge remain.

Mycosis of the smooth skin of the trunk (Fig. 2). With versicolor versicolor, brownish and white patches are usually localized on the skin of the chest, back, neck and shoulders. Peeling lesions have clear boundaries and are not accompanied by inflammation.

When the skin is damaged by other pathogenic fungi, clearly demarcated, rounded, edematous foci with a raised roller are formed. The center of the focus is flattened, with slight peeling. Lesions increase due to peripheral growth.

Inguinal mycosis. Typical localization – inner thigh, lower abdomen, buttocks. The lesions are clearly defined, scaly, erythematous, with an inflammatory ridge. Over time, the general moderately erythematous background is replaced by a brownish one.

Mycosis of the scalp. Most commonly seen in children. The disease is manifested by large, rounded, clearly delimited, scaly foci of alopecia. The inflammatory phenomena are expressed poorly. Hair of a changed color within the focus is broken off a few millimeters above the level of the skin (with microsporia) or, breaking off at the level of the skin, leaves a stump in the form of a black dot (with trichophytosis). Zoophilic pathogens can cause the development of an infiltrative-suppurative form of dermatophytosis: the lesion protrudes above the surrounding skin, is covered with purulent-bloody crusts, hair falls out.

Onychomycosis. Different types of fungal infection of the nail plates are characterized by loss of transparency, discoloration (whitish, yellowish), thickening, subungual hyperkeratosis, crumbling or destruction up to the nail fold.

Mycosis of the hands. In the squamous form of the lesion of the palm, the disease manifests itself in fine-lamellar, flour-like peeling in the skin furrows. Cracks may form, accompanied by pain and itching. In the dyshidrotic form, vesicles form, which are often clustered and may coalesce to form vesicles.

Mycosis of the face. More often lesions are localized in the neck, chin and lower lip. The infiltrative-suppurative form of the lesion is manifested in the formation of large bluish-red nodes with a bumpy surface. Numerous pustules merge to form abscesses. Altered dull hair in the lesion is removed easily and without pain. The superficial variant resembles mycosis of smooth skin.

Laboratory diagnostics

Microscopy of clinical material is a quick and simple method of preliminary diagnosis of the disease. In cases where the pathogen does not grow in culture, a positive direct microscopy result may be an undoubted confirmation of mycotic infection. In scrapings from the skin and nails, dermatophytes, as a rule, are represented by a thin, 2–4 μm in diameter, straight and rarely branching mycelium. Often in the preparation one can find atypical forms of dermatophyte mycelium – chains of rounded arthrospores (Fig. 3).

M. furfur is revealed by microscopy of skin scales as round cells 3–8 µm in diameter, collected in clusters, and short curved hyphae of the mycelium of a characteristic “banana” shape. In most cases, the diagnosis of multi-colored lichen can be established precisely with microscopy of the native preparation, since sowing of the material usually does not give results.

Scopulariopsis brevicaulis in nail scales is represented by characteristic cup-shaped spores with a rough shell.

Fungi of the genus Candida form typical budding yeast cells and pseudomycelium (branching chains of long cells).

Identification of other pathogens in native preparations is difficult.

When hair is damaged by dermatophytes, several tissue forms of the fungus are observed: 1) endectothrix – spores with a diameter of 2-3 microns “mosaic” are located inside and mostly outside the hair, forming a muff at the root (“Adamson’s cover”). Inside the hair, you can also see the mycelium, which, with light pressure on the preparation, crawls out of the hair in the form of a fringe – “Adamson’s brush”. Pathogen – Microsporum spp. .; 2) endotrix – spores with a diameter of 4-6 microns are located inside the hair in longitudinal chains, completely filling it. The causative agent is Trichophyton spp . The final identification of fungi is carried out during cultural studies.

For cultural studies of pathological material, Sabouraud medium with chloramphenicol and gentamicin is used, as well as for the selective isolation of dermatophytes – with cycloheximide (actidion), to inhibit the growth of fast-growing saprophytic fungi.

Dermatophyte genera are distinguished by the presence and morphology of multicellular macroconidia and unicellular microconidia.

Characterization of the most important pathogenic fungi

Epidermophyton floccosum. Anthropophile. It affects the skin of the inguinal folds, legs. Colonies grow slowly, greyish-brown, lemon-olive, later white, folded-bumpy in the center. The surface of the colony is leathery or velvety mealy. Microscopy: chains of intercalary chlamydospores are found in mature cultures. Macroconidia 4-5-celled, club-shaped, smooth, with rounded ends. Arranged in bunches of 3-5 pieces. Microconidia are absent.

Microsporum canis (Fig. 4). Zooanthropophile. The most common causative agent of microsporia in Russia. Colonies fast-growing flat, radiant-hairy. The mycelium is grayish-white, against the background of a brownish-red or orange reverse side, the general shade of the colony is salmon. Microscopy: forms a characteristic bamboo-like mycelium, there are scallops, short spirals, intercalary chlamydospores. Macroconidia are fusiform, spiky, spiny, multi-chambered (4–12-celled) with a clear two-contour sheath. Microconidia are pear-shaped, occurring intermittently.

M. gypseum . geophilic pathogen. It affects the skin and hair primarily in people who cultivate the soil. Colonies are fast-growing, flat, mealy (powdery), later with a slight velvety elevation in the center. The color is yellowish pink. The reverse side is yellow. Microscopically: numerous macroconidia (4-6-celled) spindle-shaped, wide, blunt, smooth. Microconidia, if present, numerous, pear-shaped or oval.

Trichophyton rubrum (Fig. 5). Anthropophile. The most common causative agent of dermatomycosis. It affects the nails of the feet, hands and skin in any part of the body.

The colonies are velvety, white, sometimes waxy at the beginning of growth, later they can acquire a pinkish or purple-red color. The reverse side is yellow, red or cherry red. Microscopically: abundant elongated, teardrop-shaped or pear-shaped microconidia are located on the sides of the mycelium. Macroconidia 5-6-celled, blunt.

T. mentagrophytes var. interdigitale . Anthropophile. It affects the nail plates and the skin of the feet.

Colonies fast-growing velvety, white, sometimes pinkish. With age, in different strains, the colonies become fluffy or densely floury. The reverse side is colorless or brownish. Microscopy: microconidia are round, located on the sides of the mycelium singly and in clusters. Cigar-shaped 3–5-cell macroconidia with a rounded end are rare. In mature cultures, there are many whorls and spirals, knotted organs and intercalary chlamydospores are formed.

T. mentagrophytes var. gypseum . Zooanthropophile. Affects skin and hair. In terms of frequency of isolation, it is in second place after T. rubrum .

Colonies fast-growing flat, granular-powdery, white, creamy, yellowish. The reverse side is brownish red. Microscopy: microconidia are abundant, rounded, located on the sides of the mycelium singly and in the form of clusters. Macroconidia are cigar-shaped, 3–8-celled, with rounded ends.

Treatment

Therapy of various mycotic lesions of the skin and nails is carried out with antifungal drugs, which can be systemic, and also used as external agents. In practice, both monotherapy and various combinations of antifungal drugs are used. In most cases, treatment should be complex with the use of external antifungal agents, systemic drugs, and symptomatic treatment. Methods and means of topical therapy are essential components of the treatment of various mycotic skin lesions. If the fungal process is in the initial stage and there are small skin lesions, then it can be cured by prescribing external antifungal drugs alone. With a widespread or deep mycotic process, as well as in patients with damage to the hair and nails, treatment may be difficult.

Antifungals or antimycotics are specific agents used to treat fungal infections of the skin, nails, hair, etc. They may have fungicidal and fungistatic properties. The fungicidal action of the antifungal agent leads to the death of fungal cells, the fungistatic action stops the formation of new fungal cells. Antimycotics are conditionally divided into 5 groups: polyene antibiotics, azole compounds, allylamine drugs, morpholine derivatives and medicines without a clear relation to any particular group.

When prescribing topical therapy, it is important to consider the nature of the specific effect of the antifungal agent. Griseofulvin preparations are known to be active only against dermatophytes. External agents containing polyene antibiotics – against yeasts and molds, preparations of selenium, zinc, benzyl benzoate – fungi of the genus Malassezia and erythrasma pathogens Corynebacterium minnutissium . A much wider range of antifungal activity, as well as anti-inflammatory and antipruritic properties and good tolerance are possessed by modern antifungal agents of the azole, allylamine, morpholine series, thiocarbamycins and pyridine compounds.

Onychomycosis is the most resistant disease to therapy. Success is based on an individually tailored treatment regimen. When treating, it is necessary to take into account the age of the patient, concomitant diseases, the number of affected nails, the degree of involvement in the pathological process of the nail plates.

Currently, mycologists have a large arsenal of agents with a wide spectrum of fungicidal action, accumulation in therapeutic concentrations in the nail plate and nail bed. The greatest preference is given to drugs that meet the requirements for therapeutic efficacy, as well as aesthetics and ease of use.

Treatment of onychomycosis is divided into local, systemic, combined.

Local treatment allows you to create high concentrations of the drug on the surface of the nail plate. However, in the nail bed, where the most viable fungi are located, the active substances of the antimycotic do not always penetrate in effective concentrations.

Local antimycotics: varnishes – Lotseril, Batrafen; creams – Lamisil, Nizoral, Mykospor, Mifungar, Travogen, Ecozax, Exoderil, Pimafucin, sprays – Daktarin, Lamisil, etc. It should be noted that they are not intended specifically for the treatment of onychomycosis, but they can be used in the treatment of fungal infections of the skin of the feet, interdigital intervals often associated with onychomycosis.

For the treatment of nails, local antiseptics are also used – alcohol solutions of iodine, dyes.

Multicomponent preparations contain an antimycotic or antiseptic in combination with an anti-inflammatory agent. In the treatment of skin infections accompanying onychomycosis, the following are used: Triderm, Travocort, Mikozolon, Pimafukort, Lorinden C, etc.

Azole, allylamine, morpholine compounds, as well as drugs of a mixed group, are active against a large number of pathogens. Considering that quite often mycoses of the feet are caused by a mixed fungal flora, it is preferable to prescribe these drugs, which are broad-spectrum antimycotics. Most of them damage the cytoplasmic membranes of fungal cell walls, inhibiting the synthesis of their main components, in particular ergosterol.

Currently, the mycologist has highly effective systemic antimycotics: itraconazole (Sporonox, Orungal), fluconazole (Diflucan, Forcan), terbinafine (Lamisil), the antifungal effect of which is reflected in the table.

One of the important principles of topical therapy of mycotic skin lesions is the alternation of external antifungal drugs, which avoids the resistance of dermatomycetes to them.

With squamous-keratotic forms of skin lesions, keratolytic agents are used as part of collodion detachments or ointments: Arabian, Arievich, Andriasyan ointment or 5-10% Salicylic ointment. For candidal lesions, Nystatin, Levorin, Amphotericin ointments, Pimafucin 1-2 times a day for 10-15 days are used. As a result of treatment, foci of candidal intertrigo, interdigital candidal erosions, and paronychia are resolved.

In acute skin mycoses with a pronounced inflammatory component, treatment begins with the elimination of edema, hyperemia, exudation, eczematization, and allergic rashes. Lotions and wet-drying dressings with disinfectants and astringents are prescribed: tannin, ethacridine, boric acid, etc. Then 2–5% boron-naftalan paste, 5% ASD paste, as well as combinations of antifungal and corticosteroid agents in creams are applied: Mycozolon, Travocort, Triderm. At the same time, acute inflammatory phenomena are quickly eliminated, which makes it possible to switch to treatment with fungicidal agents in the future. It is recommended to use external agents with corticosteroids for 7–8 days in order to avoid activation of the mycotic process.

After subsiding acute inflammatory phenomena or after detachment of the stratum corneum in hyperkeratosis, azole antimycotic drugs can be used: Kanesten, Clotrimazole, which are used 1 to 3 times a day, applying a thin layer to the lesions.

External dosage forms of terbinafine have high therapeutic activity: Lamisil (1% spray, cream), Lamisil Dermgel (gel). All forms have pronounced antimycotic and antibacterial properties. The presence of three dosage forms allows the mycologist to use the drug with the greatest benefit. So, spray Lamisil is indicated for acute mycoses with hyperemia, edema, rashes. The foci irrigated with a spray are covered with a thin film and isolated from the environment. Spray Lamisil does not cause irritation and leads to a rapid resolution of mycosis areas: soreness, itching, burning disappear, the foci turn pale and dry out. With the help of Lamisil spray, foci of erythrasma are cured within 5 days. Within 7-10 days, recovery occurs in patients with various forms of multi-colored lichen. Lamisil Dermgel, as well as a spray, is more indicated for acute mycoses, as it has a pronounced cooling effect and is easily applied to the affected areas. With erythema-squamous and infiltrative manifestations of skin mycoses, the use of Lamisil in the form of a cream is indicated. The gel and cream of this drug are also effective for microsporia, versicolor, candidiasis of large skin folds and periungual ridges. When using Lamisil cream for one week, such a concentration of the drug is created in the skin that retains fungicidal properties for another week after its withdrawal. This circumstance justifies short courses of treatment with Lamisil compared to other local antifungal agents.

Therapy of mycoses of the scalp, as well as in the treatment of smooth skin, is carried out with systemic and external antimycotics. 2-5% iodine tincture is applied to the foci of mycosis, smeared with antifungal ointment in the evening. In cases of significant inflammation, combined preparations containing, in addition to antimycotics, corticosteroid hormones are used. With an infiltrative-suppurative process, crusts are removed with 2–3% Salicylic ointment, disinfectant solutions are used (Furacilin, potassium permanganate). To increase the effectiveness of the treatment, it is recommended to shave the hair on the head every 10 days.

For literature, please contact the editor.

I. V. Kurbatova , candidate of biological sciences
G. A. Plakhotnaya , candidate of medical sciences

IMPiTM them. E. I. Martsinovsky, MMA them. I. M. Sechenov, Moscow

Table. Activity spectrum of systemic antimycotics

Fungal diseases of the skin and their prevention

Today we will talk about one of the most common types of skin diseases – a fungal infection. And we will try to answer the most common questions that patients ask in the dermatologist’s office.

So, what is a fungal infection?

This disease is caused by fungi, which are abundant in nature. To date, there are more than 200 species of various mushrooms.

Where do fungi live and how does human infection occur?

Fungi are widely distributed in the environment. They live in the soil, on plants, live on animals, and there is even a saprophytic species of fungi that successfully coexists with us, i.e. live on human skin. Fungi pathogenic for humans that affect the skin are called dermatophytes, and diseases are called dermatomycosis. Infection can occur in 2 ways: a direct route of infection through contact with soil, plants, a sick animal or a sick person; indirect – in contact with various things and objects used by patients, also through animal care items.

Why do fungal infections occur?

Susceptibility to a fungal infection is caused by numerous factors: weather conditions (hot season), the state of the immune system, skin condition, the presence of concomitant diseases. Age, gender, professional factors also matter. More often, of course, the manifestation of the disease occurs in the hot season, after returning from the “seas”, where a hot, humid climate prevails, accompanied by increased sweating. These factors are especially favorable for the introduction of pathogenic fungi and for the transition of saprophytes into pathogenic flora.

What types of fungal infections are there?

There are basically 4 groups of fungal diseases:

– keratomycosis.

They are quite superficial, as they affect the stratum corneum and cuticles of the hair, while not causing inflammatory reactions and do not affect the skin appendages (hair, nails). The most common disease from this group is versicolor, or pityriasis versicolor. It is manifested by the appearance of coffee-au-lait spots, mainly on the chest, back, and shoulder girdle.

– dermatomycosis.

This is a large group of fungal diseases that affect the skin, hair and nails. The most common disease from this group is epidermophytosis, or mycosis of the feet. The disease is very common, among the adult population – about 80% have this disease.

– candidiasis of the skin, mucous membranes, internal organs.

The disease is caused by a yeast-like fungus of the Candida series, an opportunistic flora. What does it mean? This means that the fungus exists in our body, but whether it will cause a disease or not depends not so much on it, but on the state of our body as a whole. All the factors contributing to the transition of the saprophyte into the pathogenic flora were listed above by us.

– deep mycoses with systemic lesions of the skin and internal organs.

A severe group of diseases that require long-term treatment in specialized medical institutions.

Is it contactable?

Practically non-contagious for adults, but due to the peculiarities of the structure of the epidermis, children can become infected from sick family members.

Prevention and treatment?

The disease is treated quite well, but there is no immunity to it, so preventive measures are very important. For treatment, external antifungal drugs are used, in the form of solutions, creams, gels, which are applied to the affected areas 2 times a day for 2-3 weeks. UV therapy is also used. It is desirable to use antifungal drugs different in the morning and in the evening. For prevention, the use of special shower gels marked “for skin prone to fungal infection” is recommended.

How does infection occur?

Keep in mind that athlete’s foot is a contagious disease. Infection occurs both by direct contact and through objects infected with the fungus. Of particular danger are baths, showers, beaches, gyms, swimming pools and items of clothing – shoes, socks.

Why do some get infected and some don’t?

The transition of the fungus from a saprophyte to a pathogenic state is facilitated by a whole range of reasons, for example: structural features of the foot (flat feet, narrow interdigital spaces), a tendency to increased sweating with a change in the chemical composition of sweat, metabolic and endocrine diseases, hypovitaminosis, vegetative dystonia.