Microscopic fungi are part of the human environment, and their total number on the planet approaches 1.5 million. Currently, about 69 thousand species of mushrooms have been studied, 400 of them are pathogenic for humans and cause diseases, united by the term “mycoses”.
The most common type of fungal infection of the skin and mucous membranes are superficial mycoses, which include keratomycosis, dermatomycosis, candidiasis. Keratomycosis is a group of fungal skin diseases in which pathogens affect only the stratum corneum of the epidermis. In our latitudes, the most common is multi-colored lichen, the causative agent of which is the fungi of the genus Malassezia. Folliculitis, rare disseminated infections, and seborrheic dermatitis also belong to skin lesions caused by these fungi. The role of fungi of the genus Malassezia in the initiation of exacerbations of some chronic dermatoses (atopic dermatitis, psoriasis, rosacea, etc.) is discussed [1].
Dermatomycosis
A very common type of dermatomycosis is characterized by a chronic, recurrent course of foot mycosis. Its main causative agent is Trichophyton rubrum. In addition to the feet, this fungus can affect large folds, vast areas of smooth skin (up to erythroderma) [2, 3]. Infection usually occurs in showers, swimming pools, baths, when using household items common with a sick person (towels, sponges, shoes, socks, etc.). Predisposing factors are excessive sweating of the feet, flat feet, tight shoes. The process for a long time (many months and years) can be asymptomatic or manifest minor symptoms in the form of mild peeling, maceration of the epidermis in the interdigital folds, peeling on the arch of the feet, periodically appearing minor itching. The chronic course and unsystematic short-term, and therefore unsuccessful treatment attempts lead to the unjustified conclusion that the disease cannot be cured. On the other hand, a prolonged asymptomatic course creates the illusion that the disease is not dangerous and does not create any problems. Both of these conclusions are completely wrong, since the infection continues to spread. The patient is a source of infection, especially for family members and for those with whom they use showers and a pool. In addition, violations of the integrity of the skin can become the entrance gate to a bacterial infection. Significantly increases the allergization of the body. The attached secondary microbial flora aggravates the course of fungal disease, further reducing the body’s defenses. In contact with mushrooms, such flora acquires increased resistance to antibacterial agents. The natural result of foot mycosis is a fungal infection of the nails – onychomycosis. Candidiasis is an infectious disease of the skin, mucous membranes and internal organs caused by the pathogenic effects of yeast-like fungi of the genus Candida, usually Candida albicans. The transition of these fungi from a saprophytic state to a parasitic state, and candidacy in candidiasis is facilitated by the inferiority of specific and non-specific defense factors.
It is not by chance that candidal lesions accompany immunodeficiency, infectious diseases, endocrinopathies, metabolic diseases, blood, and tumor processes. The World Health Organization attributes long-term recurrent candidiasis to AIDS markers. Most often, cutaneous candidiasis is manifested by the defeat of large folds, interdigital erosion, as well as paronychia. Especially difficult and prone to recurrence of candidiasis of the mucous membranes [1, 2].
Diagnosis The
clinical diagnosis of mycotic lesion must be confirmed laboratory. To detect the causative agent, a microscopic examination is carried out as follows: the material (scales, hair from the lesion) for dissolving keratin is treated with a 10-30% solution of caustic alkali and examined under a light microscope. Filamentous fungal hyphae or budding cells are markers of fungal infection. In the future, to clarify the type of pathogen fungus, a cultural study is carried out by sowing pathological material on nutrient media (original Saburo, Saburo on yeast water, Saburo without glucose). Crops are placed in a thermostat at 300C. Culture is determined on the basis of the study of the shape, surface character, color of the colonies and their microscopic features [1, 3]. Treatment of Mycosis of the skin even at the very early stages of development require compulsory treatment, the leading role in which belongs to antifungal drugs. Considering the chemical structure, four main groups of antifungal drugs are distinguished: polyenes (nystatin, natamycin, amphotericin B), azoles (itraconazole,
fluconazole, ketoconazole, isoconazole, econazole, bifonazole, clotrimazole), allylamines (terbinafine, naphtholphine). Other drugs are also used that are not interconnected by chemical structure (griseofulvin, undecylenic acid, chloronitrophenol, etc.) [3, 4]. Among antifungal agents in recent years, azoles in general and ketoconazole in particular have become very popular among specialists. The drug has a wide range of fungistatic and fungicidal activity against dermatophytes, yeast and molds. Its effect on the cell is due to the fact that it inhibits the synthesis of ergosterol, triglycerides and phospholipids – the necessary components of the cell wall of the fungus, blocks the germination of fungal spores into the mycelium. The drug acts on the oxidase-peroxidase system of fungi, leading to the accumulation of endoperoxides that destroy the organelles and the fungal cells themselves, which greatly facilitates their phagocytosis [1, 3, 4]. Ketoconazole can be used both for oral administration and for external use in the form of a cream. Inside, one tablet is prescribed once a day with meals with a small amount of water. The duration of treatment depends on the nosological form. Treatment is carried out under the mandatory control of the functional state of the liver and kidneys. The most effective tablets are in the treatment of patients with candidal lesions of the skin and mucous membranes, candida paronychia, mycosis of large folds, and versicolor. The drug quickly stops the phenomenon of pustulization, which is explained by the pronounced fungicidal, anti-inflammatory and antibacterial effect of ketoconazole. Ketoconazole cream is very convenient to use, because thanks to its powerful and long-lasting antifungal and antibacterial effect, it can be applied in a thin layer to affected skin areas only 1-2 times a day,
without having an unpleasant odor and without contaminating the laundry. Typically, the duration of treatment with a topical preparation is 4 weeks. The ketoconazole cream shows the greatest therapeutic efficacy in the treatment of pityriasis versicolor, smooth skin microsporia, candidiasis and foot mycosis, providing in most cases the clinical and mycological recovery of patients. The cream is well preserved, does not cause an allergenic and irritating effect on the skin, even in patients with a history of allergic manifestations. It is also advisable to use it for skin mycoses complicated by a secondary bacterial infection. The use of the representative of azoles ketoconazole in everyday clinical practice significantly expands the possibilities of treating fungal skin lesions, providing high efficiency in the treatment of even complicated clinical forms. The drug can be successfully used for the prevention of superficial mycoses with an increased risk of their development (persons from the “risk” group: military personnel, athletes, workers of hot shops, miners, etc.).