Get rid of the fungus – effectively and forever

Inflammatory diseases of the genital organs negatively affect a woman’s reproductive function and often cause infection of the fetus and newborn. Irrational use of drugs suppresses local immunity, which reduces the resistance of the vaginal biotope and contributes to the growth and progression of the number of colonies of pathogenic microorganisms.

The problem of vaginal candidiasis (VC) has acquired particular relevance. Its frequency in recent years has more than doubled, making up in different regions of Ukraine from 20 to 50% in the structure of infectious pathology of the lower genital organs.
There is evidence that with recurrent VC, the gastrointestinal tract serves as a reservoir of fungi and a source of vaginal reinfection. According to another point of view, the activation of endogenous fungal infection due to a violation of the protective role of the normal microflora of the vagina plays a leading role in the development of VC. VK often manifests itself with local or systemic antibiotic use. Apparently, a decrease in the titer of lactobacilli with the loss of the characteristic acidic environment of the vaginal biotope forms favorable conditions either for the primary penetration of fungi into the vagina, or for their intensive reproduction. VC develops against the background and exacerbates local suppression of cellular and humoral immunity under the influence of a high level of prostaglandins E2 and a decrease in interleukin-2 production. In addition, due to the presence of estrogen-binding proteins in Candida albicans, there are disturbances in the effects of estrogen at the level of vaginal cells. This damages the protective barrier on the part of the vaginal epithelium due to a decrease in the colpotrophic effect of estriol. A decrease in the content of interleukin-2 also has a systemic effect in chronic candidiasis, which leads to a violation of the synthesis of neurosteroids and neurotransmitters in the central nervous system.

Candidal infection impairs the proliferation and maturation of oligodendroglial elements as the main source of synthesis of biologically active substances in the brain, and most patients with chronic candidiasis have polyendocrine disorders, including premenstrual syndrome. The presence of VC aggravates the course of the underlying disease in women with menstrual irregularities, hyperplastic endometrial processes, climacteric syndrome.

The most common in the clinic are candidal vulvovaginitis, cervicitis and urethritis.

It is customary to isolate the acute form of VC, when the duration of the disease does not exceed 2 months, and the chronic, lasting more than 2 months. Currently, chronic vaginal candidiasis accounts for about 50-60% of all cases of the disease, and the recurrence rate reaches 25%.
Chronization of VC can be facilitated by a combination of candidiasis and trichomoniasis, since Trichomonas have the ability to keep undigested pathogenic microorganisms, including Candida, for a long time, forming a kind of “reserve” for reinfection.

Endocrine pathology, primarily disorders of carbohydrate metabolism (diabetes mellitus, metabolic syndrome X), as well as hyperandrogenism often accompanying these diseases, obesity, taking combined oral contraceptives and menopause contribute to the accumulation of glycogen in the vaginal epithelium. This allows the yeast fungi to persist on the cells of the deep layers of the vaginal epithelium, complicating therapy and facilitating chronicity. At the same time, Candida albicans is more often found in patients with type I diabetes, and Candida glabrata in women with type II diabetes.

Clinically, VC (usually acute) is manifested by itching and burning in the vagina, profuse cheesy leucorrhoea, and dyspareunia. On examination, there is swelling and hyperemia of the vaginal mucosa with whitish deposits of pseudomycelium filaments and desquamated epithelial cells, long-term non-healing abrasions and ulceration. However, it should be borne in mind that in about half of the cases, chronic candidiasis has an erased oligosymptomatic course.

The diagnosis is based on complaints, history data, objective research and laboratory methods, primarily bacterioscopy of vaginal discharge. Laboratory confirmation is extremely important, since the opinion formed by the majority of gynecologists “candidiasis is abundant cheesy leucorrhoea” is only partially correct. Only in half of the cases, this clinical sign is due to vaginal candidiasis [6].
The presence of mycelium and spores in wet smears treated with 10% KOH solution confirms the diagnosis. It is possible to use a bacteriological culture method, the material for research in which are whitish films and tiny plaque from the mucous membrane of the vagina, cervix and external genital organs. The use of bacteriological express diagnostic kits is very promising, it does not require a lot of time, it is not difficult to carry out such analyzes, but it is associated with certain material costs. They are based on a qualitative reaction of the nutrient medium, leading to its staining brown in the presence of Candida growth.

Depending on the state of the vaginal microcenosis, three forms of Candida infection of the vagina are distinguished:
Asymptomatic candida infection, in which there are no clinical manifestations of the disease, yeast-like fungi are detected in a low titer (less than 104 CFU / ml), and lactobacilli are absolutely dominant in the composition of microbial associates of vaginal microcenosis. quantity;
True candidiasis, in which fungi act as a mono-pathogen, causing a clinically pronounced picture of vaginal candidiasis. At the same time, in the vaginal microcenosis, Candida fungi are present in a high titer (more than 104 CFU / ml) along with a high titer of lactobacilli (more than 106 CFU / ml) and in the absence of diagnostically significant titers of any other opportunistic microorganisms;
Combination of VC and bacterial vaginosis, in which yeast-like fungi are involved in polymicrobial associations as causative agents of the disease. In these cases, yeast-like fungi (more often in a high titer) are detected against the background of a massive amount (more than 109 CFU / ml) of obligate anaerobic bacteria and gardnerella with a sharp decrease in the concentration or absence of lactobacilli.
Treatment of VC is carried out in several directions at once:
elimination or weakening of the influence of risk and pathogenetically significant factors;
etiotropic therapy with antimycotic drugs;
restoration of normal microflora of the vaginal biotope.
In this case, both specific and non-specific methods of treatment are used.
Nonspecific methods of therapy include well-known drugs: sodium tetraborate in glycerin, Castellani liquid, gentian violet, etc. The action of the above drugs is based on the maximum removal of mycelial forms of the fungus from the crypts of the vagina, as well as on violation of the process of attachment of the fungus to the vaginal wall and inhibition of reproduction. It should be emphasized that all these drugs are not etiotropic due to the fact that they do not possess fungicidal and fungistatic effects. In addition, the disadvantage of these methods is the need for medical procedures by medical personnel, multiple treatments, which in turn can lead to the fact that there is a risk of delay in the crypts of the vagina of fungal cells, and hence more frequent recurrence of the process.

Specific antifungal agents are available in dosage forms for internal and external use. They are represented by preparations of polyene (nystatin, levorin, amphotericin B, natamycin), imidazole (ketoconazole, clotrimazole, bifonazole) and triazole (fluconazole, intraconazole) series, as well as drugs from other groups (griseofulvin, nitroflungintozin), …

The action of fluconazole is aimed at inhibiting the sterol biosynthesis of the fungal membrane. The drug binds a group of heme dependent on cytochrome P-450 of the enzyme lanosterol-14-demethylase of the fungal cell, disrupts the synthesis of ergosterol, as a result of which the growth of fungi is inhibited. In this case, fluconazole selectively acts on the fungal cell, does not affect the metabolism of sex steroids. Concomitant use of fluconazole with oral contraceptives does not affect the effectiveness of the latter.

The leading triad of pathogens (C. albicans, C. parapsilosis, C. tropicalis) is the cause of more than 95% of candidiasis of all localizations and among the fungi of the genus Candida it is most sensitive to fluconazole.

It should be emphasized that the pharmacokinetic characteristics of drugs containing fluconazole, when taken orally and intravenously, are similar, which distinguishes them from other antimycotic drugs. The bioavailability of fluconazole is high and reaches 94%. Fluconazole is well absorbed in the gastrointestinal tract, penetrates the histohematogenous barriers. Its level in blood plasma after oral administration reaches 90% of that with intravenous administration.
It is important to note that the absorption of the drug from the intestine is independent of food intake.

Considering the long half-life of fluconazole from plasma (about 30 hours), this drug can be administered once, which determines its advantage over other antimycotic agents (already 2 hours after taking the drug, the therapeutic concentration in plasma is reached, and after 8 hours – in the vaginal contents) … The activity persists for at least 72 hours.
Recently, there has been a decrease in the effectiveness of all antimycotics and triazoles in the treatment of Candida non-albicans, which sometimes forces a change in the traditional scheme of prescribing fluconazole in the direction of increasing the “loading” dose to 200 mg.

While taking antimycotic drugs, patients with chronic vaginal candidiasis need a protein-vitamin diet with limited carbohydrate intake. The appointment of multivitamins and topical probiotics, for example, dried microbial mass of lactobacilli, is also shown. The use of a vaccine made from inactivated minus variants of lactobacilli has become widespread. Their use in 90% of cases provides a confirmed bacteriologically clinical recovery.

In the “first aid kit” of every obstetrician-gynecologist there is an arsenal of favorite means and treatment regimens for VC. At the same time, the leading role in their assessment is assigned to compliance in patients. Fluconazole is one of the few drugs that is not only effective in treating candidiasis, but also safe. This gives reason to consider it the # 1 drug in monotherapy. Fluconazole is preferable from the standpoint of pharmacoeconomics, it is safe in the treatment of VC, including in patients with a chronic recurrent form of this disease.

Vulvovaginal candidiasis (VVC) is one of the most common diseases, affecting up to 75% of women of childbearing age. Many questions of its etiology and pathogenesis, including the development and formation of chronic and complicated forms, remain controversial and not fully resolved. 

The widespread use of EBC is associated with the effect of various environmental factors on the woman’s body, a change in the ecological situation, the widespread use of antibiotics and their interaction, which leads to a decrease in the body’s immunological defense. Other predisposing factors are also important, such as radiation therapy, long-term use of oral contraceptives, corticosteroids and cytostatics, metabolic and endocrine system disorders, chronic diseases of the gastrointestinal tract, hypo- and avitaminosis, immunodeficiencies that developed against the background of an infectious or hematological disease , oncological process, intoxication, etc.
KVV – payment for civilization. Its development is facilitated by wearing underwear made of synthetic fabrics that tightly fit the body, when a microclimate with high humidity and temperature is created, leading to maceration of the stratum corneum and creating favorable conditions for the development of local microflora, including intestinal microflora. In this microflora among the fungi of the genus Candida, the most common causative agent of CVC C. albicans is over 95%.

Fungi of the genus Candida are conditionally pathogenic microorganisms and can be isolated from the vagina of a practically healthy woman. But when exposed to aggravating factors, they acquire pathogenic properties and become the cause of CVI. Usually, VVC occurs endogenously as a consequence of dysmetabolic disorders and dysfunction of the immune system, but infection is also possible through sexual contact, although this point of view is still controversial and the sexual route of transmission is currently not considered significant.

There are uncomplicated and complicated forms of CVI. Antifungal susceptible C. albicans is the main cause of nearly 90% of uncomplicated mild to moderate EBC cases. In complicated forms of CVI, the disease acquires a severe course with frequent recurrence (more than 4 times a year) and is observed, as a rule, in women with extragenital pathology. The main causative agent of complicated CVI is Candida spp., Not belonging to the C. albicans species.

The ubiquitous number of patients with VVC dictates the need for timely diagnosis and rational etiotropic therapy.
The drugs used in the treatment of VKK are intended for both local and / or systemic use.

Systemic antifungal therapy is prescribed in the case of a pronounced clinical picture of IHC, chronic course of the disease, resistance to local therapy, and immunodeficiency (HIV infection). The most effective drugs of systemic action are azole compounds: fluconazole and itraconazole.

In the case of an uncomplicated course of IHC, drugs of local action are used for 6-7 days or drugs of systemic action (fluconazole 150 mg once, itraconazole 200 mg 2 times a day for 3 days).

In cases of a complicated course of VVC, the course of therapy should be doubled, while the duration of the use of local drugs should be 14 days. Systemic antimycotics (fluconazole, itraconazole) in all cases of chronic recurrent VVC are recommended as the main course of therapy.

In recent years, there has been a decrease in the sensitivity of opportunistic microorganisms to antibiotics. In this regard, new, pathogenetically grounded methods of treatment of VKK and mixed bacterial-fungal infections of the vagina are being developed, including with the local use of antiseptics. Gynecologists and their patients have at their disposal a large number of antifungal drugs and antiseptics, suitable or specially designed for the treatment of VVC (both as prescribed by a doctor and without a prescription). While self-medication with systemic antimycotics is becoming more and more popular, local therapy remains the most demanded and safest method of treatment. Specially conducted studies have shown that specialized intravaginal forms of antimycotics are currently most in demand, occupying more than half of the methods used for self-treatment and more than a quarter in treatment according to the doctor’s prescriptions in monotherapy.

Currently available topical antifungal agents include vaginal suppositories / balls or tablets, and special vaginal creams. The choice of a drug in each specific case should depend on the severity of the clinical course of VKK, the presence of mixed infection, concomitant pathology, and predisposing factors. The active ingredients generally include imidazole or polyene antimycotics. The latter include various preparations of nystatin and natamycin. Among the imidazoles, clotrimazole preparations are most commonly used. In addition, there are vaginal forms of miconazole, econazole, isoconazole, omokonazole and other imidazole derivatives.

Despite the variety of existing methods of treatment of vulvar and vaginal candidiasis, their frequency does not tend to decrease. This circumstance encourages practitioners to constantly search for and test new medications
offered by the pharmaceutical market for the treatment of this pathology.

Since the highly active antifungal imidazoles were introduced for the treatment of vulvovaginal candidiasis about 20 years ago, two important developments have occurred: one has expanded our knowledge of the pathogenesis of the disease, and the other has changed our view of the required duration of effective treatment.

Imidazoles remain the first-line treatment for vulvovaginal candidiasis. However, it is recognized that up to 50% of patients stop treatment after experiencing relief of symptoms. To improve adherence, physicians developed a trend to shorten drug use times, and as a result, treatments with miconazole nitrate and clotrimazole were shortened from the initial 14 days to 7 and 3. Ultimately, a single dose regimen was developed. , thanks to the creation of a new bioadhesive matrix in the form of a prolonged-release cream for intravaginal use with 2% butoconazole nitrate (butoconazole 1-BSR). Butoconazole nitrate was selected for its very acceptable safety profile and proven clinical efficacy. Meticulous analyzes have shown its broad spectrum of antifungal activity: it has consistently shown high activity against the most important eight non-albicans Candida species. Butoconazole 1-BSR outperformed the currently used imidazoles (miconazole, clotrimazole, ketoconazole, and terconazole) in inhibiting the growth of C. albicans and for pathogenic Candida species other than albicans.

Effective therapies using a single dose of potent fungicidal imidazoles seem to be nearly ideal for the clinical suppression of vaginal mycoses.
For the doctor, they actually guarantee the patient’s full compliance with the treatment regimen. Single dose therapy minimizes the inconvenience of long-term therapy plans. Repeated doses of the drug are especially unpleasant for the physically active or frequent traveler. Additional inconveniences are drug leakage and possible restriction of sexual activity during repeated doses of the drug.

In this regard, a vaginal cream with butoconazole 1-BSR (in 2% concentration) is of particular interest, which has the ability to adhere to the surface of the vaginal mucosa for a long period of time with a continuous release of the active substance, which ensures constant contact of the active active substance with the pathogenic agent and as a result, its high antifungal activity. The cream does not leak out of the vagina or cause irritation. Clinical studies and experience confirm that this cream lasts twice as long in the vagina as a conventional vaginal cream, and its systemic absorption is three times lower. A single intravaginal dose of butoconazole (2%) in a prolonged-release cream provides a speed of healing comparable to the speed of the known seven-day regimen of therapy with daily doses of miconazole nitrate (2%) in a regular vaginal cream. An additional advantage of butoconazole 1-BSR is the significantly faster relief of severe symptoms of vulvovaginal candidiasis, which is already detected on the first day after administration of the drug.

Butoconazole is an antifungal imidazole proven to be effective in the treatment of VKK. The guaranteed patient compliance with the single application of the drug, its efficacy and very favorable safety profile support its use in the treatment of VKK in clinical practice.

Candidiasis is an infectious disease affecting the skin, mucous membranes and / or internal organs, caused by yeast-like fungi of the genus Candida. In the structure of nosocomial infections in debilitated patients, candidiasis is up to 12% and in the structure of infectious infectious mortality – up to 40%. The real clinical significance of this pathology is much higher: undiagnosed cases, an increase in hospital stay by 30 bed-days, significant economic losses for the treatment of visceral forms. The rapid growth (almost 11 times) in recent decades in the frequency of candidiasis in inpatients with various immunity disorders gave the specialists from the Center for Disease Control in Atlanta (USA) to call the current situation a nosocomial epidemic .

Microbiology
The main pathogen is Candida albicans, which is associated with more than 80% of candidiasis. But the infection can be caused by other species: C. tropicalis, C. parapsilosis, C. krusei, C. lusitaniae. Yeast-like fungi do not form true mycelium. The length of the pseudomycelium reaches 12-16 microns. Cells multiply by germination and multipolar budding. They can grow on agar culture media and are aerobic. Favorable conditions for growth 21-370C, pH 6.0-6.5. At 400C, growth is inhibited, at 500C, cells die, complete death with a few minutes of boiling.

Often, fungi are detected as saprophytes in the microflora on the skin and mucous membranes of the respiratory and gastrointestinal tract, and the vagina. Widely distributed in nature (fruits, vegetables, dairy products, etc.). 

Pathogenesis Yeast-like fungi of the genus Candida in small quantities can be part of the natural microflora of the mucous membranes, and therefore an important role in the development of candidiasis is played by violations of the competitive interaction of fungi with bacteria of the normal microflora of the host, the integrity of the skin and mucous membranes, phagocytosis, immunological reactions, hormonal balance, distress. Generalization of fungal infection is associated with a change in the relationship between the virulence of the fungus and the patient’s immunity.
Almost all parts of the immune system are involved in protection against fungal infections. Neutrophils, macrophages and eosinophils phagocytose candida blastospores, neutrophils and monocytes – their pseudohyphae. Disseminated candidiasis develops in patients with quantitative and functional defects of neutrophils, suppression of the T-cell link of immunity. A deep defect in the T-cell system explains the predisposition to the development of candidiasis in patients with AIDS. Specific conditions include drug neutropenia during treatment with cytostatics and immunosuppressants.
The disease usually occurs as a result of an endogenous infection. The penetration of the fungus into the tissue occurs when the skin and mucous membranes are damaged, for example, with perforations of the gastrointestinal tract, trauma, surgery, the introduction of catheters into the vessels, with peritoneal dialysis, intravenous drug administration, etc. intestinal dysbiosis.
The causative agent has allergenic and antigenic properties, but antibody titers are high only in visceral candidiasis.

Clinic
Depending on the degree of lesion, candidiasis can be superficial and deep. Superficial includes cutaneous, oropharyngeal, urogenital and is characterized by lesions of the corresponding mucous membranes. The most dangerous are disseminated candidiasis and deep visceral forms.
In the cutaneous form, the disease manifests itself in the form of small vesicles, in the place of which erosions quickly form with a shiny, moist, dark red surface, clear irregular boundaries, with a border of exfoliating macerated epidermis. Characterized by “dropouts” on healthy skin in the form of the smallest erosions with a fringe along the edges and erythematous, scaly spots in the center. The third and fourth interdigital folds of the hands and feet, the inguinal and axillary regions, and the anus may be affected. Paronychia develops. Candidiasis of the oral mucosa (pseudomembranous mucositis or “thrush”) manifests itself in the form of white plaques on the mucous membrane of the cheeks, back of the throat, and tongue. The affected area is usually painless. When plaque hardens and cracks form, slight soreness may appear.
The defeat of the esophagus by candidal infection is characterized by the appearance of dysphagia and single phagia. When the intestines are involved in the process, abdominal pain, bloating, diarrhea are noted. There may be pain and itching in the anus. Stool often contains blood. With agranulocytosis, infiltration and necrosis of the intestinal wall lead to the development of intestinal obstruction, peritonitis, gastrointestinal bleeding, and conditions characterized by high mortality.
Urogenital candidiasis has three clinical forms: candidiasis, acute and chronic (recurrent) urogenital candidiasis. Candidacy is characterized by the absence of complaints. But with microbiological research, fungi are found in small quantities. The acute form is characterized by a pronounced inflammatory picture: redness, swelling, rashes on the skin and mucous membranes of the urogenital organs. The duration of the disease with an acute form of candidiasis does not exceed 2 months. The chronic form is characterized by a disease duration of more than 2 months. Clinically, urogenital candidiasis is manifested by profuse or moderate cheesy discharge, itching, burning, irritation in the external genital area, increased itching during sleep or after water procedures and intercourse, an
unpleasant odor that intensifies after sexual intercourse. When the urethra is damaged, discharge from the urethra of a pale yellow color appears, often scanty. Candidal urethritis in men can be complicated by candidal prostatitis, epididymitis, cystitis.

Candidal endocarditis is similar in flow with bacterial, manifested by prolonged fever and the formation of vegetations on the heart valves. Against the background of immunity disorders, fungal microabscesses in the myocardium can develop, leading to arrhythmias. Sometimes fungal thromboembolism of the coronary arteries develops with the development of ischemia and heart failure.
Lung involvement usually results from hematogenous spread of infection. In such patients, sputum is almost not separated, and the symptoms of pneumonia are similar to bacterial, although they are less constant. There is a discrepancy between severe respiratory failure and scant auscultatory and radiological signs.
Candidal meningitis is typical for newborns and premature babies, and also as a secondary complication of neurosurgical interventions. It is most difficult in patients with impaired immunity. It manifests with severe cerebral and meningeal symptoms, in the case of intracerebral abscesses – focal symptoms with neutrophilic or lymphocytic pleocytosis (depending on the degree of neutropenia). Skin lesions in acute disseminated candidiasis occur in 5-10% of cases. It manifests itself in the form of dense, rising above the surface of the nodes 0.5-1 cm in diameter, pink-red in color, which do not disappear with pressure, papular or maculopapular rash, similar to drug.
For chronic disseminated candidiasis (“hepatolienal”), the most characteristic is the defeat of the liver and spleen with their increase and the development of multiple microabscesses. The disease is accompanied by prolonged fever, sometimes with the development of jaundice and pain in the right hypochondrium. In half of the patients, high leukocytosis and severe hyperbilirubinemia (mainly due to the direct fraction) are noted in the blood. The level of transaminases increases inconsistently and no more than 3 times. Often such liver damage looks like cholestatic hepatitis and is mistaken for toxic liver damage by cytostatics, especially in the absence of characteristic changes according to ultrasound data.
Hematogenously disseminated forms of candidiasis (candidal sepsis) are characterized by a severe course, high fever and severe symptoms of general intoxication. Fever of an irregular type, with repeated chills alternating with profuse perspiration. The disease is accompanied by damage to various organs (lungs, gastrointestinal tract, brain, kidneys, etc.), and the presence of several foci is characteristic. Often, the retina is involved in the process and spread to the vitreous body. Patients are worried about pain in the eyes and visual disturbances. When the lungs are damaged, a strong cough appears,
at first dry, then with a small amount of viscous mucopurulent sputum, sometimes streaked with blood. X-ray examination reveals infiltrates, more often in the lower lobes, prone to fusion. Disintegration with the formation of cavities is often observed. The pleura may be involved. The hilar lymph nodes are enlarged and indurated. Occasionally, hematogenous, deep, localized infections of Candida such as osteomyelitis, arthritis, endophthalmitis, and liver abscess occur. Blood cultures remain negative, and if they become positive, it is often only late. If granulocytopenia persists and the neutrophil count does not increase, the likelihood of death is very high, even with antifungal treatment.

Diagnosis
Diagnosis of cutaneous lesions of Candida spp. is put on the basis of clinical manifestations.
Candidiasis of the digestive tract is determined by the characteristic thrush in combination with symptoms of damage to other organs. It is possible to reveal the involvement of the esophagus, stomach, and large intestine in the process by endoscopic examination (with taking material from the affected areas for laboratory research).
In genitourinary candidiasis, colposcopy after staining with Lugol’s solution reveals colpitis in the form of small-point inclusions (“semolina”), often with a pronounced vascular pattern. Microscopy of a vaginal smear stained with methylene blue is performed. Scanty sputum discharge in pneumonia still allows the pathogen to be isolated in it.
The clinical manifestations of candidal meningitis are nonspecific, and morphological examination of the cerebrospinal fluid of the drusen of fungi or pseudomycelium cannot be detected. The nature of the disease is often established posthumously.
A reliable diagnosis is considered with the laboratory isolation of yeast-like fungi (from ulcerative lesions of the mucous membranes, pus, bile, and in case of candidal sepsis – from blood and punctuate of closed cavities). It is important to detect fungi in histological preparations obtained with targeted biopsy, re-isolation of the same type of fungi from an open affected surface, and their antigens in the blood serum. High titers (1: 160-1: 1600) or an increase in antibody titers during the course of the disease are considered positive.
Of the immunological methods in the diagnosis of candidiasis, enzyme immunoassay, agglutination reactions, complement binding, direct hemagglutination, and immuno-electrophoresis are used. The main ones are enzyme-linked immunosorbent assay, polycepid reaction, crops. In HIV-infected patients, serological tests remain negative.
At present, in addition to classical microbiological methods, the determination of D-arabinitol and mannose markers of candidiasis by gas chromatography is used, which allows not only to establish a diagnosis, but also to evaluate the effectiveness of treatment.

Treatment
Treatment is carried out in a hospital and is aimed at eliminating the factors contributing to the occurrence of candidiasis. In case of skin lesions, local treatment is carried out in an open way using antifungal ointments.

For lesions of the mucous membranes, an antifungal suspension is used. With lesions of the gastrointestinal mucosa, antifungal drugs can be administered orally, intravenously, and in the form of rectal suppositories.
For urogenital candidiasis, antifungal drugs are administered in the form of tablet forms, vaginal balls, tablets and ointments. For visceral and disseminated forms of candidiasis, antifungal drugs are prescribed intravenously in the form of drip infusions. Fluconazole occupies a special status among antifungal drugs. It is distinguished by high bioavailability and efficiency at any localization of the process – from common skin lesions to meningitis, penetration into all biological fluids and body tissues, a good effect of oral forms, the possibility of intravenous use in a serious condition of the patient and the introduction of a shock (double) dose on the first day of treatment , lack of toxicity and low frequency of adverse reactions. The drug can be used in premature babies. In all cases, fluconazole is prescribed once a day.
When fluconazole therapy is ineffective, one should think about candidiasis caused by naturally resistant Candida species, such as C. krusei. In these cases, antifungal therapy is recommended with an effective, but potentially toxic, amphotericin B. Treatment is carried out only in a hospital under close laboratory supervision. Doses of amphotericin B due to the danger of nephrotoxic reactions should not exceed 0.5-1 mg / kg per day intravenously once a day or every other day. For microabscesses in the liver, brain and other organs, the liposomal form of amphotericin B is most effective.
In stubborn cases, along with antibiotic therapy, a multivalent vaccine from Candida cultures, antihistamines, solutions of sodium or potassium iodide inside, B vitamins, ascorbic acid are used.

Prognosis
With superficial forms, the prognosis is favorable, with generalized and visceral forms, it is more serious.
Prevention
Long-term antibiotic therapy requires the appointment of antifungal drugs.

Vaginal candidiasis – this diagnosis was made at least once in the life of almost every woman. It is a collection of fungal diseases of an infectious nature, proceeding in the form of vulvovaginitis or, less often, fungal dermatitis of the vulva. They are so common that candida infection can be detected in 45% of women who have a discharge.

Source of infection: about the pathogen

The causative agent of vaginal candidiasis are specific yeast-like fungi belonging to the known genus Candida. The peculiarity of these microorganisms is that they are part of the natural vaginal flora, and do not enter the body immediately before the onset of the manifestations of the disease. Representatives of our flora are in a kind of competitive relationship. The beneficial microflora has a numerical advantage. For example, on the mucous membrane of the female vagina, the number of lactobacilli exceeds 95%. They prevent fungal agents from multiplying. The nature of candida is symbiotic: they are able to peacefully coexist with other representatives of microflora, while not harming the human body.

In order to maintain the ability to multiply and not die, fungi hide behind a protective shell. When the balance of microorganisms in the female vagina is disturbed, candida expose their cells and begin to multiply in a spore manner. New individuals create chains that turn into colonies. The causative agent of thrush begins to infect the cells – it immediately acts on the epithelium, and then penetrates deeper. Its pathogenic effect is expressed through the poisoning of cells with toxins after the fungus “takes away” all the useful substances that interest it.

Features of female microflora

At different periods of life, the composition of the microflora of the female vagina is very different. So, in newborn girls, the vaginal mucous membranes are sterile. During the first three weeks, he is still affected by maternal estrogens, and after the mother’s hormones are completely eliminated from the body, microorganisms settle in the vagina, which will make up the microflora. In adolescence, the flora of a girl becomes identical to an adult, fully consistent with her composition. In addition to a large number of lactobacilli (their number can reach 95-98%). They are lactobacilli or lactic acid bacteria of nine different species. Conditionally pathogenic microorganisms coexist with them:

• Staphylococci
• Staphylococci
• Streptococci
• Anaerobic bacteria
• Gardnerella
• Mycoplasma
• Candida.

Of course, the percentage of representatives of opportunistic flora is individual for each woman. Moreover, the total number of conditional threats is too small to cause harm. The superficial layer of the vagina contains glycogen, the amount of which is regulated by estrogen. Lactobacilli are involved in the breakdown of glycogen to lactic acids, which maintain the acidity level on the mucous membranes. Lactoflora also unites in colonies, and then becomes attached to the mucous membranes of the vagina. As a result, epithelial cells are surrounded by the vital products of lactobacilli in the form of a special biofilm – a protective glycocalyx. Lactic acid does not allow opportunistic microorganisms to multiply, protecting the body from inflammation and infections. Lactic acid also helps regulate the candida population. Penetration into the mucosa is prevented by glycocalyx. But as soon as the number of lactobacilli decreases , the number of conditionally pathogenic flora increases, and the protective abilities of the vaginal mucosa are significantly reduced.

Manifestations of vaginal candidiasis at different periods

The self-regulating dynamic system, which is the flora of our vagina, can malfunction. Fluctuations in her parameters accompany a woman constantly, they can be associated with different life stages and simply cyclical changes. 75% of women claim that they have encountered such a phenomenon as thrush at least once. However, not all deviations from the norm can affect the development of the disease. One of the most common causes of vaginal candidiasis is called pregnancy. During this period, the frequency of cases increases almost 3 times. Most often, the disease manifests itself in the first and last trimesters. At the beginning of pregnancy, there is literally a crazy hormonal surge, so the composition of the microflora can change significantly. In recent months, the load on the woman’s body has been increasing as much as possible, the body can weaken under the influence of a variety of external and internal factors. Against this background, genital candidiasis willingly develops . The same diagnosis can be made not only for adult women, but also for children. Girls at three, seven years old, and then during puberty are often victims of infection. If a teenager has an inflammatory disease on the genitals, then in 25% of cases it is the development of the fungus that becomes its cause. Vaginal candidiasis does not spare older women. During the period when hormonal functions fade away, a decrease in lactobacilli in the vagina is considered quite natural. Candida use this state with pleasure. In the period before menstruation, the number of estrogen changes, which entails changes in the composition of the flora and acidity. Therefore, chronic thrush usually manifests itself a week before the onset of menstruation. After they are over, the acidity returns to normal, so candidiasis itself fades away. Usually, the disease has a rather bright clinic, a persistent course and a recurrent nature. Moreover, if a woman has a good immune system, then the symptoms may be mild, and then disappear on their own. 

Why is thrush worried: reasons

The cause of the development of the disease is the excessive reproduction of the fungal flora in the vagina. It occurs against the background of a general decrease in immunity. There are also a number of predisposing factors that contribute to the fact that thrush manifests itself as a disease: 

• Antibiotics (if they are used very often or uncontrollably) that reduce local immunity, as well as adversely affect the growth of beneficial microflora.
• Injuries that are on the vaginal mucosa: for a number of reasons, it is possible to violate the integrity of the vaginal epithelium with simultaneous damage to the protective layer of lactobacilli. As a result, these areas are defenseless when exposed to infection.
• Diabetes mellitus is accompanied by impaired glucose metabolism, therefore, the sugar content in the epithelial cells of the vagina increases, which leads to a decrease in the number of beneficial bacteria. Also, diabetes in itself greatly affects the immune system, reducing its protective abilities.
• Pregnancy, as already mentioned, is a very favorable period for fungal agents. Hormonal changes at this time are combined with immune disorders, which gives rise to the reproduction of harmful microorganisms.
• The climacteric period is characterized by atrophy (thinning) of the natural mucous layer. As a result, such mucosa contains less glycogen, and the number of lactobacilli decreases.
• Hormonal drugs (especially if they are oral contraceptives) artificially regulate the level of female estrogen. If natural cyclic changes occur under the pressure of drugs, then this again affects the concentration of glycogen.
• Inflammatory processes of the reproductive system lead to the fact that the mucous membrane becomes vulnerable, losing its natural protective properties.
• Bacterial vaginosis can be a backdrop for yeast infection in the vagina.
• Intestinal dysbiosis, as well as other chronic ailments associated with the work of the gastrointestinal tract, can provoke the growth of candida.
• Drugs that suppress the immune system – corticosteroids, cytostatics, immunosuppressants – can lead to the fact that protective mechanisms cannot work with sufficient force.
• Allergies and immunodeficiencies also seriously reduce immunity.
• Children’s age from two to seven years is characterized by increased allergization, in addition, the structure of the vaginal mucosa during this period is somewhat “inferior” due to insufficient maturation, therefore girls often develop vulvovaginitis of a fungal nature.
• During adolescence, the risk of developing vaginal candidiasis increases greatly. This is due to physiological hormonal surges.
• Failure to comply with personal hygiene standards can provoke the growth of candida. This fungus is able to survive not only in the human body, but also in the environment. Together with contact with unwashed hands and insufficiently clean tissues close to the genitals, a large number of pathogens can penetrate into the vagina.
• The fact that candidiasis is contagious remains unresolved. This is due to the fact that the presence of a disease in a sexual partner is not a guarantee that it will develop in a woman. However, sexual contact with an infected man against the background of a weakened female immunity can provoke the development of the disease. If one of the partners is sick, then it is more advisable to conduct treatment in pairs. At the same time, it is better to abandon sexual intercourse for the duration of therapy, and after it ends, use barrier contraception for some time in order to protect against re-infection in case of recurrent thrush.

Infection options

The disease usually affects the surface layer of the vaginal epithelium. Until the fungal agents are deepened, they can interact quite closely with the rest of the microorganisms. As a result, the further development of the disease is closely related to the state of the vaginal environment and its composition at the microbiological level. Along with the decline in the number of lactobacilli, a chance for reproduction appears not only in fungi, but also in other microorganisms. They can create peculiar associations and even supplant fungal agents or, conversely, help her take a leading position. In approximately 20% of patients, trichomoniasis or gardnerellosis is also detected simultaneously with vaginal candidiasis. If the vaginal dysbiosis is moderate, then the number of lactobacilli can still inhibit the growth of candida, preventing it from penetrating deeper into the mucosa, however, their strength is not enough to completely eliminate the fungal infection. As a result, the body is in a state of some balance that occurs between the fungus and the beneficial flora. As a result, the disease can go in the following ways: 

• Candidiasis, which is not a pathology, since it has no negative consequences.
• If the body has sufficient internal strength, then at the expense of its own reserves, it simply restores the normal ratio of microorganisms. In this case, the fungi die and recovery occurs. Such a course is characterized by acute thrush in those women who have strong immunity. 
• When the internal resources for the complete extermination of the infection are not enough, but enough to prevent the infection from multiplying for some time, this results in the remission of chronic candidiasis.
• The internal resources of the body are often severely depleted, which aggravates the infectious process and constantly provokes an exacerbation of the disease. Chronic vaginal candidiasis, which is constantly accompanied by relapses, is usually characteristic of women who have not only weakened immunity, but also have an unfavorable gynecological history and extragenital pathology.

Most patients can clearly describe the situation that provoked the development of infection in their case.

Symptoms: how to recognize vaginal candidiasis

As a rule, the disease has characteristic symptoms that can be quite easily recognized. It: 

• Itching

It manifests itself both on the external genitalia and inside the vagina, accompanied by burning and usually intensifies in the afternoon, after the mucous membranes come in contact with water and at night. The severity of the symptom is also facilitated by walking and sexual intercourse. Doctors have a test for thrush: a woman sits in the “foot to foot” position, at this time the itching with candidiasis intensifies. The manifestation of this symptom is also affected by cyclicality: before menstruation, it is more pronounced. It happens that other symptoms of the disease do not appear, but itching itself requires research for the presence of fungal flora.

• Allocations

Of course, women constantly have vaginal discharge, but during the development of a fungal infection, they differ from the norm. At first, there are more of them, and then, with the development of the disease, the discharge also changes its structure. They become like cottage cheese due to the presence of white lumps and flakes in them.

• Pain sensations, urination disorders

Due to the strong inflammatory process that provokes a fungal infection, the mucous membranes of the vulva and urethra also suffer, so pain accompanies urination. Also, due to contact with urine, a burning sensation occurs.

• Puffiness, hyperemia

Inflammation leads to the fact that the external genital organs and the vagina swell and swell, and the places of direct introduction into the epithelium of the fungus turn red.

• Discomfort during intercourse

Due to swelling of the mucous membranes, painful sensations are more pronounced, pain and burning accompany sexual intercourse, and in most cases there is no orgasm.

Establishing diagnosis

Despite the fact that the symptoms of vaginal candidiasis are quite characteristic, it is impossible to engage in self-diagnosis. The fact is that the disease can occur against the background of more severe infections, and the combined infection is fraught with a lot of threats. In addition, for successful treatment, it is necessary to establish the reason why candidiasis began to develop. Only after its elimination will the disease leave the woman. In nature, there are about 20 species of candida that can provoke symptoms of thrush in the human body. For successful treatment, you need to determine which species caused the disease in order to be able to choose the right drugs. The doctor makes a diagnosis by analyzing data from such sources:

• Anamnesis
• Clinical picture
• Analysis data.

The history contains information about the patient’s complaints, as well as her assumptions about the cause of the disease and a history of recent illnesses. The clinical picture gives the doctor a high probability to assume that it was the manifestation of vaginal candidiasis that led the woman to the doctor. During the examination, the doctor sees characteristic discharge, a white coating on the mucous membranes. Due to itching, mechanical damage is observed in the form of ulcers, scratching, and wounds. In a smear taken from the vagina, a large number of candida is found (a moderate amount is considered normal). Inoculation is also carried out on a nutrient medium to determine the type of yeast. Additionally, you will need to pass general blood and urine tests, a blood glucose test. If the disease is started, the specialist will recommend visiting an ultrasound room to see how seriously the infection is spread inside, and check the organs for complications.

How is fungal infection treated?

Treatment of vaginal candidiasis should be prescribed only by a specialist. Contrary to the information that we hear on television, this disease is not so easy to get rid of. The treatment has a lot of nuances that only a good gynecologist can know. An important point is the elimination of provoking factors. For this, the patient needs to follow a few simple rules:

• Give up all bad habits
• The patient is shown sexual rest
• Do not take unnecessarily antibacterial and hormonal agents
• Follow the rules of personal hygiene.

It is important to follow a diet during the treatment of vaginal candidiasis. To do this, you need to focus on cereal dishes, as well as eat more vegetables and fruits. It is useful during this period to drink yoghurts, kefirs, starter cultures based on beneficial bacteria to restore microflora. However, it is better to temporarily exclude some products:

• Chocolate
• Sweets
• Bread
• Bakery products
• Smoked meats
• Pickles
• Spicy and highly seasoned dishes
• Milk products.

If you follow this simple diet, then recovery comes much faster. Hygiene procedures must be performed with great care. It is better if the woman will wash herself twice a day. Douching is contraindicated. Do not use aggressive hygiene products for washing. You can use a solution of soda to reduce acidity, a slightly pink manganese solution in order to dry mucous membranes, as well as decoctions and infusions of chamomile, barberry, calendula, and cloves. By the way, chamomile is also good for ingestion (like a herbal tea). After water procedures, you need to blot the external genitals with a clean, specially designed towel or pharmacy napkins. Linen should be worn only clean, made from natural fabrics, it should not be tight, like the clothes themselves.

Topical treatment of vaginal candidiasis

If thrush bothers a woman for the first time, then the infection reacts to local therapy. They produce drugs for external use in the following forms: 

• Vaginal suppositories
• Candles
• Vaginal tablets
• Creams
• Ointments
• Gels
• Solutions
• Sprays.

Local treatment has many advantages, since the effect on the fungus is carried out directly in the place where the infection has settled, then they do not have a negative effect on the body. The therapeutic effect of this interaction is quite strong, therefore, local drugs quickly relieve the patient of the manifestations of candidiasis. It is convenient and easy to apply. Most popular now:

• Clotrimazole
• Pimafucin
• Ketoconazole
• Miconazole
• Nystatin.

The course of treatment ranges from a week to a month, depending on the drug and the severity of the disease. But drugs for external use are in most cases single-component, and this leads to the fact that they cannot cope with an infection that has managed to take root.

Systemic treatment of thrush

Where local therapy is not effective enough, reinforcement in the form of systemic drugs is required. They are available in the form of tablets or capsules. Oral antifungal agents attack the fungus from the inside, but at the same time they have a large number of contraindications, so their intake should be carried out under the supervision of a specialist. Most of the pills for thrush are developed on the basis of Fluconazole. A single dose of 150 mg of the drug is enough to help the body cope with the infection, but there are times when the drug is extended to 3-4 weeks (the dose is the same, taken once every seven days). Intraconazole is considered an alternative to Fluconazole. Its dosage is slightly higher, and the doctor determines the intensity of the course individually. Also in the treatment of fungal infections for oral administration, Nystatin and Levorin (these are antibiotics) are suitable. Acute thrush, subject to timely treatment, takes place after a week, but the treatment of the chronic form of the disease is more difficult, after getting rid of the symptoms for three months, control is performed to avoid new outbreaks. It is impossible to stop treatment when the symptoms disappear, you need to bring the course to the end – this will avoid complications. If you are worried about vaginal candidiasis, and you do not know how to cope with the problem, or have doubts, write to our specialist and get a detailed qualified answer as soon as possible.

Photodermatitis is a type of dermatitis in which there is an acute skin reaction to sunlight, or, more specifically, to ultraviolet rays. It can be sudden or chronic acute. Photodermatitis occurs when the immune system reacts to ultraviolet rays as hostile to the body.

A person with photodermatitis can develop a rash, blisters, or flaky spots after exposure to the skin of the sun. The degree of exposure and reactions differ for each person. Photodermatitis can also appear as a side effect from certain medications: antibiotics, antifungal drugs, nonsteroidal anti-inflammatory drugs, diuretics, antidepressants, chemotherapy agents.

People who are most prone to photodermatitis usually have fair skin, lupus erythematosus, or those who actively take sunbaths from 11 a.m. to 3 p.m.

For the prevention and treatment of photodermatitis, according to the recommendation of the medical site “ altherapy.ru ”, you should completely exclude exposure to the sun from 11 to 15 hours, constantly use sunscreens with a degree of protection from 30 to 50 spf, limit the intake of drugs that provoke manifestations of photodermatitis. If a disease occurs, an urgent appeal to a dermatologist is necessary to prescribe means of suppressing the immune system and antihistamines. Also, homeopathy is successfully fighting the manifestations of photodermatitis. 

Most reactions of photodermatitis, according to the site & quot; altherapy.ru & quot , will disappear sooner or later, without causing any permanent harm, if the patient promptly contacts a dermatologist and the underlying cause of the disease is diagnosed and eliminated. In rare severe cases, the treatment of photodermatitis can take several years, and also have serious complications in the form of a chronic form of the disease, as well as photosensitivity, hyperpigmentation, premature aging of the skin, melanoma (skin cancer). 

Patients suffering from photodermatitis should be closely monitored by a doctor, who must always monitor the frequency and duration of attacks. This information may help determine the most appropriate treatment.

We are often extremely inattentive to our own legs. But summer roads and swelling make you care for them regularly. Let’s start with simple gymnastics: legs up! Legs are great “workaholics.” They “work” every day, from morning to night, and at the same time carry the entire weight of the body. In return, they require basic attention: daily care and good shoes.

The measure of attention to the legs is directly proportional to overall well-being: all internal organs are projected onto the foot. Cardiovascular disease or kidney disease can cause regular leg swelling. Failure to pay attention to flat feet can lead to deformity of the fingers or to more serious complications. So make it a rule to follow Beauty Tips every night.

GENTLE MASSAGE

It is advisable to rub foot cream with simultaneous massage. Foot massage is a combination of stroking, rubbing and kneading movements. Start with your foot. Feet and lower legs massage, gradually rising up to the knee joint (3-4 times). Then massage each finger from the tip to the base, then stretch the entire foot. Finish the massage with stroking (3-4 times).

NO FATIGUE, NO SWEAT

With excessive sweating of the legs, it is recommended to use talcum powder daily or do foot baths with the addition of boric acid or borax (1 teaspoon per basin). After such a procedure, it is very good to wipe the gaps between the fingers and sprinkle them with a powder consisting of a mixture of 6 teaspoons of borax, 6 teaspoons of talcum powder and 1 teaspoon of boric acid. Put on your socks at night. Do not wash your feet in the morning.
Oak bark bath (for sweating). Brew 1 tbsp. a spoonful of bark with a glass of boiling water, leave for 2-3 hours; add the infusion to the water prepared for the bath.

DRY AGAINST FUNGI

Strangely enough, fungal diseases occur in very clean people. Try to keep your feet dry at all times to avoid problems.
In the evenings, rinse your feet and wipe dry all the interdigital spaces.

If there are cracks, itching, redness, lubricate the skin between the fingers with green paint or Novikov liquid (glue), or just iodine (it is better to dilute the iodine solution in half with vodka). In more serious cases, use antifungal ointments – mycoseptin or Teymurov paste.

GYMNASTICS FOR LEGS

Gymnastics for the legs is very useful: walk on tiptoes, on the lateral surfaces of the feet, on a rubber mat or in massage slippers. On vacation, try to paddle your barefoot more on water and on pebbles.

Foot care prevents varicose veins. As a preventive measure, the exercise “bicycle” and walking with feet on the wall are effective.

SAFE PEDICURE

A pedicure is not only a sure sign of true love for yourself, but also a pleasant excuse to bring your legs to life.
A professional procedure can be provided only by a beauty salon and pedicurist with experience. Look for your master in a salon with a good reputation, with disposable tools and sterile underwear. Any infection threatens with months of painful treatment. If you yourself have mastered the pedicure technique, do not forget:

pre-take a warm soapy foot bath;
sanitize tools;
cutting off nails, do not round their edges;
try not to hurt the delicate cuticles on the toes, the wounds are painful and take a long time to heal.

BEAUTY TIPS
If you have been walking intensively all day or have stood a lot, do not go to bed until you have relieved fatigue from your legs with a cream, bath or massage.
Avoid uncomfortable tight shoes with high erratic heels. Do not spare money for expensive, comfortable shoes.
If you have problems with the foot – flat feet,
deformation of the fingers – buy shoes with arch support or insert them into new shoes.
Use a special foot cream regularly. Try to get one that contains extracts of horse chestnut, caffeine, horsetail, or other ingredients that improve blood and lymph circulation.
In the evening, lie on the floor for at least half an hour and lift your legs up or lean them against the wall.
Take a foot bath after exercise. If time permits, alternate hot and cold baths, normalizing (the temperature of hot water should be 40-50 °, cold – 20 °). While sitting on a chair, lower your legs first in a bowl of hot water, then with cold water and so on 8-10 times (legs should be three times longer in hot water than in cold). Finish the procedure in cold water. In a bowl of hot water, you can add an infusion of chamomile, linden blossom or nettle. After the bath, dry your feet well, then rub in the cream.

According to the World Health Organization, herpes, one of the most common viral diseases, “sits” in almost every person.

By the age of 12, 90% of Russians are already infected with the herpes simplex virus type 1 (facial herpes). The infection sticks to the rest later, already in adulthood.

Microtraumas of the skin, mucous membranes, and conjunctiva of the eyes have been and remain the entry gates for infection. Having penetrated the nerve endings into the sympathetic ganglia (the oldest formations of the human nervous system), the virus settles there for life.

Lurking in nerve nodules, he patiently waits for his time and as soon as this hour strikes (hypothermia, stress, weakened immunity), extremely painful vesicles and sores appear on the skin.

But some people carry the virus in themselves for years and do not get sick, while others are regularly subjected to the strongest 2-3-week herpes attacks, when the temperature rises to almost 40 degrees, the lymph nodes increase and hurt.

Herpes can occur under the guise of a variety of diseases, such as cystitis or thrush. Traditional antibiotics and antifungal medications that are effective for these diseases are completely useless in the case of herpes. In combination with certain types of papillomoviruses, genital herpes becomes one of the factors in the occurrence of cervical cancer in women and prostate cancer in men.

Herpes simplex virus type 1 causes a “fever” on the lips. It can also affect the eyes, larynx and pharynx (herpetic sore throat). The main target of the herpes simplex virus type 2 is the genitals. More recently, facial herpes and genital herpes affecting the genitourinary system lived on their own, but today, when the concept of oral sex is known to every schoolchild, the spheres of influence of viruses have mixed.

Cytomegaly disease, which weakens the immune system and leads to severe pathology of pregnancy and newborns, is also one of the forms of herpes. Zoster caught herpes can get one of two “pleasures”: children – chicken pox,
adults – herpes zoster.

The latter, in addition to the strongest skin rashes, gives a complication in the form of inflammation of the nerve node, in which the virus “slept” from the moment it entered the body in childhood. True, the skin will heal (if it is well treated – in two weeks, bad – in two months), but the pain can remain for many years.

Herpes, like HIV, suppresses cellular immunity, multiplying in white blood cells, white blood cells and lymphocytes. As soon as they stop working, the body’s defenses are weakened, the virus multiplies even more.

It is almost impossible to avoid infection with the herpes virus. After all, the owner of herpes can be infectious not only at those moments when the virus finds itself with rashes on the skin and mucous membranes. Sometimes the infection does not manifest itself at all, but the virus is nevertheless excreted with saliva, sperm, and cervical secretions.

If a woman with a “fever” on her lips cleans her face, then the virus from the lips can get into every pore
cleaned by the beautician. And herpes of the whole face will begin. It can cause severe pain along the branches of the trigeminal nerve – in the ear canal, in the jaw, pain syndrome like cervical radiculitis and angina pectoris.

Genital herpes can sometimes provoke terrible pain in the pelvic plexus in women and in the perineum in men. And when such manifestations are seen by doctors who do not know the characteristics of the virus, then they begin to treat not for it, and the story can be very delayed.

Modern methods of DNA diagnostics are able to detect virus particles and tell with high accuracy whether there is this “beast” in your body. But information about how active he is will not be given. For this, a special culture for the virus is done. Pregnant women or just planning to become mothers are recommended to do just such tests.

The scenario depends on how strong a person’s immune system is. If herpes worsens again and again,
it means that a serious breach has appeared in the body’s defense line.

So, the best, cheapest and most affordable way to strengthen the body is a healthy lifestyle. If the defenses are completely weakened, the doctor may recommend drugs that stimulate the production of their own interferon.

And most importantly, it is necessary to eliminate the cause that brought down the immune system. Exit, finally, from stress, relax, eat right. In short, take care of yourself.

Who needs to see a doctor
Those who have a fever on the lips or genitals regularly, more often 3-4 times a year;
parents with herpes, who have a small child in their family;
those who have had eye herpes at least once;
children with frequent fever on the lips, under the nose, in the nose;
genital herpes should be treated in any case, especially for women preparing for pregnancy.

Doctors say that in recent decades 20-25% of the inhabitants of our planet are diagnosed with nail diseases. About 90% of cases of these diseases are due to fungal lesions of the nail plates on the legs or arms. Many patients are mistaken and believe that this is a cosmetic defect, but this is a dangerous delusion. Fungal lesions contribute to the penetration of a wide range of infections into the nail and skin of the foot. As a result, you can completely lose nails, as well as get damage to nearby skin.

Where and how can you get infected?

There are certain risk factors that can contribute to the spread of nail plate infection. Let’s indicate the main limits of risk where infection with onychomycosis occurs.

So, where and under what circumstances does this infection penetrate easier on the nails?

• When you visit pools, baths or a water park without proper shoes;
• when visiting cinemas and supermarkets, where a person comes into contact with public facilities that may contain fungal microorganisms (binoculars, baskets, carts, money and tickets);
• contact with non-sanitized manicure accessories;
• when you wear shoes that meet the latest fashion trends, but do not quite meet the requirements of comfort and safety (narrow, uncomfortable, impermeable). Such shoes contribute to the appearance of scratches and cracks in the nails, and it is much easier to get a fungus into an injured nail;
• when you live with a person who suffers from fungal diseases of the nails (using common household items, bedding and bedding).

When to be treated?

If you find a fungus on your toenails, immediately contact a specialist podologist: 

• when there is itching and burning of the skin of the foot, against the background of which peeling or redness appears;
• discoloration of the nail, the appearance of spots;
• changes in the structure of the nail, the appearance of cavities or tubercles;
• bad smell.

Please note that in the initial stage of the development of the disease, the nails may become white or gray, with yellowish spots. More advanced forms can be characterized by the appearance of spots and green stripes, and the nail can become completely black or brown.

Stomatitis is a generalized name for inflammation of the mucous membranes of the gums, cheeks, palate, tonsils, and tongue. Every year, a quarter of the country’s population faces the disease, from infants to elderly pensioners, so the logical question often arises is how to quickly cure stomatitis.

General characteristic of stomatitis

Oral inflammation develops in response to external and internal stimuli as an independent disease or a complication of other pathologies.

The manifestation of stomatitis is signaled by changes in the oral mucosa:

• redness
• edema;
• rashes;
• plaque;
• vesicles;
• aphthae;
• sores;
• cracks and “jams” in the corners of the lips.

The disease occurs regardless of gender and age, but more often occurs in children under 7 years of age. Inflammation of the infectious etiology is contagious. Pathogens are transmitted by contact and everyday means through kisses, common dishes, personal hygiene items. Non-infectious types of disease are not dangerous to others.

In mild cases, stomatitis in the tongue and mucous membranes is stopped in 2–4 days by rinsing. For the treatment of moderate inflammation, complex therapy will be required, recovery occurs in 7-14 days. Complex forms develop against the background of systemic disorders, it is difficult to treat, the only way to cope with inflammation is to eliminate the root cause.

Types of Stomatitis

Stomatitis is classified by the nature of the course, causes and the depth of the lesion.

By etiology, the following types are distinguished:

• The traumatic appearance is due to mechanical damage. The disease provokes abrasions from fragments of teeth, dentures, braces, solid food, thermal burns after hot drinks, irritation from tobacco smoke.
• Allergic begins with intolerance to the components of prostheses, crowns, fillings, toothpaste, hygienic solutions. Sometimes allergens become foods, drugs.
• Infectious includes 3 subspecies. The viral form is caused by influenza, herpes, chickenpox, rubella, measles. Bacterial develops with damage to staphylococci, streptococci, diplococci, often begins as a complication of infections of the ENT organs. Fungal provoke Candida yeast. This form manifests itself in a weakened immune system, after prolonged treatment with antibiotics, often observed in infants.
• Atrophic appearance occurs with an unbalanced diet, an acute shortage of vitamins A, C, group B, iron, against a background of chronic diseases.
• Toxic is the result of poisoning with metal salts, chemicals.

According to the depth of the inflammatory process and morphological changes, 3 types of disease are distinguished:

• Catarrhal occurs with mechanical irritation, careless hygiene. The mucous membranes swell, redden, hurt, the tongue is covered with a yellowish or whitish coating. This form develops without damage and tissue defects, passes without a trace with quick and proper treatment.
• Aphthous often takes place against the background of gastrointestinal tract disorders, with the defeat of the herpes virus. First, colorless vesicles appear in the mouth. Then they burst and turn into aphthae – round or oval erosive foci with a dirty white or gray film and a red inflamed edging. With the aphthous form, salivation increases, severe pain occurs during eating, swallowing, talking.
• Ulcerative begins when a bacterial infection enters the microcracks. Gums, tongue are covered with ulcerations with a gray coating. The lesion penetrates deep into the mucosa, covers soft tissues, in advanced cases, affects muscle fibers and reaches the bone. As the disease progresses, the tissue dies, so scars remain after healing of the ulcers. Ulcerative stomatitis is accompanied by fever, headache, swollen lymph nodes, and repulsive bad breath. 

The acute form is diagnosed when symptoms first occur. Relapse, progressing regardless of the duration of remission, indicates chronic stomatitis. They occur with immunodeficiency, systemic diseases, and untreated acute inflammation.

How to treat, depending on the form of the disease

When signs of inflammation of the oral cavity appear, they turn to the dentist or therapist, and the child is taken to the pediatrician. With a traumatic and allergic type of disease, an external stimulus is eliminated. Defective prostheses are changed, teeth are chipped, new fillings are placed, allergens are identified and removed. Sometimes after these actions, inflammation goes away spontaneously. In the infectious form, the pathogen is determined using microscopic examination, PCR diagnostics. According to the results of laboratory tests, a treatment regimen is chosen.

Drug therapy

Inflammation is treated with external etiotropic and symptomatic drugs. The first eliminates the cause, destroys the pathogen. The second ones alleviate discomfort and accelerate recovery.

The table lists how to treat stomatitis in adults:

Antibacterial: • Levomekol; • Holisal; • Metrogil dent; • Ingalipt; • Chlorophyllipt.	Antiviral: • Oxolin; • Tebrofen; • Acyclovir; • Viru-Merz Serol; • Viferon.	Antifungal: • Candide; • Miconazole; • Nystatin; • Levorin; • Dactarin.
Painkillers and antiseptics: • Kamistad-Gel; • Hexoral Tabs; • instillagel; • Lidocaine.	Antimicrobial and anti-inflammatory: • Lugol; •Vinyl; • Miramistin. • Ingafitol.	Wound healing: • Solcoseryl dental paste; • Methyluracil; • Vinylinum; • Carotolin; •Propolis.

With the ulcer form, oral antibiotics are additionally prescribed, with the herpetic form – antiviral tablets. To correct the protective reactions of the body, take immunomodulators Polyoxidonium, Immunal, vitamin complexes.

Folk remedies

The treatment of stomatitis at home is supplemented with herbal compounds:

• They rinse their mouths with decoctions of herbs with antiseptic properties: insist on collecting chamomile, calendula, sage, St. John’s wort, a string, oak bark.
• Juice or pulp of a fresh leaf of Kalanchoe, aloe process ulcers.
• Sea buckthorn and rosehip oil are used to heal cracks and wounds.
• Carrot juice is half diluted with boiled water and rinsed with mucous membranes when ulcers appear.

Folk remedies safely treat only the catarrhal form of the disease at an early stage, for the rest, pharmacy drugs will be required.

How to rinse your mouth

Mucous membranes are periodically cleaned of bacterial plaque with antiseptic solutions:

• hydrogen peroxide;
• chlorhexidine;
• potassium permanganate;
• furatsilina;
• Miramistin;
• Clotrimazole;
• Stomatidine.

Rinses are repeated at least 3-4 times a day after meals before treatment with stomatitis preparations.

Features of treatment during pregnancy

During gestation, most drugs are prohibited, so therapy is started when the first symptoms appear. At an early stage, improvement can be achieved without systemic drugs. In the first trimester, medicines are completely abandoned. Inflammation gradually disappears if you rinse your mouth with decoctions of oak bark, chamomile, and sage 6-7 times a day. Herbs alternate. The wounds are spot treated with aloe juice.

In the 2nd and 3rd trimesters, treatment is supplemented with pharmaceutical preparations under the supervision of a doctor. With the viral form, Viferon gel is used, with the bacterial one at 13 weeks and later, Metrogil Denta is used. Fungal infection is treated by rinsing with a weak soda solution, damage is treated with Nystatin ointment. A universal remedy is Holisal gel, which reduces pain, swelling, disinfects bacteria, viruses, and fungi. Pregnant women are allowed to use funds from the 2nd trimester. Before applying ointments, gels, the mouth is treated with Miramistin, chlorhexidine.

Rules for the treatment of childhood stomatitis

Stomatitis comes first among inflammatory diseases of the oral cavity in children. The kid will not be able to explain what worries him, because parents are guided by his behavior. At the same time, they examine the mouth if the child is capricious for no reason, refuses to eat, drink, temperature rises, salivation increases, but there is no cough, runny nose.

Recommendations for pediatricians will quickly cure stomatitis in a child:

• The room maintains humidity at 60%, air temperature – no higher than 22˚C. Thermoregulation at an early age is imperfect, therefore, in a hot room, saliva dries quickly, loses antimicrobial properties.
• The child is fed only soft food: they switch to a homogenized canned food or chopped food in a blender. Solid foods injure the mucous membranes.
• They drink abundantly, do not allow dehydration, if it is painful for the baby to drink, they use a tube.
• Do not give hot food, drinks with temperatures above 30˚C.
• Exclude acidic, spicy foods, fruit juices that irritate the mucous membranes.
• Angular stomatitis or “seizures” in 90% of cases develops with iron deficiency. A hemoglobin level is checked in a child; a clinical blood test shows it.
• After eating, rinse your mouth from food debris with an antiseptic or soda solution – 1 tsp. into a glass of boiled water. The babies are gently wiped with mucous piece of gauze, which is pre-wound on the little finger and moistened in an antiseptic. From infancy, it is allowed to use Derinat, Miramistin solutions.
• With severe pain, dental anesthetics are used: Kalgel, Denthol-baby, Baby Doctor.
• The treatment of mouth ulcers in small patients after 1 year is allowed with Holisal gel.

With the herpetic and bacterial form of the disease, etiotropic drugs are required, they are prescribed only by the doctor in accordance with the age and condition of the child.

Disease prevention

The risk of mucosal inflammation is reduced if you follow important recommendations:

• Carefully observe hygiene. Gently brush your teeth, do not injure your gum brush. Additionally use an irrigator, thread, preventive solutions.
• In time to treat caries, periodontal inflammation, nasopharynx infection. Periodically remove tartar.
• Maintain immunity: walk more often, temper, eat balanced, quit smoking.
• Wean a child to constantly lick, bite her lips – a bad habit leads to the development of stomatitis on the lip.
• Regularly wash the pacifier, the toys that the baby pulls in its mouth.

Stomatitis is a non-dangerous disease, but in advanced cases it constantly returns, sometimes more often 3-4 times a year. Doctors advise not to wait until the inflammation “goes away”, but to immediately treat an unpleasant ailment.

Fungal diseases (mycoses) constitute a significant part of the infectious pathology of the skin. The causative agents of mycoses are anthropophilic fungi that are parasitic in humans, zoophilic, carried by animals, as well as opportunistic organisms, mainly yeast-like fungi of the genus Candida.
One of the reasons for the significant prevalence of mycosis in the population can be considered a lack of awareness of the sources and routes of distribution, clinical manifestations and preventive measures of infection, as well as a later visit to a doctor, which leads to a chronic course of diseases. The increase in the incidence of candidiasis is associated with the widespread use of modern therapies, environmental pollution, increased background radiation and other factors that weaken the body’s defenses. According to the WHO, only about 5% of all mycoses are primary diseases, in other cases these are secondary processes that develop against the background of basic disorders of various origins.
There are superficial mycoses of smooth skin – keratomycosis and dermatophytosis (dermatomycosis), in which the epidermis, dermis and skin appendages are affected – nails, hair.
Keratomycosis is multicolored (pityriasis) versicolor. The most common disease from the group of dermatophytosis is mycosis of the feet (hands). Often there is mycosis due to yeast-like fungi of the genus Candida, superficial candidiasis of the skin.

Versicolor

Multi-colored lichen is a fungal disease whose pathogen Pityrosporum orbiculare (Malassezia furur) belongs to yeast. The disease is quite widespread in all countries, young and middle-aged people are ill.
Etiology. Pityrosporum orbiculare as a saprophyte is on the skin of a person and, under favorable conditions, causes clinical manifestations.
Pathogenesis. Factors contributing to the development of the disease have not yet been precisely determined, however, the disease is more common in people suffering from excessive sweating, changes in the chemical composition of sweat, diseases of the gastrointestinal tract, endocrine pathology, autonomic-vascular disorders, and also with immune deficiency.
Clinic. The disease is characterized by the presence of small spots on the skin of the chest, neck, back, abdomen, less often the upper and lower extremities, axillary and inguinal-femoral areas, which are initially pink in color, then light and dark brown, with slight peeling, sometimes it can be hidden and come to light only when scraping. Rashes often merge and form extensive areas of skin lesions. After tanning, as a rule, white spots remain as a result of increased peeling. The disease is characterized by a long course with frequent exacerbations.
Diagnosis and differential diagnosis. The diagnosis is made on the basis of clinical manifestations, the detection of the pathogen in the skin flakes during microscopic examination and the characteristic yellow or brown glow under a Wood fluorescent lamp, a positive test with iodine. It is necessary to differentiate the disease in the acute stage from pink lichen giber, syphilitic roseola, with a prolonged course of pigmentation observed after the resolution of various skin diseases, in the presence of depigmented spots with syphilitic leukoderma, as well as dry streptoderma.
Treatment. Currently, the arsenal has a sufficient selection of topical antimycotic drugs that have a pronounced antifungal effect against the causative agent of multicolored lichen. These include imidazole and triazole derivatives, allylamine compounds. Use: ketoconazole cream, oxyconazole cream, cream and clotrimazole solution, bifonazole cream (prescribed 1 time per day for 2-3 weeks); econazole cream (prescribed 2 times a day for 3-4 weeks); terbinafine cream and spray, exifin cream (applied to cleaned and dried lesions 2 times a day for 7-14 days, if necessary, after a 2-week break, the treatment can be repeated). With common, often recurring forms of multicolored lichen, antimycotics of a systemic effect (itraconazole, fluconazole) are more effective.
Prevention Disinfection of underwear and bed linen during the treatment period and prophylactic treatment courses 1-2 months after the end of treatment, using the same drugs as for treatment, but using them for 7-10 days.

Mycosis of smooth skin of the feet (hands)

In some countries, foot mycosis affects up to 50% of the population. The disease is more common in adults, but in recent years it has often been observed in children, even infants.
Etiology. The main causative agent of mycosis of the feet is the fungus Trichophyton rubrum (T. rubrum), which is secreted up to 90%, then T. mentagrophytes var. interdigitale (T. interdigitale). The defeat of the interdigital folds may be due to yeast-like fungi (from 2 to 5% of cases). The anthropophilic fungus Epidermophyton floccosum is rarely isolated in our country.
Epidemiology. Infection with foot mycosis is possible in the family in close contact with the patient or through household items, in a bathhouse, sauna, gym, when using other people’s shoes and clothes.
Pathogenesis. The penetration of fungi into the skin is facilitated by cracks, abrasions in the interdigital folds, due to sweating or dry skin, abrasion, poor drying after water procedures, narrow interdigital depots, flat feet, etc.

Clinical manifestations on the skin depend on the type of pathogen, the general condition of the patient.

Mycosis of the feet (hands) caused by
T. rubrum (trichophytosis)

The T.rubrum fungus can cause damage to the skin of all interdigital folds, soles, palms, the dorsum of the feet and hands, lower legs, thighs, inguinal-femoral, intergluteal folds, under the mammary glands and axillary region, trunk, face, and rarely the scalp. The process can involve fluffy and long hair, nail plates of the feet and hands.
With lesions of the skin of the feet, 3 clinical forms are distinguished: squamous, intertriginous, squamous-hyperkeratotic.
The squamous form is characterized by the presence of peeling on the skin of the interdigital folds, soles, palms. It can be flour-shaped, ring-shaped, lamellar. In the area of ​​the arches of the feet and palms, an increase in the skin pattern is observed.
Intertriginous form is most common and is characterized by slight redness and peeling on the lateral contacting surfaces of the fingers or maceration, the presence of erosion, superficial or deep cracks in all folds of the feet. This form can be transformed into dyshidrotic, in which bubbles or bubbles form in the area of ​​the arches, along the outer and inner edges of the feet and in the interdigital folds. The superficial vesicles open with the formation of erosion, which can merge, resulting in the formation of lesions with clear boundaries, weeping (see. Fig. On the color inset, p. 198). When a bacterial infection is attached, pustules, lymphadenitis and lymphangitis occur. With the dyshidrotic form of mycosis, secondary allergic rashes are observed on the lateral and palmar surfaces of the fingers of the hands, palms, forearms, legs. Sometimes the disease acquires a chronic course with exacerbation in the spring and summer.
Squamous-hyperkeratotic form is characterized by the development of foci of hyperkeratosis on the background of desquamation. The skin of the soles (palms) becomes a reddish-cyanotic color, pityriasis peeling is noted in the skin grooves, which passes to the plantar and palmar surfaces of the fingers. On the palms and soles there may be pronounced annular and lamellar peeling. In some patients, it is insignificant due to frequent hand washing.
In children, damage to the smooth skin on the feet is characterized by small-plate peeling on the inner surface of the terminal phalanges of the fingers, often III and IV, or there are superficial, rarely deep cracks, mainly in the III and IV interdigital folds or under the fingers, hyperemia and maceration. On the soles of the skin, the skin pattern may not be changed or the skin pattern may be strengthened, ring peeling is sometimes observed. Subjectively sick, itching. In children, more often than in adults, exudative forms of lesion occur with the formation of vesicles, weeping, eczema-like foci. They appear not only on the feet, but also on the hands.
For rubrophytia of smooth skin of large folds and other areas of the skin, a characteristic feature is the development of foci with clear boundaries, irregular outlines, an intermittent ridge along the periphery, consisting of merged pink nodules, scales and crusts, with a bluish tint, the color in the center is bluish-pink. On the extensor surface of the forearms, lower legs, rashes can be located in the form of open rings. Often there are foci with nodular and nodular elements. The disease sometimes proceeds as an infiltrative suppurative trichophytosis, more often in men with localization in the chin area and above the upper lip. Foci of rubrophytes on smooth skin can resemble psoriasis, lupus erythematosus, eczema and other dermatoses.

Mycosis of the feet due to T. interdigitale

Mushroom T. interdigitale affects the skin of the III and IV interdigital folds, the upper third of the sole, the lateral surfaces of the foot and fingers, and the arch of the foot. It has pronounced allergenic properties.
With foot mycosis due to T. interdigitale, the same clinical forms of lesion are observed as with rubrophytia, however, the disease often proceeds with more pronounced inflammatory phenomena. With a dyshidrotic, less often intertriginous form, large blisters may appear on the skin of the soles and fingers along with small vesicles in the case of the attachment of bacterial flora with purulent contents. The foot becomes swollen, swollen, pain when walking. The disease is accompanied by fever, poor health, the development of allergic rashes on the skin of the upper and lower extremities, trunk, face, enlarged inguinal lymph nodes, the clinical picture is similar to eczema.
Diagnosis and differential diagnosis. The diagnosis is established on the basis of clinical manifestations, detection of the fungus by microscopic examination of skin flakes and the possibility of identifying the type of pathogen in a culture study.
Mycosis of the feet (palms) must be differentiated from dyshidrotic eczema, psoriasis, pustular Andrews bactericide, keratoderma, as well as with the localization of foci: on the legs – from nodular vasculitis, papulonecrotic tuberculosis, limited neurodermatitis; on the skin of the body – from psoriasis, superficial and chronic trichophytosis, infiltrative and infiltrative suppurative forms of zooanthroponous trichophytosis, inguinal epidermophytosis; on the face – from lupus erythematosus.
Treatment. Treatment of mycosis of smooth skin of the feet and other localizations is carried out with antimycotic agents for external use. With squamous and intertriginous forms of lesions on the feet and other parts of the skin, drugs are used in the form of a cream, ointment, solution, spray, you can combine a cream or ointment with a solution, alternating them. Medicines that are currently used include: ketoconazole cream, oxyconazole cream, clotrimazole cream and solution, bifonazole cream, naftifine cream and solution, cream and terbinafine spray. These preparations are applied to cleansed and dried skin once a day, the duration of treatment is on average up to 2 weeks. Antimycotics isoconazole, econazole, cyclopirox, undecylenic acid + undecylenic acid zinc salt, miconazole + mazipredone are used 2 times a day until clinical manifestations are resolved, then treatment is continued for another 1-2 weeks, but once a day to prevent relapse. In case of nodular and nodular forms of rubrophytia, after removal of acute inflammatory phenomena, one of the indicated ointments is prescribed sulfur-tar ointment (5-10%) for further resolution of clinical manifestations. With intertriginous and dyshidrotic forms (the presence of only small vesicles) of mycosis of the feet, drugs with a combined effect are used, which along with an antifungal agent include a corticosteroid – isoconazole + diflucortolone-21-valernate, miconazole + mazipredone; corticosteroid and antibacterial drug – hydrocortisone + natamycin + neomycin, naftifin, betamethasone + clotrimazole + gentamicin.
In acute inflammatory conditions (weeping, the presence of blisters) and severe itching, treatment is carried out as in eczema: desensitizing agents (intravenous administration of calcium chloride solution (10%), sodium thiosulfate solution (30%), calcium gluconate solution (10%) or calcium pantothenate orally; antihistamines. Of the external drugs at the first stage of therapy, lotions are used (2% boric acid solution, potassium permanganate solution 1: 6000, 0.5% resorcinol solution), 1-2% aqueous solutions of methylene blue or brilliant green, fucorcin . Then, moving to a paste – boric naftalan, ichthyol-naftalan, ACD paste – F3 with naftalan, at complication of bacterial flora – linkomitsinovuyu (2%) in the second stage of treatment after resolution of acute inflammation using listed antimycotic agents..
when infiltrative-suppurative in the form of rubrophytia, the treatment is carried out as with zooanthroponous trichophytosis.First, the crusts in the lesion are removed oia, applying dressings with salicylic ointment (2%) under the compress for several hours, hair is epilated. Then, lotions with furacilin 1: 5000, rivanol 1: 1000, potassium permanganate 1: 6000 are used on the foci. Subsequently, a resolving sulfur-tar ointment (5-10%) is prescribed by rubbing or under compress paper. After resolving the infiltrate, undecylenic acid ointment + undecylenic acid zinc salt, clotrimazole cream, cyclopirox, oxyconazole and others are used until the clinical manifestations are completely resolved.
With the ineffectiveness of external therapy, antimycotics of systemic action are prescribed.
Prevention To prevent infection of foot mycosis, it is necessary to first observe the rules of personal hygiene in the family, as well as when visiting a bathhouse, sauna, pool, gym, etc .; disinfection of shoes (gloves) and linen during the treatment period.

Superficial candidiasis of the skin

Superficial skin candidiasis is a fungal disease caused by yeast-like fungi of the genus Candida.
Etiology. Pathogens belong to opportunistic fungi, which are widespread in the environment. They can also be found on the skin and mucous membrane of the mouth, digestive tract, genitalia of a healthy person.
Epidemiology. Infection from the external environment can occur with constant fractional or massive infection with fungi.
Pathogenesis. The emergence of candidiasis can contribute to both endogenous and exogenous factors. Endogenous factors include endocrine disorders, more often diabetes mellitus, immune deficiency, severe somatic diseases and a number of others. The disease develops in premature babies and receiving broad-spectrum antibacterial drugs.
Frequent contact with water contributes to the development of candidiasis in the interdigital folds of the hands, as maceration of the skin develops, which is a favorable environment for the introduction of the pathogen from the external environment.
Clinic. On smooth skin, small folds on the hands and feet are more often affected, less often large ones (inguinal-femoral (see. Fig. On the color insert, page 198), axillary, under the mammary glands, intergluteal). Foci outside the folds are located mainly in patients suffering from diabetes mellitus, severe general diseases, and infants.
In some folds of the skin in some patients, the disease begins with the formation of small, barely noticeable vesicles on the lateral contacting surfaces of the hyperemic skin, the process gradually spreads to the fold area, then peeling, maceration or immediately eroded surfaces of a deep red color appear with a shiny, as if varnished surface, clear boundaries, with peeling of the stratum corneum of the epidermis on the periphery. More often the III and IV interdigital folds on one or both hands are affected. The disease is accompanied by itching, burning, sometimes soreness. The course is chronic with frequent relapses.
In large folds of skin, small bubbles or pustules appear with a pinhead, which quickly open, erosion is formed in their place, rapidly increasing in size, merging with each other. The lesion foci occupy a significant surface, have clear boundaries, irregular outlines, dark red, shiny, with a moist surface, a strip of exfoliating stratum corneum of the epidermis. Around large foci, new small erosions arise. In children, the process of large folds can extend to the skin of the thighs, buttocks, abdomen, trunk. Painful cracks sometimes form in the depths of the folds.
Candidiasis of smooth skin outside the folds has a similar clinical picture.
One of the clinical forms of smooth skin candidiasis is candidiasis of the nipples in nursing women. Clinical manifestations may be different: in the area of ​​the perosseous circle there is a small focus of hyperemia, covered with white scales; focus near the nipple with clear boundaries, maceration; there is a crack between the nipple and the nasal circle with maceration along the periphery, small bubbles.
Diagnosis and differential diagnosis. The diagnosis is made on the basis of a typical clinic, detection of the fungus in scraping with skin flakes under a microscopic examination. Candidiasis of large folds is differentiated from seborrheic eczema, psoriasis; small folds on the hands – from dyshidrotic eczema; on the feet – from mycosis caused by T. interdigitale and T. rubrum, dyshidrotic eczema; smooth skin without folds – from eczema, other fungal diseases: rubrophytia, superficial trichophytosis, pseudomycosis – erythrasma.
Treatment. Limited, sometimes widespread acute forms of smooth skin lesion, especially those developed during treatment with antibacterial drugs, are usually easily treatable with local antimycotics in the form of a solution, cream, ointment and can be resolved even without treatment after antibiotic withdrawal.
In case of candidiasis of smooth skin of large folds with acute inflammatory phenomena, treatment should be started with the use of an aqueous solution of methylene blue or brilliant green (1-2%) in combination with an indifferent powder and carried out for 2-3 days, then apply antimycotic drugs until clinical symptoms are resolved .
Of the antimycotic agents for smooth skin candidiasis, use: clotrimazole solution and cream, oxyconazole cream, bifonazole cream, natamycin and hydrocortisone + natamycin + neomycin, naphthifin, isoconazole + diflucortolone-21-vernate and isoconazole, ketoconazole cream, ecoconazole cream, ecoconazole cream powder.
With common processes on the skin in case of ineffective local therapy, systemic antimycotics are prescribed (fluconazole, itraconazole).
Prevention Prevention of candidiasis of smooth skin in adults and children is to prevent its development in patients suffering from background diseases, as well as in individuals who have been receiving antibacterial, corticosteroid, immunosuppressive therapy for a long time.