What are the uses of Lamisil Oral? What are the side effects of Lamisil Oral? What are the drug interactions of Lamisil Oral? What are the pictures, warnings and dosage instructions for Lamisil Oral?

Uses of Lamisil Oral

Terbinafine, the active ingredient in Lamisil Oral, is used to treat certain types of fungal infections, such as those affecting the fingernails or toenails. It works by stopping the growth of the fungus. Lamisil Oral belongs to a class of drugs known as antifungals.

How to Use Lamisil Oral

Read the Medication Guide provided by your pharmacist before starting terbinafine and each time you get a refill. Take this medication by mouth, with or without food, usually once a day or as directed by your doctor. The dosage and length of treatment are based on your medical condition and response to treatment.

It may take several months after finishing treatment to see the full benefit, as it takes time for your new healthy nails to grow out and replace the infected ones. Continue taking the medication until the full prescribed amount is finished. Stopping the medication too early may allow the fungus to continue growing, resulting in the return of the infection.

Side Effects of Lamisil Oral

Diarrhea or stomach upset may occur. If these effects persist or worsen, let your doctor or pharmacist know promptly.

Changes in your sense of taste or smell, or loss of taste or smell, may occur. These side effects may improve after stopping terbinafine, but can also last for a long time or become permanent. Inform your doctor right away if you notice either of these effects.

Seek medical help immediately if you experience serious side effects, such as vision changes, mental/mood changes (including depression), unexplained bleeding/bruising, unusual tiredness, or signs of kidney problems.

Lamisil Oral can rarely cause serious, potentially fatal liver disease. Get medical help right away if you have symptoms of liver damage, such as persistent nausea/vomiting, loss of appetite, severe abdominal pain, yellowing of the eyes/skin, or dark urine.

A very serious allergic reaction to this drug is rare, but seek immediate medical attention if you notice any symptoms of a severe allergic reaction, including fever, swollen lymph nodes, rash, severe dizziness, or trouble breathing.

Drug Interactions with Lamisil Oral

Drug interactions can change how your medications work or increase the risk of serious side effects. Tell your doctor and pharmacist about all the products you use (including prescription/non-prescription drugs and herbal supplements).

Terbinafine can slow down the removal of other drugs from your body, affecting their effectiveness. Examples of affected drugs include pimozide and thioridazine.

Lamisil Oral Warnings and Precautions

Before taking terbinafine, tell your doctor or pharmacist if you are allergic to it or have any other allergies. This medication may contain inactive ingredients that can cause allergic reactions or other problems.

Inform your doctor or pharmacist about your medical history, especially any immune system problems, kidney disease, liver disease, or lupus.

Limit your alcohol consumption, as daily use of alcohol may increase your risk of serious side effects.

Terbinafine can make you more sensitive to the sun. Limit your time in the sun, avoid tanning booths and sunlamps, and use sunscreen and protective clothing when outdoors.

During pregnancy, this medication should only be used when clearly necessary. Fungal nail infection treatment can often wait until after the baby is born. Discuss the risks and benefits with your doctor.

This drug passes into breast milk, so consult your doctor before breastfeeding.

Lamisil Oral Pictures, Dosage, and Administration

Lamisil Oral is available in 250 mg tablets. The dosage and length of treatment will be determined by your doctor based on your specific condition and response to the medication.

Follow your doctor’s instructions carefully and continue taking the medication until the full prescribed amount is finished, even if your symptoms improve. Stopping the medication too early may allow the fungus to continue growing, leading to the return of the infection.

Lamisil Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

Terbinafine is used to treat certain types of fungal infections (for example, of the fingernail or toenail). It works by stopping the growth of fungus. This medication belongs to a class of drugs known as antifungals.

How to use Lamisil 250 Mg Tablet

Read the Medication Guide provided by your pharmacist before you start taking terbinafine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food, usually once a day or as directed by your doctor. Dosage and length of treatment is based on your medical condition and response to treatment.

It may take several months after you finish treatment to see the full benefit of this drug. It takes time for your new healthy nails to grow out and replace the infected nails.

Continue to take this medication until the full prescribed amount is finished. Stopping the medication too early may allow the fungus to continue to grow, which may result in a return of the infection.

Tell your doctor if your condition lasts or gets worse.

Side Effects

Diarrhea or stomach upset may occur. If either of these effects lasts or gets worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Changes in your sense of taste/smell or loss of taste/smell may occur. These side effects may improve after stopping terbinafine, but can last for a long time or become permanent. Tell your doctor right away if you notice either of these side effects.

Tell your doctor right away if you have any serious side effects, including: vision changes, mental/mood changes (such as depression), unexplained bleeding/bruising, unusual tiredness, signs of kidney problems (such as change in the amount of urine).

Terbinafine may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, such as: nausea/vomiting that doesn’t stop, loss of appetite, severe stomach/abdominal pain, yellowing eyes/skin, dark urine.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking terbinafine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: immune system problems, kidney disease, liver disease, lupus.

Limit alcoholic beverages. Daily use of alcohol may increase your chance for serious side effects.

This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.

During pregnancy, this medication should be used only when clearly needed. Fungal nail infection treatment can usually wait until after you have had your baby. Discuss the risks and benefits with your doctor.

This drug passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Terbinafine can slow down the removal of other drugs from your body, which may affect how they work. Examples of affected drugs include pimozide, thioridazine, among others.

Does Lamisil 250 Mg Tablet interact with other drugs you are taking?

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Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Do not share this medication with others.

This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.

Lab and/or medical tests (such as complete blood counts, liver function tests) should be done before you start taking this medication and while you are taking it. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Types, Treatment, Risk Factors, More

Fungi live everywhere. They can be found in soil, in the air, or even inside the body. They can also be found on plants, surfaces, or the skin. These microscopic organisms typically don’t cause any problems for your skin unless they multiply faster than normal or penetrate the skin through a cut or lesion.

Since fungi thrive in warm, moist environments, fungal skin infections can often develop in sweaty or damp areas that don’t get much airflow. Some examples include the feet, groin, and folds of the skin.

These infections usually appear as a scaly rash or as discolored and often itchy skin.

You often acquire a fungal skin infection through direct contact. This can include coming into contact with fungi in or on:

• another person
• an animal
• items such as clothing
• gyms
• gym mats, like those used in wrestling
• hot tubs
• saunas and steam rooms

Some fungal skin infections are very common. Although the infection can be uncomfortable and possibly contagious, it’s typically not serious unless you’re immunocompromised.

Did you know?

Although there are millions of species of fungi, just a few hundred of them can actually cause infections in humans, according to the Centers for Disease Control and Prevention (CDC).

What’s more, only a few of those species are dermatophytes, which can affect the skin, nails, and hair. Nondermatophyte fungi can affect the nails but are more likely to occur in other places, such as the lungs or brain.

Many common fungal infections can affect the skin.

Yeast infection (Candida skin infection)

Yeast is a type of fungus.

A yeast called Candida is naturally present on the skin and inside the human body. When it overgrows, an infection can occur, including on the skin. The most common species of Candida is Candida albicans.

Other names for a yeast infection of the skin include:

• a Candida skin infection
• a candidal skin infection
• cutaneous candidiasis
• candidiasis of the skin

The infection occurs in warm, moist, and poorly ventilated areas. Areas that are typically infected include the folds of the buttocks (as in certain types of diaper rash) and under the breasts.

The symptoms of a yeast infection of the skin can include:

• a red or discolored rash
• itching
• stinging
• burning
• acne-like bumps around the rash

Other yeast infections

The mucous membranes are another common site of fungal infections. Some examples of yeast infections in the mucous membranes are vaginal yeast infections and oral thrush.

How it’s diagnosed

A primary care doctor should be able to diagnose a yeast infection of the skin during a physical examination. They may also swab the skin and use a skin culture to confirm that yeast is the organism causing your symptoms.

If you see a dermatologist instead, they may perform a skin scraping of the rash and then view the sample under a microscope to determine if there’s Candida growth.

How it’s treated

An important step in treating any yeast infection is keeping the skin clean and dry.

Some yeast infections will go away on their own. Prescription and over-the-counter (OTC) antifungal drugs are also available. These drugs can either kill fungi directly or prevent them from growing and thriving.

Topical versions include:

• clotrimazole
• econazole
• ketoconazole
• nystatin
• oxiconazole

To help reduce itching, you can also use a corticosteroid cream such as hydrocortisone.

Powders may help you keep your skin dry. It’s important to apply them 2 to 3 hours before or after applying any creams.

If the infection doesn’t resolve or improve, a doctor may prescribe oral antifungal medications, such as:

• fluconazole (Diflucan)

To help treat diaper rash, consider using zinc oxide creams to soothe your baby’s skin. OTC options include products from the brands:

• A+D
• Balmex
• Desitin
• Triple Paste

Home remedies such as changing diapers more frequently and using disposable diapers may also relieve symptoms.

The best disposable diapers

Check out our reviews of the best disposable diapers on the market.

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Ringworm of the body (tinea corporis)

Ringworm is a common fungal skin infection. It’s highly contagious but not serious.

Despite its name, ringworm is caused by a fungus and not a worm. It typically occurs on the torso and limbs, in a subtype known as ringworm of the body (tinea corporis). Ringworm on other areas of the body can go by different names, such as jock itch and athlete’s foot.

The main symptom of ringworm is a ring-shaped rash with slightly raised edges. The skin inside these circular rashes usually looks healthy. The rash can spread and is often itchy.

Ringworm can come from petting an animal infected with the fungus or from gyms and gym mats.

How it’s diagnosed

A doctor can usually diagnose ringworm by sight or after performing a skin scraping.

Some doctors may also perform a fungal culture to help them determine a diagnosis.

How it’s treated

Ringworm of the body that’s limited to a few areas can usually be treated with a topical antifungal medication, such as:

• clotrimazole (Lotrimin AF Ringworm Cream)
• econazole
• ketoconazole (Extina, Ketozole)
• luliconazole (Luzu)
• naftifine
• oxiconazole (Oxistat)
• sulconazole (Exelderm)
• terbinafine (Lamisil AT Cream, Silka Antifungal Cream)

Doctors often recommend oral antifungals for a deeper or more extensive infection. They include:

• fluconazole (Diflucan)
• itraconazole (Sporanox)
• terbinafine

If you think you have ringworm

If you think you may have ringworm, try to refrain from using over-the-counter antifungal products (such as creams) before you receive an official diagnosis.

Using these products can make the fungus harder to identify when a healthcare professional views it under a microscope.

According to the Centers for Disease Control and Prevention (CDC), over-the-counter antifungal products aren’t effective against ringworm of the scalp (tinea capitis). This type of ringworm typically requires prescription antifungal products.

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Ringworm of the scalp (tinea capitis)

This fungal infection affects the skin of the scalp and the associated hair shafts. It’s most common in children and teens 3 to 14 years old.

You can contract ringworm of the scalp from animals, soil, or other humans (via hairbrushes or hats).

Symptoms of ringworm of the scalp (tinea capitis) can include:

• broken hair shafts
• localized bald patches that may appear scaly or red
• associated scaling and itching
• associated tenderness or pain in the patches
• patches that ooze or crust over
• permanent hair loss, in some severe cases

It may resemble severe dandruff.

It can also cause symptoms unrelated to the scalp, such as fever and swollen lymph nodes in the neck.

How it’s diagnosed

A doctor can diagnose ringworm of the scalp during a physical examination.

They usually perform a skin scraping, such as a skin lesion KOH exam. In the skin lesion KOH exam, skin scrapings are mixed with potassium hydrochloride (KOH) to determine if fungi are present.

How it’s treated

Ringworm of the scalp requires prescription oral medication, which may come in the form of a tablet, capsule, or liquid. Examples include:

• fluconazole (Diflucan)
• griseofulvin (Fulvicin, Gris-PEG), which is typically the drug of choice and is safe for children
• itraconazole (Sporanox)
• terbinafine

Everyone with ringworm of the scalp should use an antifungal shampoo. All members of their household should use it too. Examples include ketoconazole shampoo (Nizoral Anti-Dandruff Shampoo).

Jock itch (tinea cruris)

Jock itch happens in the area near your groin and thighs. It’s most common in men and adolescent boys.

The main symptom is an itchy, red, and sometimes painful rash that typically starts in the groin or around the upper inner thighs. The rash may worsen after exercise or other physical activity and can spread to the buttocks and abdomen.

The affected skin may also appear:

• scaly
• flaky
• cracked
• moist and possibly macerated, in the case of an open sore

The outer border of the rash can be slightly raised and darker.

How it’s diagnosed

A doctor can diagnose jock itch during a physical examination or after examining a sample under a microscope.

How it’s treated

Treatment often begins with OTC or prescription creams.

OTC creams, sprays, and powders include:

• butenafine (Lotrimin Ultra Jock Itch Cream)
• clotrimazole (Lotrimin AF Jock Itch Antifungal Cream)
• miconazole (CareALL Miconazole Cream, Lotrimin AF Jock Itch Antifungal Powder Spray)
• terbinafine (Lamisil AT Cream for Jock Itch, Silka Antifungal Cream, Silka Jock Itch Cream)

Prescription creams include:

• econazole
• ketoconazole (Ketozole)
• luliconazole (Luzu)
• oxiconazole (Oxistat)
• sulconazole (Exelderm)

Applying a cool compress can also help soothe the skin.

If topical treatments don’t work, a doctor may prescribe oral antifungals, such as:

• fluconazole (Diflucan)
• itraconazole (Sporanox)
• terbinafine

Oral medications are typically reserved for recurrent, treatment-resistant, or chronic infections.

Tinea versicolor (pityriasis versicolor)

In tinea versicolor, small oval discolored patches develop on the skin. It’s sometimes called pityriasis versicolor.

This infection is caused by an overgrowth of a fungus called Malassezia. Malassezia is naturally present on the skin of most adults.

The discolored skin patches mostly occur on the back, chest, and upper arms, but they can also affect the scalp. They may look lighter or darker than the rest of the skin and can be red, pink, tan, or brown. On people with darker skin, the patches may appear white. These patches can be itchy, flaky, or scaly.

Tinea versicolor is more likely to appear during the summer or in areas with a warm, wet climate. It’s also common in people who work out or sweat often. The condition can sometimes return following treatment.

How it’s diagnosed

A doctor can diagnose tinea versicolor with a:

• physical examination
• Wood’s lamp examination, in which a healthcare professional uses a handheld blacklight to confirm the presence of fungi or bacteria
• skin lesion biopsy, which involves removing a small skin sample and having it tested in a laboratory
• skin lesion KOH exam

How it’s treated

The standard treatment for tinea versicolor is topical products such as soaps, creams, lotions, and shampoos. Ingredients to look for include:

• ketoconazole, found in products such as prescription-strength shampoo and Extina foam
• pyrithione zinc, found in products such as Vanicream Z-Bar Medicated Cleansing Bar, Vanicream Dandruff Shampoo, and Selsun blue Itchy Dry Scalp Antidandruff Shampoo
• selenium sulfide, found in products such as Selsun blue Moisturizing Antidandruff Shampoo and Selsun blue Medicated Antidandruff Shampoo

If tinea versicolor returns following treatment, a doctor may recommend you use a medicated cleanser once or twice a month.

Oral medication is rarely needed. A doctor may prescribe a short course of oral antifungals if tinea versicolor is recurrent, treatment-resistant, widespread, severe, or creates thick scales.

They include:

• fluconazole (Diflucan)
• itraconazole (Sporanox)

Athlete’s foot (tinea pedis)

Athlete’s foot affects the skin on your feet, often between your toes. It can also appear on the soles of your feet.

Typical symptoms of athlete’s foot include:

• itching or a burning, stinging sensation between your toes or on the soles
• skin that appears red, scaly, dry, or flaky
• peeling skin
• thickened soles
• cracked or blistered skin
• deep blisters on the soles, in rare cases

In some cases, the infection can also spread to other areas. Examples include the:

• nails, as in onychomycosis
• groin, as in jock itch (tinea cruris)
• hands, as in tinea manuum

How it’s diagnosed

A doctor can diagnose athlete’s foot by observing your symptoms or performing a skin test such as the skin lesion KOH exam.

How it’s treated

You can treat athlete’s foot with a variety of OTC topical products, such as:

• butenafine (Lotrimin Ultra Athlete’s Foot Cream)
• clotrimazole (CareALL Athlete’s Foot Cream, Lotrimin AF Cream for Athlete’s Foot)
• miconazole (Desenex Athlete’s Foot Shake Powder)
• terbinafine (Lamisil AT Cream, Lamisil AT Cream for Athlete’s Foot, Silka Antifungal Cream)
• tolnaftate (Dr. Scholl’s Odor-X Antifungal Spray Powder, Lotrimin AF Athlete’s Foot Daily Prevention Deodorant Powder Spray, Tinactin Athlete’s Foot Cream)

Terbinafine tends to be the fastest-acting of these medications.

If OTC products don’t help clear up athlete’s foot within 2 weeks or so, a doctor may prescribe:

• prescription-strength topical clotrimazole
• sulconazole (Exelderm)

Doctors usually prescribe oral antifungals when the infection is recurrent, causes blisters, or involves the tops of the feet, soles, or heels. They include:

• fluconazole (Diflucan)
• griseofulvin (Fulvicin, Gris-PEG), which is safe for children
• itraconazole (Sporanox)
• terbinafine

Did you know?

Athlete’s foot tends to recur, so it’s important to dry the toes and feet thoroughly after showering or bathing. Use a powder, especially in between the toes.

Onychomycosis

Onychomycosis is a fungal infection of the nails. It can affect the fingernails or the toenails, although infections of the toenails are 7 to 10 times more common.

Symptoms of onychomycosis include nails that:

• have flaky white patches and pits near the top
• are discolored (typically yellow, brown, black, purplish, green, or white)
• are brittle or break easily
• are thick
• are raised or crusty, in the case of toenails

How it’s diagnosed

A doctor will usually take a nail clipping and some subfungal debris and send them off for a periodic acid–Schiff (PAS) stain or culture.

On some occasions, they may perform a skin lesion KOH exam. However, the PAS stains and cultures are more accurate.

How it’s treated

Prescription medications are often required to treat this type of infection. The standard treatment is oral terbinafine. It’s typically prescribed for 6 or 12 weeks, depending on whether you have a fingernail or toenail infection.

Treatment is notoriously tricky due to factors such as prolonged treatment time and the likelihood of recurrence.

Other oral antifungals that may be used include:

• fluconazole (Diflucan)
• griseofulvin (Fulvicin, Gris-PEG), which is safe for children
• itraconazole (Sporanox)

Doctors often prescribe topical antifungals as well. They include:

• ciclopirox (Ciclodan)
• efinaconazole (Jublia)
• tavaborole (Kerydin)

In severe cases, a doctor may remove some or all of an affected nail.

Emerging treatment options include lasers and light therapy. More data on their effectiveness is needed.

Because a rash is a common symptom of most fungal skin infections, they’re often referred to as fungal skin rashes or fungal rashes. Onychomycosis is one of the few fungal skin infections that doesn’t typically cause a rash.

Several factors can increase your risk of getting a fungal skin infection. They include:

• living in a warm or wet environment
• sweating heavily
• not keeping your skin clean and dry
• sharing items such as clothing, shoes, towels, or bedding
• wearing tight clothing or footwear that doesn’t breathe well
• taking part in activities that involve frequent skin-to-skin contact
• coming into contact with animals that may be infected
• having a weakened immune system due to immunosuppressant drugs, cancer treatment, or conditions such as HIV or AIDS

To help prevent a fungal skin infection from developing, try to keep the following tips in mind:

• Be sure to practice good hygiene.
• Do not share clothing, towels, or other personal items.
• Wear clean clothes every day, particularly socks and underwear.
• Choose clothing and shoes that breathe well. Avoid clothing or shoes that are too tight or have a restrictive fit.
• Make sure to dry off properly with a clean and dry towel after showering, bathing, or swimming.
• Wear sandals or flip-flops in locker rooms instead of walking with bare feet.
• Wipe down shared surfaces, such as gym equipment or mats.
• Stay away from animals that have signs of a fungal infection, such as missing fur or frequent scratching.

Fungal skin infections are common.

Although these infections aren’t usually serious, they can cause discomfort and irritation due to itchy or scaly red skin. If not treated, the rash may spread or become more irritated.

Many fungal skin infections eventually improve in response to OTC fungal treatments. However, call a doctor or other healthcare professional if you:

• have a fungal skin infection that does not improve, gets worse, or returns after OTC treatment
• notice patches of hair loss along with itchiness or scaly skin
• have a weakened immune system and suspect a fungal infection
• have diabetes and think you have athlete’s foot or onychomycosis

If you are immunocompromised or have diabetes, an untreated infection can lead to cellulitis or systemic infection.

Also, call a doctor or other healthcare professional if you have an infection that does not improve with OTC medications. You may need a prescription for more effective treatment.

The role of bacterial and fungal infections in the pathogenesis of skin diseases and methods of their treatment

The causative agents of bacterial and fungal infections play an important role in the pathogenesis of the most common skin diseases. Dermatologists daily face manifestations of bacterial, fungal and mixed infections in patients with various skin diseases. The growth of these infections is due to many factors. The widespread uncontrolled use of antibacterial agents (including in skin care cosmetics), environmental degradation in large cities, the introduction of modern immunosuppressive drugs into medical practice – all this leads to a violation of the biocenosis of the skin and the development of bacterial and fungal infections. The failure of the skin barrier in patients with dermatoses (psoriasis, atopic dermatitis, eczema) makes them the most vulnerable to infectious aggression.

Also, one should not forget about the role of the inflammatory process. Inflammation can be primary, and the microflora joins it, and the microflora can also cause a disease, and under the influence of the waste products of microorganisms, an inflammatory process occurs.

In 2009-2010 in the dermatology department of the Research Institute of Medical Mycology named after. N.P. Kashkin were examined and treated 2562 patients with skin diseases. A significant part of those treated were patients with psoriasis (845 people, 33%). Atopic dermatitis caused hospitalization in 384 (15%) patients. Eczema was diagnosed in 333 (13%) patients, ringworm in 231 (9%), pyoderma — in 128 (5%), other dermatoses — in 205 (8%). The share of dermatoses complicated by bacterial, fungal or bacterial-fungal infections accounted for 17% (436 people). Most patients suffering from dermatoses associated with bacterial, fungal or bacterial-fungal infections have come a long way from the onset of the disease or its exacerbation to receiving the effective medical care they need. Two groups of reasons for the development of this situation can be distinguished: a combination of adverse circumstances and medical errors. The inevitable results of the course of the dermatosis itself should be attributed to coincidences. For example, a severe course of psoriasis or atopic dermatitis, as a rule, was accompanied by the addition of a secondary infection, both bacterial and fungal. The addition of a secondary infection changed the clinical picture and the nature of the course of dermatosis, which in turn prevented its timely diagnosis and rational treatment. Also, coincidences include adverse events resulting from the pathogenetic therapy of skin diseases with immunosuppressive drugs. The main reasons for medical errors were ignorance of this pathology and / or inability to apply knowledge in practice. All this led to the fact that dermatoses associated with bacterial, fungal or bacterial-fungal infections remained unrecognized for a long time, and patients did not receive the treatment they needed. Often, the treatment prescribed before admission to the hospital was not effective enough. Errors in the choice of therapy consisted in the appointment of monotherapy of one of the drugs: a topical glucocorticosteroid, an antibiotic, or an antifungal drug. Drugs with obviously low efficacy and bioavailability were often used. When prescribing therapy, the etiological factor that contributed to the development of the pathological condition was not taken into account, the analysis of causal relationships was not carried out, and short, intermittent courses of therapy were prescribed.

In this regard, a study was conducted, the purpose of which was to assess the characteristics of the etiology, pathogenesis, clinical manifestations, the nature of the course of dermatoses associated with bacterial, fungal or bacterial-fungal infections, to study the efficacy and safety of the combination drug Travocort containing the antimycotic isoconazole and topical glucocorticosteroid diflucortolone, in the treatment of these dermatoses.

Material and methods

238 patients with dermatosis associated with bacterial, fungal or bacterial-fungal infections were under observation: 112 (47%) men aged 24–82 years (median 57 years), 126 (53%) women aged 25–80 years ( median 56 years). There were no differences in gender and age (p>0.05).

At the first stage of the study, all patients with suspected dermatoses associated with bacterial, fungal or bacterial-fungal infections underwent microbiological studies: bacteriological inoculation of pathological material (pus, skin scales, exudate) from the surface of lesions, microscopic examination and inoculation on the medium Saburo to detect micromycetes – pathogens of fungal skin diseases. Further, risk factors for the development of dermatoses associated with bacterial, fungal or bacterial-fungal infections were assessed, pathogenetic mechanisms of their development were analyzed, and clinical manifestations were evaluated.

At the second stage of the study, 30 patients with dermatosis associated with bacterial, fungal or bacterial-fungal infections were selected for the appointment of Travocort according to the standard scheme 2 times a day for 14 days. The effectiveness of therapy was assessed by the speed and degree of resolution of lesions, mycological, clinical effectiveness. The inclusion criteria for patients in the study were at least 18 years of age; the presence of dermatoses associated with bacterial, fungal or bacterial-fungal infections, confirmed by microscopic and / or cultural methods of research; damage to no more than 30% of the skin; lack of manifestations of general intoxication. Exclusion criteria: pregnancy, taking systemic antifungal drugs no later than 1 month before the start of isoconazole treatment, the use of external antimycotics no later than 2 weeks before the start of isoconazole treatment, intolerance to isoconazole. Security Travocort was evaluated for the presence or absence of adverse events.

Research results

As a result of examination of patients with dermatosis associated with bacterial, fungal or bacterial-fungal infections, it was found that the nosological forms of dermatosis in these patients were represented by atopic dermatitis (48%, 115 patients), psoriasis (20%, 48), eczema (30 %, 70), lichen planus (1%, 3), focal scleroderma (1%, 2). Of the 238 observed, most (42%, 98) were patients in whom the course of dermatosis was complicated by the addition of pyococcal infection. A complication of dermatosis by the addition of a fungal infection was observed in 17% of patients with dermatosis associated with bacterial, fungal or bacterial-fungal infections (41). In 39 (16%) patients, a complication of dermatosis with a bacterial and fungal infection was revealed. In 32 (13%) patients, the prolonged course of pyoderma and its irrational therapy led to the development of microbial eczema and the appearance of pyoallergides. The development of mycotic eczema due to a long course of skin mycosis was established in 41 (12%) patients with dermatoses associated with bacterial, fungal or bacterial-fungal infections. The causative agents of mycoses were found in 108 (45%) patients with dermatoses associated with bacterial, fungal or bacterial-fungal infections. The results of the examination of patients made it possible to establish risk factors for dermatoses associated with bacterial, fungal or bacterial-fungal infections. Endocrine diseases, including diabetes mellitus, were observed in 25% of patients, obesity – in 37%, hypothyroidism – in 5%. Diseases of the cardiovascular system were detected in 20% of patients, metabolic syndrome – in 18%, immunodeficiency states – in 7% of patients.

Laboratory studies have revealed that the main causative agents of skin mycoses in patients with dermatoses associated with bacterial, fungal or bacterial-fungal infections are dermatomycetes. They were isolated in 45% of cases, Candida spp. – in 31%, Malassezia spp. — in 24%. Species identification of dermatomycetes was established in 48 cases. Among dermatomycetes, Trichophyton rubrum dominated (76% of cases), T. mentagrophytes was isolated in 14%, Epidermophyton floccosum – 8%, Microsporum canis – 2%. Purulent process inducers in dermatoses associated with bacterial, fungal or bacterial-fungal infections were Staphylococcus aureus (48% of cases), Streptococcus pyogenes (24%), Corynebacterium minutissimum (20%), 90 009 Pseudomonas aeruginosa (8%).

The analysis of cause-and-effect relationships made it possible to establish three variants of the pathogenesis of dermatoses associated with bacterial, fungal or bacterial-fungal infections. In the first variant of the development of dermatoses associated with bacterial, fungal or bacterial-fungal infections (60 cases, 25%), infectious agents (bacteria and/or fungi) were the primary causative agents of infectious diseases of the skin and its appendages. In the case of a prolonged or complicated course of pyoderma (mycosis), patients developed pioallergides, mycids, and microbial (mycotic) eczema as a result of sensitization. The second variant of the pathogenesis of dermatoses associated with bacterial, fungal or bacterial-fungal infections (134 cases, 56%) included the development of secondary infectious complications in patients with skin diseases (atopic dermatitis, psoriasis, lichen planus, etc.). In the third option (44 cases, 19%) bacteria and fungi acted as triggers. Changes in the biocenosis of the skin, colonization of pathogenic and opportunistic pathogens on the skin, as well as contamination of bacteria and fungi – all this ultimately led to the appearance of specific rashes on the skin in patients with atopic dermatitis, psoriasis (Koebner phenomenon) and the progression of these dermatoses.

During the initial examination of patients, it was noteworthy that in a large number of patients (79 people, 33%) the clinical picture of dermatoses was atypical. It was impossible to determine the nosological affiliation of these dermatoses from the first time. Only after carrying out laboratory, and in some cases histological studies, it was possible to make a diagnosis.

Patient Z. , aged 59, was admitted for treatment with a diagnosis of atopic dermatitis, toxic allergic reaction. At the time of admission to the hospital, the patient complained of itchy red rashes spread over the entire skin. The patient characterized itching as painful, paroxysmal, aggravated by contact with water and in the evening and at night. When collecting an anamnesis of the disease, it was possible to establish that the patient had been suffering from atopic dermatitis since childhood, which in the last 10 years proceeded favorably, without severe exacerbations, and was manifested only by the presence of areas of lichenification on the hands, in the elbows and popliteal fossae. Rashes in the form of red itchy spots appeared about 2 weeks before the patient was admitted to the hospital. Regarding these rashes, the patient applied to the KVD at the place of residence, where this condition was regarded first as an exacerbation of atopic dermatitis, and then as a manifestation of a toxic-allergic reaction of unclear etiology. The patient was treated with antihistamines and desensitizing drugs, glucocorticosteroid ointments. Despite the treatment, the itching intensified, fresh spotted rashes continued to appear. This caused the patient to be hospitalized in the dermatology department. During the initial examination, rashes of two types were noted. Foci of stagnant color of hyperemia and lichenification with single excoriations were located in the elbows, popliteal fossae and on the back of the hands. The boundaries of the foci were not clearly expressed, peeling was insignificant. Skin scales adhered tightly to the surface of the skin. Rashes of another type were represented by widespread rounded, bright red spots 0. 5–1.0 cm in diameter, edematous plaques, places with vesiculation and single micropustules in the central part of these eruptive elements. The rashes were located on the face, trunk, upper and lower extremities (Fig. 1, a). Figure 1. Patient Z., 59years. a — before treatment, b — after application of Travocort and Travogen. To verify the diagnosis of the patient, a histological examination of the skin was performed. Biopsy material was taken from one of the spotted eruptive elements from the anterior abdominal wall. The following changes were revealed in the histological specimen (stained with hematoxylin and eosin): in the epidermis — massive reticular orthokeratosis, focal spongiosis, exocytosis of neutrophils and lymphocytes with the formation of a single subcorneal cavity; in the dermis — moderately pronounced edema, perivascular lymphohistiocytic infiltrates (Fig. 2). 2. Patient Z. Histological specimen of the skin of the anterior abdominal wall (stained with hematoxylin and eosin; ×40). After additional staining of the preparation with the PAS method, it was possible to identify a single mycelium of the fungus (Fig. 3). Subsequent mycological examination identified fungus M. canis. According to the results of the examination, the patient was clinically diagnosed with atopic dermatitis, widespread microsporia, and itraconazole 200 mg 2 times a day and for external use the drug Travocort were prescribed. After 2 weeks of application of Travocort ² / ₃ the spotty rash resolved, Travogen was prescribed for the remaining spots. Complete (clinical and mycological) recovery was achieved 1 month after the start of treatment (see Fig. 1b). The presented example shows how atypical the manifestations of a fungal infection are in patients with chronic dermatosis, which makes it difficult to diagnose them in a timely manner and leads to the appointment of irrational therapy.

However, some signs suggest the presence of dermatoses associated with bacterial, fungal, or bacterial-fungal infections. So, according to our observations, the pathological process is often localized in the folds of the skin (inguinal-femoral, interdigital spaces, intergluteal, under the mammary glands, in the corners of the mouth). In most patients, a pronounced local inflammatory reaction was noted, manifested by exudation, weeping, the formation of erosions, crusts, and bright hyperemia of the skin around the pathological focus. In 27% of patients, the course of dermatoses associated with bacterial, fungal or bacterial-fungal infections resolved with the development of a bacterial-fungal infection and was accompanied by a general reaction of the body with intoxication and fever. In 7 patients, the course of dermatoses associated with bacterial, fungal or bacterial-fungal infections was complicated by lymphadenitis, in 3 patients by lymphangitis, in 2 patients by erysipelas of the lower extremities, and in 1 patient thrombohemorrhagic purpura developed.

At the second stage of the study, 30 patients (15 women, 15 men) were selected in accordance with the inclusion criteria. All patients received Travocort 2 times a day for 14 days. The effect of using Travocort was noticeable by the end of the 1st day: itching, swelling, hyperemia decreased, exudation phenomena subsided. By the end of the 2nd day, weeping completely stopped in all patients, and by the end of the 3rd day, epithelialization of erosions occurred. As a result of the treatment, all 30 patients showed mycological recovery. Clinical recovery was noted in 21 patients. 9By the 12th-14th day, weeping and vesiculation completely resolved in patients, but hyperemia and desquamation persisted, so further treatment was carried out with symptomatic indifferent drugs. All patients noted good tolerance of the drug Travocort . No adverse events were recorded in any of the patients.

In fig. 4Figure 4. Patient M., 14 years old: atopic dermatitis, mild course, complicated by mycotic infection caused by fungi of the genus Malassezia spp. a — before treatment, b — after treatment with Travocort. a case of using Travocort in a patient with atopic dermatitis is presented.

Patient M., aged 14, applied to the clinic of the Research Institute of Medical Mycology. P.N. Kashkin with complaints of severe itching, burning, rashes, peeling on the skin of the back of the neck, scalp. When questioning the patient and her mother, it was found that the girl has been suffering from atopic dermatitis since the age of 3 months. Initially, the disease manifested itself as itchy red, weeping and scaly spots, plaques and vesicles on the cheeks, buttocks, and thighs. The appearance of rashes was associated with the introduction of complementary foods and the child’s consumption of fruits and sugary foods. The girl was under the supervision of a pediatrician all the years. Exacerbations of the disease were seasonal and, as a rule, occurred in spring and autumn. Antihistamines, topical glucocorticosteroids, moisturizing creams and ointments containing urea were used in therapy. In the last 4 years, the disease proceeded more favorably: exacerbations were rare and were mainly associated with a violation of the diet. However, 6 months before applying to the Research Institute of Medical Mycology, the course of the disease changed: a small-lamellar peeling appeared on the scalp of the patient, and a focus of lichenification with pronounced peeling appeared on the back of the neck. The rash was accompanied by severe paroxysmal itching and burning. The patient’s mother did not go to the doctors, the girl was treated on her own with antihistamines and a cream containing betamethasone. Initially, the treatment brought short-term improvement: the rash faded, the peeling decreased. However, immediately after the end of the use of drugs, the itching intensified, and the severity of the rashes became the same.

On examination, the patient was found to have skin lesions on the scalp and back of the neck. On the scalp, the skin was diffusely hyperemic, on the back of the neck there was a focus of lichenification. The skin in the focus was pinkish-bluish in color, infiltrated with a pronounced skin pattern. The edges of the hearth were clearly delineated and in some places had a roller-like shape. As a result of mycological examination, direct microscopy of skin scales with KOH revealed a large number of large yeast-like cells. In a cultural study, a growth of Malassezia spp.

Examination of the patient revealed an increased content of total IgE in the blood. According to the history of the disease, an objective examination of the patient and the results of mycological and immunological studies, the patient was diagnosed with atopic dermatitis, a course of mild severity, complicated by a mycotic infection caused by fungi of the genus Malassezia spp. For the treatment of the patient, the combination drug Travocort 9 was chosen0010 containing the antimycotic isoconazole and the glucocorticosteroid diflucortolone. Travocort was applied to the skin of the lesion 2 times a day for 14 days. Shampoo with zinc pyrithione and ketoconazole was prescribed for scalp sanitation. The effect of the use of Travocort was observed after the 1st day of therapy. The patient noted a decrease in itching and burning 24 hours after the start of the drug, and their complete disappearance after 48 hours. The intensity of erythema decreased 12 hours after the start of use Travocort . Erythema completely resolved on the 9th day of treatment. Lichenification and desquamation decreased after 48 hours and completely resolved 12 days after the start of therapy. After the end of treatment, microscopic and cultural studies were performed three times at intervals of 24 hours. Fungi were not found, culture growth was absent.

Talk

Over the past decade, not only dermatologists [1] have noted an increase in the number of skin diseases associated with bacterial, fungal or bacterial-fungal infections. Most often, the development of such a pathology was observed in cancer patients and patients receiving immunosuppressive therapy [2]. All authors agree that the timely diagnosis of diseases of combined etiology is difficult. For diagnosis, it is necessary to use, first of all, microbiological methods, which make it possible to identify species of pathogens (bacteria, fungi) and determine their sensitivity to antibacterial and antifungal drugs [3, 4].

There are several approaches to the choice of method of therapy for dermatoses associated with bacterial, fungal or bacterial-fungal infections. Firstly, this is the use of combination therapy with the simultaneous administration of drugs of different pharmacological groups with different mechanisms of action. Secondly, this is the appointment of combined local preparations containing several active substances. However, these methods have their drawbacks: the more components these therapies include, the greater the likelihood of developing adverse events such as sensitization and allergic reactions. In addition, many official combined topical agents are not always effective, as they contain active ingredients such as gentamicin, tetracycline and clotrimazole, to which many pathogens of infectious processes are insensitive. In these cases Travocort is the drug of choice, as it contains the glucocorticosteroid diflucortolone and a broad-spectrum antimycotic with a pronounced antibacterial effect. The mechanism of action of isoconazole is associated with a violation of the synthesis of ergosterol in the plasma membranes of a microbial cell, which provides fungistatic and fungicidal effects. The antibacterial action of isoconazole is associated with blocking the synthesis of para-aminobenzoic acid, which is involved in the synthesis of bacterial proteins [5, 6].

High efficiency and good tolerance of the drug Travocort are noted by domestic and foreign authors [7, 8], who indicate that the manifestations of acute inflammation, such as hyperemia, edema, exudation, when using the drug Travocort resolve 2 times faster than when using preparations containing only antimycotics. This property makes their use necessary in cases of development of dermatoses associated with bacterial, fungal or bacterial-fungal infections, such as mycotic eczema, and in patients with chronic skin diseases with the addition of a secondary fungal infection.

Terminals

1. The incidence of dermatoses associated with bacterial, fungal, bacterial-fungal infections was 17%.

2. The absence of specific clinical manifestations in dermatoses associated with bacterial, fungal or bacterial-fungal infections leads to their late diagnosis and irrational therapy.

3. The drug Travocort has a pronounced antifungal, antibacterial and anti-inflammatory activity.

4. Travocort is a highly effective drug and can be used in the treatment of dermatoses associated with bacterial, fungal or bacterial-fungal infections.

Fungal infections – Official website of the Center for Public Health and Medical Prevention of the Health Committee of the Kursk Region have contact with their pathogens – fungi. In principle, all mycoses are contagious. Fortunately, the disease does not develop in everyone who comes into contact with fungi, but only in those who, due to physiological characteristics, have a predisposition to this infection (for example, flat feet, increased sweating), or at the time of contact there are any particularly favorable external conditions for the development of the process (for example, high humidity, infection in common areas).

In other cases, some concomitant diseases (for example, diabetes mellitus, AIDS) or even treatment for other reasons (for example, the use of antibiotics or cytostatics) may be predisposing factors.

Meanwhile, statistics show that every 3-4th adult inhabitant of the Earth suffers from mycosis. There are many known fungal infections. The pathology that they can cause in humans is also diverse.

Fungi can infect a variety of places on the human body, and under certain conditions even inside the human body. An important role is played by the immune status of a person, that is, his ability to resist, in principle, any infection. So, with severe immunodeficiency, in particular, in AIDS patients, a variety of fungal pathologies occur, and it is very difficult to treat.

In general, according to the existing classification of fungal infections, they are usually divided into several main groups.

Some types of fungi affect only the most superficial, so-called stratum corneum of the skin. Such diseases are called keratomycosis. It is this layer that we see when we look at our skin. An example of keratomycosis is the extremely widespread pityriasis or versicolor versicolor. Since this disease affects the most superficial layer of the skin, where there are no sensitive receptors, the “happy” owners of this infection do not feel anything. They can only notice a cosmetic defect: the appearance of brownish merging spots on the torso, shoulders, and neck. At the same time, the shades of brown are very diverse, and in addition, these spots, when scraped, peel off with the separation of scales resembling bran. Hence the two names of this disease: pityriasis or multi-colored versicolor. As a rule, people do not notice brownish spots, but pay attention to their illness only when, after appearing in the sun, instead of a beautiful uniform tan, white spots remain on the places affected by the fungus. In fact, these are not white spots, but skin of a normal color, but not tanned, since the fungus that loosens the surface layer of the skin does not allow ultraviolet rays to penetrate into those layers where the melanin pigment is contained. Therefore, the skin in these places does not tan. Seeing a doctor during this period with a request to rid the patient of “white” spots is doomed to failure, because even with the most successful treatment of fungi, the spots will disappear only after the tan comes off and the skin color evens out. Therefore, it is important to treat such patients before they begin to sunbathe. Then there will be no cosmetic disappointments. It is interesting that pityriasis versicolor, being an unconditionally contagious disease, since there is no pathology without a fungus, does not manifest its pathological essence in everyone who gets it on the skin, but only in people who are susceptible to it. The main role is played by the nature of perspiration, and not only the abundance of the resulting sweat, but also its composition. The peculiarities of the course of the infection are also associated with this: the appearance of rashes in the places of the most active sweating, that is, on the upper half of the body, neck, shoulders, as well as the curious fact that even with many years of contact with this fungus, the disease may not develop. Let’s say one spouse can have it, but the other can’t. The secret is simple: these spouses sweat differently.

Keratomycosis conditionally also includes another common infectious disease – erythrasma, associated with damage to the stratum corneum, but in deep folds (usually in the inguinal or axillary region). This disease only superficially resembles a fungal pathology with the appearance of brownish itchy spots, but it is caused by bacteria, not fungi, and therefore is considered pseudomycosis.

Another group of fungal diseases includes dermatomycosis, in which all layers of the skin are affected, including its appendages – hair and nails. This is a very large group of fungal infections, and it is customary to subdivide it into 2 subgroups – epidermomycosis, in which the entire thickness of the epidermis (upper layer of the skin), including nails, is affected, and trichomycosis (from the Greek word TRICHOS – hair) in which the hair is affected.

Among epidermomycosis, epidermophytosis (groin and feet) and rubromycosis are distinguished. Infection with these fungi occurs as a result of direct contact, or through infected objects, such as someone else’s shoes. It is these fungi that are most often the cause of damage to the nails (onychomycosis, from the Greek ONYCHOSIS – nail), which at the same time thicken, crumble, turn yellow. Both fingernails and toenails can suffer, but more often on the legs. If the process affects only the skin of the feet, and this is the most common variant of epidermomycosis, then the process is accompanied by the appearance of itchy scaly rashes in the interdigital region or on the soles (squamous form of epidermophytosis). Often with this form, bubbles and weeping appear in the interdigital region (usually the 3rd and 4th interdigital folds – the intertriginous form of epidermophytosis) or on the soles (dyshidrotic form of epidermophytosis or the so-called “athlete’s foot”).

With rubromycosis, the process on the feet, on the contrary, is dry, the skin becomes thickened, dry, and in the skin folds there is an abundance of very small, easily falling scales, which gives the impression that a person has stepped into flour. Therefore, the phenomenon was called “mucoid peeling”, and “flour” in this case is nothing more than numerous spores of the fungus, which can easily infect other people. With rubromycosis, damage to other areas of the skin is possible, for example, on the legs or torso. Then there are clearly limited from healthy skin foci of redness of bizarre outlines.

Among trichomycosis, microsporia (or as it is more popularly called “ringworm”), trichophytosis and favus (scab) are distinguished. The latter has practically ceased to be found in our country. Microsporia and trichophytosis can be infected both from a sick person (anthropophilic forms of the disease) and from an animal (zoophilic forms). Microsporia people become infected from small domestic animals (stray dogs, cats). People can become infected with trichophytosis from cattle, so the zoophilic form of this disease is less common than microsporia. At the same time, anthropophilic forms proceed much more easily than zoophilic ones. Any hair is affected, that is, not only long on the head, but also fluffy on the body. With the defeat of vellus hair, the appearance of the foci with trichophytosis and microsporia is the same: ring-shaped itchy formations with enlightenment in the center and an inflammatory roller along the edges. Bald spots appear on the scalp as a result of hair damage by a fungus. With microsporia, the bald patch looks like a clipper, because the hair breaks off at the same height (2-4 mm), and with trichophytosis, the hair can be broken off at different heights, from which the so-called “burnt forest stumps” are determined in the bald area. There are also very severe infiltrative – suppurative forms of trichophytosis associated with the defeat of a zoophilic pathogen. Then the head is covered with purulent crusts, after removing which you can see a bald spot.

A separate group consists of lesions of the skin and mucous membranes with yeast-like fungi of the genus Can did a. These diseases are called candidiasis. The most common pathogen is Can dida albicans . This pathogen is classified as conditionally pathogenic. This means that the mere fact of its presence on the skin or mucosa is not an indication for its immediate elimination. However, in some cases, when for some reason especially favorable conditions are created for the development of this infection, a disease, better known as thrush, may occur. Among the most common reasons for the development of thrush is irrational antibiotic therapy, when, after the appointment of potent antibiotics, the growth of microbes is suppressed, and since antibiotics do not act on fungi, they get the opportunity to take the place of the destroyed “neighbors”.

Another reason for the uncontrolled growth of a normal inhabitant of the human body may be the presence of special conditions on the skin or mucous membranes that promote the growth of fungi. For example, it can be an increased level of glucose in diabetic patients or malocclusion due to missing teeth in infants and the elderly. One of the important reasons contributing to the development of candidiasis is an immunodeficiency state. So, with AIDS, patients have very severe generalized candidal lesions not only of the skin, but also of internal organs, in particular, various sections of the intestine. When the process is localized on the mucous membranes of the oral cavity or vagina, a curdled coating appears, which is easily removed, exposing erosion underneath. All this is accompanied by a feeling of itching and burning. It is also possible that this fungus can damage the interdigital folds, nails, and the corner of the mouth (candidiasis jam).

As for the group of so-called deep mycoses, this is a special group of diseases (chromomycosis, blastomycosis, antinomycosis, etc.), standing apart from other fungal pathologies. When infected with these fungi, a severe pathology occurs with damage to the skin and internal organs, which, as a rule, is subject to surgical treatment.

Treatment of fungal infections should of course be carried out by a specialist. But there are certain principles that would not hurt to know even an amateur. It would seem that such a wide variety of fungal diseases should require completely different approaches to therapy. Of course, the principles of treatment of mycoses vary depending on the nature of the lesion. It is impossible to approach the problem of damage to the mucous membranes and nails, or hair and smooth skin in the same way. However, modern antifungal drugs have a high degree of versatility, since their action is based on the suppression of the development of the fungal cell wall, and its structure in fungi of different species does not differ so much. However, there are and are still widely used drugs that are effective only against certain types of fungi. For example, nystatin and levorin can be used exclusively for the treatment of candidiasis. Conversely, universal antifungal drugs can be successfully used to treat not only fungal infections, but also pseudomycoses caused by bacteria. An example of such a universal tool is exoderil. It can be used as an ointment for the treatment of keratomycosis, including erythrasma, or ringworm. In the form of a solution, it is successfully used to treat onychomycosis. At the same time, only local treatment is sufficient to achieve the effect and, as a rule, there is no need to use drugs inside. Of course, there are situations when the effect cannot be achieved without a general systemic treatment. This is usually associated with immunodeficiency, extensive multifocal lesions. Then antifungal drugs are prescribed orally. But in such cases, of course, the treatment should be carried out under the supervision of a specialist doctor with monitoring of the state of the liver and taking into account all possible contraindications.

Prevention of fungal infections and, above all, personal issues are very important.

• Do not wear other people’s shoes, especially bare feet.

• It is necessary to use slippers in places with a high probability of contact with fungi (baths, swimming pools, etc.