Athlete

Athlete's foot is a fungal disease of the skin, mainly large folds and feet and nails, caused Epidermophyton floccosum (Fig. 1-8), Epidemiological importance of violation of sanitary regime showers, baths: remaining from patients flakes of skin on wet wood for a long time remain viable fungi, being a reservoir of infection in the General population. In the pathogenesis of neurohumoral violations, sweating, rash.
Athlete's inguinal - femoral and other large skin folds appear defined, severely itchy, red, sometimes merging spots, swollen on the periphery, where there peeling, vesicles, brown. During the first acute, chronic then.
Athlete's foot digidrozitrat, similar to a skin disease, disgidros (see). In the thick skin of the foot there elastic bubbles, reminding cooked grain sago; skrivas, they leave erosion, bordered scalloped collar exfoliated epidermis. For relapsing, aggravation more frequently in warm time of the year.

athleteFig. 1. Inguinal athlete's right. Fig. 2. Athlete's squamosal. 3. Epidermofitia. Fig. 4. Athlete's disgestrotical. Fig. 5. Eczematous athlete on the rear foot. Fig. 6. Interdigital intertriginoznoy athlete's foot. Fig. 7. Athlete's nails. Fig. 8. Epidermofitia disgestrotical.


Other clinical forms of plicarum stop are essentially phases of development, successive: interdigital athlete - type rash; ackzemopodobne athlete - appearance of vesicles and soak; giperkeratoza athlete - expressed keratinization; acute athlete - expressed inflammation and erased form is barely visible peeling.
Athlete's nails somewhat different from other onychomycosis (see) localization on the feet and yellow subungual corneal deposits.
When aggravation of plicarum occur an allergic rash - epidermofitia that different clinical manifestations and remind sometimes listed forms of plicarum, however, unlike them, epidermofitia are arranged symmetrically, disappear without treatment following a setback plicarum, fungi do not contain.
The preliminary diagnosis is based on the clinical picture, precise laboratory analysis emitting fungi culture (see parasitic Fungi), which is especially important, as athlete has many similarities with other fungal infections (see) and streptococcal intertrigo with the defeat of large folds of skin, and with the defeat stop with mycosis caused mainly by Trichophyton. Among the last great originality different infections caused by fungus red Trichophyton. Clinical manifestations close to chronic trihofitii: on the palms and soles hyperkeratosis, onychomycosis not only on the fingers of legs, but also hands-follicular papules on the shins, infiltrative psoriatiformnye plaques on the head.
The course of chronic.
The forecast is favorable for life.
Treatment. When epidermophytia plicarum - 2% iodine alcohol solution or aniline dye in a few days; then in 2-3 weeks 2% sulfur, salicylic, 3-10% tar ointments, powders of oxide of zinc and talc with 10% boric, acid and tannin. When squamous and erased plicarum - externally alcoholic solutions of aniline dyes (1-2%), salicylic acid (2%), iodine alcohol solution (2-5%); liquid Castellani. When disgestrotical and intertriginoznoy the plicarum-bath (temperature of 38 degrees) with a solution of potassium permanganate (1 : 6000 - 1 : 8000) for 10-15 minutes; bubbles to open, lubricate alcoholic solution of aniline dye. When expressed inflammatory effects - lotions (see Feature). Then ointment - linkungan, undecen, dekumanova, 2% sulfur, salicylic, 3-10% sulfur-tar and others, again 2-3 week course with 1-2-week break and change medications. In acute plicarum and allergic rashes first, you need total desensitizing treatment: 10% solution of chloride calcium, 30% solution of sodium thiosulfate (intravenous 10 injections), diphenhydramine 0.03 g 3 times a day, vitamins, etc.. the Treatment of plicarum smooth skin caused by red Trichophyton, the same as chronic trihofitii (see); the impact of nails, except local treatment and removal of the affected nails using the patch epilinovogo, appoint griseofulvin 0.25 g 4 times daily (for 1 month), then a day later in the same dose (1 month). and twice a week to complete regrowth of healthy nails.
Prevention. Sanitary-educational work; timely detection and treatment of athlete, regular disinfection of footwear, socks, subjects of care of plicarum (see Disinfection, ringworm); premises and equipment baths, pools, showers (5% solution of bleach, wash with soap); the use of rubber Slippers in the bath, swimming pools, private towel for the feet. Treatment sweating; patients should be regularly to boil socks and stockings, do not wear synthetic fabric.
Patients will be screening.


Athlete's foot (epidermophytia) - one of the most common fungal infections of the skin and nails.
The athlete's called three types of fungi of the genus Epidermophyton: E. inguinale (synonym E. floccosum) - exciter epidermophytia Plicarum; E. Kaufmann-Wolf (synonym: Trichophyton interdigitale, mentagrophytes)that causes athlete's foot with a single defeat of nails of the feet; that is, rubrum (synonym: Trichophyton rubrum, purpureum), which affects the skin and nails of the feet and hands, skin folds, the skin of the trunk, extremities, face, so-called rubrofitia. In the pathological material epidermofitony have views septate or sporulirovannyh branching filaments mycelium; disputes rare.
Histologically, the mycelium found in the stratum corneum, in the thick of all of the nail plate; thread mycelium, penetrating between the cells of the granular layer and into the lymph cracks, often cause inflammation of the underlying layers of the epidermis.
Athlete's foot is distributed mainly in the baths, showers, basins and in the conditions of family contact when they use the same shoes, socks, stockings, scissors for cutting the nails, washcloth, pelvis, back vessel, an oilcloth of it. p., pedicure, manicure medizintechnologie tools.
In the pathogenesis of plicarum play a role increased sweating, skin injury, platypodia, disorders of blood circulation of the limbs, exchange, disorders of Central and peripheral nervous system. Permanent use of rubber shoes, stockings, socks made of synthetic materials, high temperature and humidity of the environment also contribute to the development of plicarum.
Athlete's sick just people. Transferred athlete leaves no immunity. Epidermophyton Kaufmann-Wolf possess sensitizing properties, causes allergic reactions - epidermofitia. The incubation period lasts indefinitely, as epidermofitony can long exist in the stratum corneum of the skin, without causing clinical manifestations. There are an athlete's groin, athlete's foot and rubrofitia stop.
Inguinal athlete is localized in the inguinal-femoral folds less axillary and under the Breasts in women; looks red swollen inflammatory stains, round, and merging them scalloped shape - with clear boundaries, sharply hyperemic, peripheral cushion on which arise pustules, crust (Fig.. 1). Occasionally strikes interdigital folds, as if plicarum stop. Severe itching. During the first acute, chronic then.
Athlete's foot is localized in the area of the arch of the foot, exterior and interior of its edges (Fig. 4), in III and IV, rarely folds between toes. Often hits the nail I and V of the toes.
Clinical forms: athlete squamous - annular plate and peeling, minor inflammation; athlete disgestrotical, or vezikuleznaya,- rash on the same area of the foot of surface and deep located in the skin bubbles and blisters with transparent, fast mathewson content, often opened with the formation of erosion, weeping and ackzemopodobne foci; moderate itching; athlete interdigital, or intertriginoznoy (Fig. 6),- peeling, bubbles, erosion, maceration of the skin in contact surfaces of the fingers, cracks in the interdigital transition folds, severe itching; athlete's nail - yellow spots and stripes in the interior of the nail, usually in the Central part of the plate, nail thickens, develops subungual hyperkeratosis, then the record crumble; epidermofitia - secondary, allergic rashes, often vezikuleznaya not containing fungi, mainly on the lateral surfaces of the fingers, palms and palm surfaces of the fingers (Fig. 4). The course of chronic, relapsing, with exacerbations more frequently in warm time of the year.
When rubrofitia stop the fungus can infect any part of the skin, all the nails of the feet and hands, all interdigital folds. Allergic rash, usually absent. On the soles and palms skin is slightly redness, corneal layer is thickened, peeling has a ring-shaped plate and, in the furrows mocoviny character; bubbles rare, deep, usually not opened. Unlike plicarum, affected the entire surface of the soles and palms, the back surface of the feet and hands (Fig. 5 and 7). In folds between toes of the feet (and sometimes hands) - hyperkeratosis, reasonable maceration, peeling the side surfaces of the fingers (children sometimes weeping), cracks in the interdigital folds, very painful itching. Nails quickly amazed one at another; yellow spots appear in the thick side, proximal and distal edge of the nail. The fungus quickly grows entire thickness of the plate, penetrating into the nail bed. The nails are cut on the side edges, getting hooked form; separated from the Lodge at the free edge (Fig. 6 and 8).
On the skin of the trunk hyperemic pockets in the form of rings, half-rings, open the rings with peripheral, often intermittent cushion on which you can see small papules and brown. The lesions in the inguinal folds, unlike epidermophytia plicarum, often spread on the area of the scrotum, perineum, pubic area, buttocks, merge, forming large areas scalloped shape. On the skin of the lower legs, rarely hips, buttocks often found acne-nodular form of rubrofitia in the form of follicular knots and units, sometimes with fungus lanugo hair. Rash simulate pyoderma, indurativnyy erythema and other chronic, sluggish, resembling chronic trichophytosis adults.
Diagnosis of clinical must be confirmed by detection of threads mycelium microscopic examination of caustic lye flakes, tires bubbles, scrapings from deep parts of the nail. Planting on Wednesday Saburo (see Saburo environment) determines the form of the pathogen. It is necessary to differentiate the athlete from eczema, pyoderma stop, pustular psoriasis.
Treatment epidermophytia plicarum begin with lubricating 1-2% alcoholic iodine solution. During the next 2-3 weeks apply 2-3% salicylic-sulphur ointment, powder of zinc oxide and talc with 10% boric acid and tannin. When disgestrotical the plicarum large bubbles pierce, impose wet-drying, bandages with etakrydina, furatsilina, 0.25% solution of silver nitrate, grease with liquid Castellani; then apply the ointment linkungan, undecen, dekumanova, sulfur, salicylic, mikoseptin and nitrofungin in the form of repeated 2-3-week courses with intervals of 1, 2, 3 weeks and change of drugs in each course. Allergic rashes - calcium chloride, sodium hyposulphite, diphenhydramine, pipolfen, in severe cases, prednisolone. Treatment of rubrofitia basically the same as chronic trihofitii (see), using the method of detachment by A.. When disgestrotical the plicarum and rubrofitia with the defeat nails - antibiotic griseofulvin inside of 0.25 g (or griseofulvin-Forte 0.15 grams) 4 times a day for the first month, every day, the second - in a day and continue twice a week to complete regrowth of healthy nails. Necessarily local treatment of all foci of mycosis and removal of infected nails (see Trichophytosis, Onychomycosis).
Prevention: use of rubber Slippers, sandals in the bath, shower, separate bath towel doormat, drying powders, regular disinfection of footwear, socks. Inspections of all family members of the patient, the examination and treatment of athlete's bathhouse attendants; disinfection of premises and equipment baths. Sanitary-educational work.

Fig. 4. Epidermofitia brushes.
Fig. 5. Rubrofitia palm.
Fig. 6. Rubrofitia nails of his hands.
Fig. 7. Rubrofitia soles.
Fig. 8. Rubrofitia toe nail.