Well-groomed legs

Dr. Hooman-Khorasani
Posted in Uncategorized

With the onset of warm, fine days, women change their shoes in summer shoes – sandals, clogs, panties.
The director of the Moscow Image Studio Larisa SHARIN tells how to provide foot care.

– Larisa, what does foot care begin with?

– The first step in foot care is to wash them. Healthy feet should be washed with warm water and soap. First wash your feet. Then thoroughly washed between the fingers. To get to each area between the fingers, you can use a natural bristle brush. This is a kind of massage that improves blood circulation. After re-soaping the feet, it is useful to carefully rub the foot, especially the heel, with a pumice stone, a brush with stiff bristles, and a scrub to remove dead cells. After rinsing your feet, wipe them dry with a towel. It’s better not to wipe the delicate interdigital areas, but gently pat them dry with a dry towel. The rest of the feet can be wiped quite energetically. This is also a kind of massage. Proper drying of the legs is an important procedure. Otherwise, fungal diseases, such as epidermophytosis, can easily occur on warm, moist skin. At the end of the procedure, you need to rub foot cream, which will soften the skin. In diabetes, legs are washed in soapy water, adding any vegetable oil to it. After washing, they are not wiped, but soaked in a clean waffle or other towel that quickly absorbs moisture and smeared with a baby cream – domestic production or Baby Jonson.

– Are there special cleansing procedures?

– Flaxseed infusion well cleanses the skin of the feet (2 tablespoons per 1 liter of boiling water). It works effectively with daily use. You can do cleaning baths. For example, soda. Even more useful cleansing and tonic bath with soda and sea salt. Dissolve a handful of sea salt and 1 tablespoon of baking soda in 3 l of warm water (pour hot water to maintain temperature). The duration of the procedure is 15-20 minutes. And a very simple recipe: with a lemon peel, wipe the skin between the toes and soles.
The acidic environment is held in the skin for 5 hours, thereby maintaining its health.

– How to care for dry and roughened skin of the legs?

– Very dry skin of the feet should be greased with oily cream. It’s better to do it at night. It is useful, having lubricated the feet, fingers and interdigital folds with fat cream, to sleep in cotton socks so that the cream is well absorbed into the skin. Keratinized areas can be wiped with tomato puree. The skin of the squeezed lemon can be applied to the roughened skin and a compress is applied. Hot soapy-soda baths clean well the rough skin on the feet. Dissolve 1-2 teaspoons of baking soda in 1 liter of warm water, add 1 tablespoon of soap shavings or soap cream, whip the soap foam. Dip your feet in a basin, adding hot water. Allow time for the legs to steam out, and with the help of pumice in a circular motion, peel the coarsened skin. The duration of the bath is 15-20 minutes. After this, a cream is rubbed into wet skin.

– Sometimes cracks and abrasions appear on the heels. What to do in this case?

– If you have cracks in the heels, make a bath with starch. You can make a potato peel bath. Rinse them well and add a handful of flaxseed, pour water and boil until thick porridge. In this thick, hold your feet for about 20 minutes, then rinse them with water and carefully cut the skin around the cracks. Lubricate the cracks with iodine, feet and fingers with cream, rubbing it until it is absorbed. If abrasions and cracks form on the soles of the feet, you can wash the inflamed area with a solution of potassium permanganate or 2% solution of boric acid. After drying the skin, sprinkle it with oily powder, talc, zinc oxide or grease with a cream, it is better for children.

For scuffs and cracks in the soles of the feet, baths are recommended: prepare a tincture of St. John’s wort herb (2 tablespoons) mixed with marigold inflorescences (1 tablespoon) per 1 liter of water.
You can make a bath without St. John’s wort, only with calendula flowers. Keep your feet in the bath for 15-20 minutes. It can also be used for sweating feet.

Nettle and plantain infusions are prepared from the calculation: 2 tablespoons of crushed plant leaves per 1 liter of water. The duration of the bath is 10-15 minutes. A decoction of chamomile for a bath is prepared from 1 tablespoon of dry chamomile, which is filled with 0.5-1 l of boiling water and boiled for 10 minutes. A strained and slightly cooled broth is used.

After baths, it is recommended to make a bandage on the legs, lubricating them with emollient cream or fat, making a light massage. At least once a month and a half, do a pedicure, which includes not only the care of the toes, feet, cleaning and polishing of nails, but also the removal of corns, skin growths on the foot and around the fingers.

How to treat a fungus on the head?

Dr. Hooman-Khorasani
Posted in Uncategorized

Head fungus is the “popular” name for a number of diseases of the scalp caused by microorganisms. The cause of such diseases is in most cases insufficient hygiene and contact with carriers of the causative agents of the disease. Treatment can be quite lengthy.
Content

  • Classification and features
  • Treatment

Classification and features

Four main groups of fungal diseases that affect the scalp can be distinguished:

  • Superficial trichophoria. The main source of infection is contact with an infected person. Characteristic signs: significant fragility of the hair, redness and peeling of the skin, hair loss. Small dark spots appear on the spot of the fallen hair.
  • Deep trichophoria. The main source of infection is animals that carry pathogens. Characteristic signs: hair falls out, and after a while, large red tubercles appear in their place.
  • Favus Chronic fungal disease of the scalp. Often the fungus is found in those people who constantly wear a wig or a tight hat. Characteristic features: the appearance of yellow spots on the skin, brittleness and hair loss.
  • Microsporia. Infection occurs through contact with cats, dogs and other pets. Characteristic signs: redness of the scalp, the appearance of red pimples on it. After some time, two foci of infection are formed, which are pronounced. In them, hair quickly breaks and falls out.

The fungus on the head can manifest itself with the following symptoms:

  • The scalp is peeling. Often there are separate foci of peeling of a rounded shape.
  • Hair ceases to shine, becomes dry and brittle, falls out. Small black dots remain at the place of occurrence.
  • With ringworm, it may deprive purulent foci on the head, which in severe cases have to be treated with antibiotics.
  • Skin plaques appear on the head, which are noticeably protruding above its surface.

As a rule, the fungus of the head proceeds in a latent form for a rather long time, so it is difficult to diagnose it and start treatment. Vivid symptoms appear after a while, when the disease is already progressing. An alarming sign can even be the usual dandruff, which does not disappear for a long time or manifests itself in those people who did not have it before.

Treatment

The fight against fungal diseases of the scalp should take place only under the supervision of a doctor. Self-treatment can bring negative consequences, since the specific treatment regimen depends on the nature and course of the disease. Treatment of head fungus with traditional methods includes the use of the following drugs:

  • Antifungal gels, ointments, therapeutic shampoos.
  • Exfoliating, softening agents.
  • Antifungal antibiotics. They are prescribed in severe cases when external treatment does not bring the desired result.
  • Vitamin preparations for strengthening hair and skin.
  • Iodine preparations, antiseptics for superficial use. They lubricate the skin with purulent diseases.
  • Immunomodulating drugs. Fungal diseases often develop amid weakening of the body’s defenses, which requires strengthening immunity. For the same purpose, a special diet is prescribed, which allows you to effectively treat even complex skin diseases.
  • Throughout the treatment, you should adhere to special rules of hygiene of the scalp and follow all the requirements of a doctor.

Folk methods:

  • Lubricate affected areas with fresh onion juice.
  • Effectively and treatment with lemon juice (can be diluted in water), tomato juice.
  • Mix evenly burned copper sulfate, yellow sulfur and tar (can be replaced with goose fat). Boil, cool and lubricate the affected areas.
  • Onion garlic bulbs are crushed into a homogeneous gruel and apply to the skin.
  • Ripar raisins so that it is soft. Cut raisins in half and rub their skin.
  • Mix the softened pork fat and sifted wood ash evenly. Rub the ointment into the skin in the morning and evening.
  • Mix 100 ml of alcohol (for lack of alcohol it is permissible to treat the fungus with good vodka) and 10 flowers of lilac. Insist 10 days, lubricate the skin with tincture.

It should be noted that alternative treatment can be effective in the initial stages of the development of fungal infection. If the fungus progresses in the future, you can not do without special medications.

What does podology do

Dr. Hooman-Khorasani
Posted in Uncategorized

A comfortable and healthy state of the body is extremely important for normal well-being and life. The discomfort caused by a deterioration in health immediately affects our mood and performance. There is no doubt that health plays the most important role in our well-being. Aching, pulling pains, constant discomfort can nullify all efforts at work, spoil the mood and disappoint in life. Let’s talk today about the podology and problems of our feet.

So, podology is a branch of medical science that studies and deals with the treatment and prevention of diseases and pathological conditions of the feet. You can learn more about this area of ​​medicine here . We will consider it superficially.

The problems of our feet become immediately visible, because this part of the legs is constantly in motion. Even small changes that bring pain, irritation or discomfort are immediately felt by a person. Of course, they must be addressed immediately, since many problems can develop into more serious ones.

The doctor podologist should be consulted for any problem and negative sensations of the feet, however, the doctor of this specialization identifies and deals with the treatment of the following pathological conditions and diseases:

  • Corns and corns of the feet, coarsened and painful;
  • The condition of the ingrown nail, its correction and prosthetics;
  • Deformations and lesions of the nails;
  • Fungal diseases of the skin of the feet and nails;
  • Warts and other formations;
  • Metabolic disorders caused by various diseases – for example, diabetic foot pi diabetes mellitus;
  • Heel spur;
  • Arthrosis and arthritis of the joints of the feet;
  • Fasciitis;
  • Thickening of the skin of the feet;
  • Deformations of the toes of various etiologies.

Of course, it is difficult to get rid of some diseases and conditions that have developed over the years, but the doctor-podologist will at least be able to relieve his patients of pain and discomfort that prevent them from fully enjoying life and making full use of the ability to move around.

Fungus skin

Dr. Hooman-Khorasani
Posted in Uncategorized

Skin fungus is a type of skin disease. It is very common, accounting for half of all skin diseases. The skin fungus is not among the dangerous diseases, but people suffering from it experience a lot of inconvenience and discomfort. 

The appearance of the fungus becomes possible when it is affected by dermatophytes and saprophytic infections. At the same time, dermatophytes penetrate and grow in the skin, hair and nails. Skin fungus can occur in any area of ​​the trunk, limbs, head. If it is not treated on the scalp, it can result in hair loss. Therefore, early diagnosis of the disease when referring to a doctor, and its effective treatment are so important . 

Damaged skin becomes a very convenient environment for the defeat of its fungal infections. Getting on the surface of damaged skin, the fungus begins to invade its stratum corneum. The presence of injuries on the skin is a contributing factor. Infection can occur both through household items, and through clothing.

The fungus is by no means a harmless disease, as many are accustomed to consider. So in places where it penetrates the skin, it causes an inflammatory process. And with immunodeficiency, he can wear severe forms. Among the factors that provoke the appearance of fungal diseases, such as: disturbances in the endocrine system. This is possible with diabetes. The lack of vitamins in the body also leads to this. A provoking factor is dysbiosis. Immunodeficiency can trigger many diseases. Including fungus. Increased sweating is also among the adverse factors for skin fungus.

The fungus may show a rash that is red or brown. The area of ​​the skin that is affected by the fungus is clearly limited to a rash. The danger is that the rash present on the body can turn into vesicles filled with fluid. When peeling, small cracks form on the body. And the tissues that are located nearby become edematous. It is especially dangerous when the bacterial flora joins the fungus. In this case, pustules are formed – vesicles with purulent contents. Fungus of the legs, hands, feet is not uncommon. They may be affected by the head, there are fungal diseases of the ears.

For effective treatment of the fungus, timely diagnosis and early treatment of this disease is necessary.

Fungal skin lesions and ketoconazole

Dr. Hooman-Khorasani
Posted in Uncategorized

Microscopic fungi are part of the human environment, and their total number on the planet approaches 1.5 million. Currently, about 69 thousand species of mushrooms have been studied, 400 of them are pathogenic for humans and cause diseases, united by the term “mycoses”.
The most common type of fungal infection of the skin and mucous membranes are superficial mycoses, which include keratomycosis, dermatomycosis, candidiasis. Keratomycosis is a group of fungal skin diseases in which pathogens affect only the stratum corneum of the epidermis. In our latitudes, the most common is multi-colored lichen, the causative agent of which is the fungi of the genus Malassezia. Folliculitis, rare disseminated infections, and seborrheic dermatitis also belong to skin lesions caused by these fungi. The role of fungi of the genus Malassezia in the initiation of exacerbations of some chronic dermatoses (atopic dermatitis, psoriasis, rosacea, etc.) is discussed [1].

Dermatomycosis
A very common type of dermatomycosis is characterized by a chronic, recurrent course of foot mycosis. Its main causative agent is Trichophyton rubrum. In addition to the feet, this fungus can affect large folds, vast areas of smooth skin (up to erythroderma) [2, 3]. Infection usually occurs in showers, swimming pools, baths, when using household items common with a sick person (towels, sponges, shoes, socks, etc.). Predisposing factors are excessive sweating of the feet, flat feet, tight shoes. The process for a long time (many months and years) can be asymptomatic or manifest minor symptoms in the form of mild peeling, maceration of the epidermis in the interdigital folds, peeling on the arch of the feet, periodically appearing minor itching. The chronic course and unsystematic short-term, and therefore unsuccessful treatment attempts lead to the unjustified conclusion that the disease cannot be cured. On the other hand, a prolonged asymptomatic course creates the illusion that the disease is not dangerous and does not create any problems. Both of these conclusions are completely wrong, since the infection continues to spread. The patient is a source of infection, especially for family members and for those with whom they use showers and a pool. In addition, violations of the integrity of the skin can become the entrance gate to a bacterial infection. Significantly increases the allergization of the body. The attached secondary microbial flora aggravates the course of fungal disease, further reducing the body’s defenses. In contact with mushrooms, such flora acquires increased resistance to antibacterial agents. The natural result of foot mycosis is a fungal infection of the nails – onychomycosis. Candidiasis is an infectious disease of the skin, mucous membranes and internal organs caused by the pathogenic effects of yeast-like fungi of the genus Candida, usually Candida albicans. The transition of these fungi from a saprophytic state to a parasitic state, and candidacy in candidiasis is facilitated by the inferiority of specific and non-specific defense factors.
It is not by chance that candidal lesions accompany immunodeficiency, infectious diseases, endocrinopathies, metabolic diseases, blood, and tumor processes. The World Health Organization attributes long-term recurrent candidiasis to AIDS markers. Most often, cutaneous candidiasis is manifested by the defeat of large folds, interdigital erosion, as well as paronychia. Especially difficult and prone to recurrence of candidiasis of the mucous membranes [1, 2].

Diagnosis The
clinical diagnosis of mycotic lesion must be confirmed laboratory. To detect the causative agent, a microscopic examination is carried out as follows: the material (scales, hair from the lesion) for dissolving keratin is treated with a 10-30% solution of caustic alkali and examined under a light microscope. Filamentous fungal hyphae or budding cells are markers of fungal infection. In the future, to clarify the type of pathogen fungus, a cultural study is carried out by sowing pathological material on nutrient media (original Saburo, Saburo on yeast water, Saburo without glucose). Crops are placed in a thermostat at 300C. Culture is determined on the basis of the study of the shape, surface character, color of the colonies and their microscopic features [1, 3]. Treatment of Mycosis of the skin even at the very early stages of development require compulsory treatment, the leading role in which belongs to antifungal drugs. Considering the chemical structure, four main groups of antifungal drugs are distinguished: polyenes (nystatin, natamycin, amphotericin B), azoles (itraconazole,
fluconazole, ketoconazole, isoconazole, econazole, bifonazole, clotrimazole), allylamines (terbinafine, naphtholphine). Other drugs are also used that are not interconnected by chemical structure (griseofulvin, undecylenic acid, chloronitrophenol, etc.) [3, 4]. Among antifungal agents in recent years, azoles in general and ketoconazole in particular have become very popular among specialists. The drug has a wide range of fungistatic and fungicidal activity against dermatophytes, yeast and molds. Its effect on the cell is due to the fact that it inhibits the synthesis of ergosterol, triglycerides and phospholipids – the necessary components of the cell wall of the fungus, blocks the germination of fungal spores into the mycelium. The drug acts on the oxidase-peroxidase system of fungi, leading to the accumulation of endoperoxides that destroy the organelles and the fungal cells themselves, which greatly facilitates their phagocytosis [1, 3, 4]. Ketoconazole can be used both for oral administration and for external use in the form of a cream. Inside, one tablet is prescribed once a day with meals with a small amount of water. The duration of treatment depends on the nosological form. Treatment is carried out under the mandatory control of the functional state of the liver and kidneys. The most effective tablets are in the treatment of patients with candidal lesions of the skin and mucous membranes, candida paronychia, mycosis of large folds, and versicolor. The drug quickly stops the phenomenon of pustulization, which is explained by the pronounced fungicidal, anti-inflammatory and antibacterial effect of ketoconazole. Ketoconazole cream is very convenient to use, because thanks to its powerful and long-lasting antifungal and antibacterial effect, it can be applied in a thin layer to affected skin areas only 1-2 times a day,
without having an unpleasant odor and without contaminating the laundry. Typically, the duration of treatment with a topical preparation is 4 weeks. The ketoconazole cream shows the greatest therapeutic efficacy in the treatment of pityriasis versicolor, smooth skin microsporia, candidiasis and foot mycosis, providing in most cases the clinical and mycological recovery of patients. The cream is well preserved, does not cause an allergenic and irritating effect on the skin, even in patients with a history of allergic manifestations. It is also advisable to use it for skin mycoses complicated by a secondary bacterial infection. The use of the representative of azoles ketoconazole in everyday clinical practice significantly expands the possibilities of treating fungal skin lesions, providing high efficiency in the treatment of even complicated clinical forms. The drug can be successfully used for the prevention of superficial mycoses with an increased risk of their development (persons from the “risk” group: military personnel, athletes, workers of hot shops, miners, etc.).

Sweating legs – causes and treatment

Dr. Hooman-Khorasani
Posted in Uncategorized

Sweating legs is a fairly common and unpleasant symptom. To one degree or another, this applies to most people. But some suffer from excessive sweating of the legs, and in this case, careful foot care is required.

It is impossible to deprive attention of such a seemingly unimportant disease in any case, since sweating of the legs can lead to fungal diseases, writes Ladyhealth.com.ua. Then you will have to spend twice as much effort so that your legs regain health. 

To do this, today in the piggy bank of cosmetic medicine there are more than enough various means: baths, lotions, exercises, etc. We will offer some of them to you, and you, having tried them all, using it one at a time or in combination, will surely be able to get rid of unnecessary sweating feet.

Baths are prepared according to one technique: 1 tsp. the herbal mixture is poured with 1 glass of boiling water, infused for 20-30 minutes. After that, they are ready for use.

As a rule, mixtures of several herbs or other components are used for baths. Infusion for the bath can be prepared, for example, by mixing in equal proportions the crushed root of the coil, oak bark and St. John’s wort and pour the mixture with boiling water. Then this mixture should be boiled for 5 minutes and let it brew. When the infusion has cooled sufficiently, you need to lower your feet into it for 15-20 minutes, after which you should thoroughly wipe your feet and use a powder consisting of equal parts of urotropin and talc.

You can prepare a decoction for a bath of oak bark, nettle and sage. The method of preparing the infusion and application of the bath is already known to you.

But for the treatment of foot sweating, it is not necessary to use only plant components. Regular use of vinegar baths will significantly reduce sweating in the legs. For the preparation of the bath, dilute 3 tsp. vinegar in 1 liter of water and hold the feet in this solution for 5 minutes.

Do not ignore the contrast shower and bath with salt. These procedures have no less effect in the treatment of excessive sweating.

But, in addition to these methods of treatment, daily special foot care is needed.

Fungal infections in immunocompromised patients

Dr. Hooman-Khorasani
Posted in Uncategorized

Infections that occur mainly in patients with local or general impaired immunity or immunodeficiency are called opportunistic. The deep mycoses and fungal infections occurring in the Netherlands belong exclusively to this category, although they are sometimes observed in patients who have no apparent immune disorders. In other parts of the world, endemic fungi are found that often cause deep infections in people with normal immunity, the so-called primarily pathogenic fungi, such as Blastomyces dermatitidis, Coccidioides immitis and Histoplasma capsulatum in the USA and Penicillium marneffei in Southeast Asia, mainly in Thailand . In rare cases, as an imported disease, these infections are observed in the Netherlands, and in immunocompromised patients the risk is much higher than in healthy ones.
Table 1. The relationship between host immunity and mycoses

Immunity ImpairedSuperficial infection
 Candida  
 deepAsper-cryptogillus coccus
Nonspecific immunity
Reduction of the skin and mucous barrier+
Intravascular catheter+
Decreased resistance and colonization+±
Phagocyte deficiency+++
Specific immunity
Decrease in humoral immunity
Decrease in cellular immunity+±++
Note. + obvious connection, -no connection, ± doubtful connection

The main causative agents of opportunistic mycoses in Holland are some species of Candida, Aspergillus and Cryptococcus neoformans. Less common are Mucorales (pathogens of mucosal mycosis), Pseudoallescheria boydii, Fusarium and Trichosporon beigelii. An increase in the intensity of treatment of hematological malignant neoplasms and an increase in the number of organ transplants, apparently, led to an increase in the number of opportunistic mycoses.
Possible relationships between fungus, host and treatment are shown in Fig. 1. The occurrence of generalized fungal infections is determined by the balance between the virulence of the fungus and the patient’s immunity. We will not consider virulence factors. Almost all parts of the immune system are involved in defense against fungal infections, but the role of specific host mechanisms in different fungal infections is different. We will consider this in more detail later when discussing the most important opportunistic mycoses.

Diagnosis of generalized mycoses is difficult, since it is often impossible to distinguish between colonization and infection (mainly with Candida infection), crops become positive only in the late stages of the disease, and currently there are no reliable serological techniques for routine diagnosis of most infections. The treatment of generalized mycoses is also complicated. Available drugs are ineffective (compared with the effectiveness of antibiotics against bacteria), and the use of older drugs, amphotericin B (arnfotericine B) and flucytosine (flucytosine), is limited by their toxicity. Impaired host immunity, insufficiently sensitive diagnostic methods and treatment imperfections are the reasons why mortality from generalized mycoses is still unacceptably high.

Predisposition and epidemiology. Most Candida infections are caused by C. albicans, but infections can also occur with species such as C. parapsilosis, C. krusei, C. tropicalis, and C. glabrata. Immunity is multifactorial precisely against Candida infections . Violation of the integrity of the skin and mucous membranes when using cytostatic drugs or burns, impaired colonization resistance due to the use of antibiotics, and hormonal imbalance (for example, in diabetes mellitus) play an important role in the pathogenesis of superficial Candida infections. Granulocytopenia and the presence of intravascular catheters are important risk factors for candidaemia. Factors causing the occurrence of superficial infections can also indirectly predispose to the development of candidaemia and deep infections. A recent epidemiological study has shown that this is mainly true for antibiotic use. Our own research has shown that in patients with granulocytopenia who are colonized by Candida and are receiving treatment for proven bacteremia, the incidence of candidaemia can reach up to 50%. The best prevention of deep Candida infections, in our opinion, is strict monitoring of the use of antibiotics in the hospital.

Violations of T-cell immunity that occur with the use of glucocorticosteroids and with AIDS lead exclusively to superficial infections of Candida. Deep infections in AIDS patients are observed only in the presence of granulocytopenia caused by HIV infection itself or taking myelosuppressive medications, or when a deep intravenous catheter for parenteral nutrition is administered to the patient.
For Candida infections, it is important to distinguish between superficial and deep infections. Oropharyngeal candidiasis is the most common superficial Candida infection. Vaginal candidiasis and a rare hereditary syndrome of chronic mucocutaneous candidiasis, which may be accompanied by endocrinopathies, are not considered in this article.
Oropharyngeal and esophageal candidiasis. The clinical manifestation of oropharyngeal candidiasis is most often pseudomembranous mucositis (“thrush of the mouth”), but other manifestations, such as acute erythematic mucositis, chronic atrophic candidiasis (such as angular cheilitis) and chronic hyperplastic candidiasis, are possible and are more difficult to diagnose based on clinical data. Oropharyngeal candidiasis in AIDS patients must be distinguished from “oral hairy leukoplakia”, which is most often limited to the edge of the tongue, and from sores caused by herpes simplex virus. Oropharyngeal candidiasis without a clear reason (poorly fitting denture, the use of antibiotics or glucocorticosteroids) is an indication for an HIV test. Ultimately, more than 70% of AIDS patients experience oropharyngeal candidiasis.
The most important symptoms of esophageal candidiasis are pain and impaired food passage. In many patients, symptoms are absent and the disease is detected by chance during an endoscopic examination. In patients with esophageal candidiasis, oropharyngeal candidiasis is not always present. If an AIDS patient with oropharyngeal candidiasis complains of esophagitis, it is reasonable to assume that the cause is Candida. Only in case of doubt in the diagnosis or treatment failure is endoscopy indicated. In other immunocompromised patients, such as those undergoing bone marrow transplantation, an invasive examination should be performed earlier, as they are more likely to have other diseases, such as esophagitis caused by herpes simplex virus or cytomegalovirus.

Candidemia in patients without granulocytopenia. This complication is observed mainly in patients in intensive care units after abdominal surgery, in those receiving parenteral nutrition and after treatment with broad-spectrum antibiotics. Fever is often the only symptom, and a positive blood culture on Candida is often a surprise. Given the risk of focal scattering, treatment is shown, in our opinion, even if there is only one positive sowing of shelter and . The situation is much more complicated if the patient in the intensive care unit with constant fever has a colonization of Candida respiratory, digestive and genitourinary tracts. Due to the fact that blood cultures often become positive only in the late stage, it is difficult to distinguish between colonization and invasive infection. Modern molecular biological studies may show that an isolated strain is identical to the strain by which the patient has previously been colonized. Empirical antifungal treatment is sometimes indicated to begin, even if it is not possible to clearly determine when exactly this treatment should have been started. However, the threshold for initiating antifungal therapy under these circumstances decreased, since less toxic fungostatic agents became available.
Disseminated candidiasis in patients with granulocytopenia. This is the most severe form of Candida infection. Fever, general malaise, and worsening general condition are the most important symptoms. Specific symptoms such as skin lesions or fungal lesions are absent in most cases. Sometimes disseminated candidiasis can manifest with sepsis or septic shock. Blood cultures often become positive only in the late stage of the disease or remain negative. There are no reliable serological tests for an early diagnosis. If there is no recovery from granulocytopenia, then mortality is very high, despite antifungal treatment. An autopsy often reveals common lesions of the heart (endocarditis, myocarditis), brain, liver, spleen and kidneys.
Deep localized candidiasis. Deep localized Candida infections, such as osteomyelitis, spondylodiscitis, arthritis, endophthalmitis, and liver abscess, are sporadically occurring. In most cases, candidaemia, which led to the appearance of a scattered lesion, goes unnoticed. In addition, deep localized infections can occur as ascending urinary tract infections, which happens in patients with diabetes mellitus or after a kidney transplant. In some cases, this can lead to the formation of the so-called fungus ball in the pelvis. Very rarely, Candida infection leads to isolated pneumonia. In the vast majority of immunocompromised patients with pulmonary infiltrate, in which Candida is sown from sputum, colonization occurs.
Chronic disseminated candidiasis. Initially, this disease was called hepatosplenal candidiasis. The new name is more accurate, since in addition to the liver and spleen, other organs, such as the kidneys, can be affected [4]. The classical clinical picture consists of a period of prolonged incomprehensible fever in a patient with leukemia, and the fever persists after recovery from granulocytopenia. The presence of abdominal pain of an indeterminate nature and increased activity of alkaline phosphatase in the blood should suggest a chronic disseminated candidiasis. The disease is diagnosed by ultrasound or computed tomography of the liver and spleen.
Punctures sometimes show the presence of characteristic content, but the results of sowing in most cases are negative. Failing antifungal treatment often interferes with further antileukemic treatment.

Aspergillus Infections

Aspergillus species can cause disease in humans in various ways. Allergic aspergillosis is a disease in which, due to the presence of Aspergillus spores, type 1 allergic reactions or external alveolitis occur in the bronchial tree. In principle, these diseases are treated with glucocorticosteroids. In the case of aspergilloma, saprophytic growth of Aspergillus in the previously existing cavity in the lung is noted. Next, we consider the clinical manifestations.
Aspergillus infections most often occur aerogenically due to spore inhalation. The most important predisposing factors for invasive infections of A. fumigatus and other Aspergillus species are neutropenia and prolonged use of high doses of glucocorticosteroids, mainly after bone marrow transplantation, as well as after kidney transplantation. Aspergillus infections often occur immediately in a group of individuals during construction work. Initially, these infections rarely occurred in HIV-seropositive patients, but have been reported more frequently in recent years. These infections occur mainly during the final stage of AIDS [5]. The most important invasive infections of Aspergillus are given in table. 3.

Rhinocerebral aspergillosis. Chronic sinusitis due to Aspergillus can occur in immunocompromised patients, mainly in tropical areas where there is intense contact with fungal spores. Acute sinusitis due to Aspergillus occurs only in immunocompromised patients, in most cases against the background of severe granulocytopenia. The most important symptoms are pain, swelling around the eye, retroorbital pain, then proptosis, chemosis and ophthalmoplegia of the eye develop. Due to blockage of the vessel, the formation of a blood clot and local necrosis, the infection can spread to the brain, resulting in a decrease in consciousness and epileptic seizures. The clinical picture cannot be distinguished from that of rhinocerebral mucosal mycosis, and this disease is often fatal. With severe sinusitis in a patient with graulocytopenia, therefore, the possibility of a fungal infection should always be considered. Diagnosis can be made by computed tomography, paranasal sinuses and biopsy. Intensive surgical treatment and high doses of amphotericin B are the means of choice, if the patient’s condition permits.
Pulmonary aspergillosis. The most important clinical manifestations are cough, fever and hemoptosis due to necrotizing pneumonia. However, these are already late symptoms of the disease. More often only fever is noted, and in the first instance there are slight deviations in the chest radiograph, which may not be. With the help of computed tomography, sometimes with a still normal chest x-ray, it is already possible to identify multinodular pulmonary foci with a halo or cavity characteristic of Aspergillus. Pneumonia caused by Aspergillus infection can give a picture of a lung infarction or even diffuse interstitial pneumonia on a chest x-ray. Inoculation of Aspergillus from sputum or bronchoalveolar fluid in an immunosuppressed patient is highly indicative of invasive aspergillosis and is an absolute indication for treatment. The final diagnosis (based on tissue biopsy results) often cannot be made due to coagulation problems. For serological diagnosis, there are the same limitations as in disseminated candidiasis. In the future, it may be possible to use molecular biological techniques to detect Aspergillus DNA.
Disseminated aspergillosis. In patients with persistent granulocytopenia, dissemination of infection to other organs may occur, most often from the focus of pulmonary aspergillosis. Foci of scattering can occur in the skin, which makes it possible to diagnose, in the bones or internal organs (liver, spleen, kidneys, thyroid gland). Localization in the brain (hematogenous abscess of the brain) is the most dangerous, it is characterized by very high mortality. Despite a common disseminated infection, Aspergillus is almost never able to be sown from blood or cerebrospinal fluid.
Chronic necrotizing Aspergillus pneumonia. Several years ago, it was not possible to recognize that patients with chronic pulmonary diseases receiving glucocorticosteroids may develop invasive aspergillosis. This disease was called chronic necrotizing Aspergillus pneumonia. The most important differences from the already considered Aspergillus pneumonia in patients with granulocytopenia are that the disease progresses slowly, dissemination to other organs occurs very rarely. The diagnosis is made on the basis of the clinical picture, Aspergillus culture from sputum or bronchoalveolar fluid and in the absence of other pathogens of chronic pneumonia, such as anaerobes and mycobacteria.

Cryptococcal meningitis

Cryptococcus neoformans is a ubiquitous yeast that can be isolated mainly from bird excrement. Meningitis due to C. neoformans is observed exclusively in patients with reduced T-cell immunity (see Table 1). In the past, this infection was observed in patients after transplants who received treatment with glucocorticosteroids or thymocytic immunoglobulin; in some patients it was not possible to indicate predisposing factors. Currently, we observe cryptococcal meningitis, mainly with HIV infection [6].
Cryptococcal meningitis occurs in the Netherlands in 4-10% of AIDS patients and is an indicator disease for the diagnosis of AIDS. The infection occurs aerogenically, but the primary pulmonary infection is often asymptomatic. The pia mater and the brain are the site of primary localization, as well as the prostate gland, where relapses can often occur.
Symptoms can range from mild headaches to severe clinical meningitis and coma.
Sometimes patients are treated with extra-neural manifestations, such as lung or skin lesions. A persistent headache in an HIV-seropositive patient is always an indication for lumbar puncture if CT scan of the brain does not find sufficient explanation for the complaints. Regardless of the cell number, the concentration of protein and glucose in the cerebrospinal fluid (these three indicators in a patient with cryptococcal meningitis may be normal), a patient with AIDS should always quantify cryptococcal antigens in the cerebrospinal fluid, since this test has high sensitivity and specificity. In approximately 75% of cases, cryptococci can become visible when stained with an East Indian ink preparation.
Ultimately, the diagnosis must be confirmed by a positive culture result.

Other systemic opportunistic mycoses

Other opportunistic mycoses are also increasingly recorded in the United States, but in the Netherlands they are still rare.

The most important infections are Mucoraceae, Pseudoallesheria boydii, Fusarium and Trichosporon beigelii.
Mucoric mycosis is an invasive fungal infection, the causative agents of which are most often the species Rhizopus, Rhizomucor, Mucor and Absidia, belonging to the genus Mucoraceae. In many ways, mucous mycosis is similar to invasive aspergillosis. In addition to patients with granulocytopenia, mucosal mycosis occurs in patients with ketoacidotically deregulated diabetes mellitus and in patients with iron accumulation disease, regardless of whether they received treatment with desferoxamine or not. As with aspergillosis, there are rinocerebral, pulmonary and disseminated forms. For treatment, it is important to distinguish between aspergillosis and mucosal mycosis, because Mucoraceae are always resistant to azole derivatives.
With Pseudoallesheria boydii infection, the clinical picture may be similar to that of aspergillosis. Differential diagnosis is extremely important because this fungus is resistant to amphotericin B.
Disseminated infections caused by Fusarium or Trichosporon beigelii are rare. Clinical characteristics are not very specific, the diagnosis is made mainly on the basis of positive blood culture results.

Exotic mycoses

The so-called primarily pathogenic fungi in the Netherlands are not endemic, but can be observed as imported diseases. Therefore, a thorough history of recent and past travels is crucial.
Histoplasmosis is caused by the dimorphic yeast fungus Histoplasma capsulatum and is sometimes observed in the Netherlands from natives of Suriname and Indonesia. Histoplasmosis can also occur in patients who have traveled throughout the United States, mainly in the states of Mississippi and Ohio. Primary infection may be asymptomatic or manifest as pneumonia. As with tuberculosis, an infection acquired at a young age can become manifest at an older age due to a decrease in immunity. Histoplasmosis in AIDS patients is most often manifested by disseminated infection with fever, general malaise, hepatosplenomegaly, damage to the skin and mucous membranes, and nodular pulmonary infiltrates. Diagnosis is by blood culture or biopsy of affected organs. Sometimes a diagnosis can be quickly made by directly examining a bone marrow aspirate, if the laboratory is specifically asked about it.
Penicillium marneffei infections are endemic in Southeast Asia, mainly in Thailand [7]. In HIV seropositive patients with fever, general malaise, papulopustular skin lesions, hepatosplenomegaly, anemia, and lung lesions who have traveled to Southeast Asia, a diagnosis of P. marneffei infection should be taken into account. In most cases, patients have advanced AIDS and the number of CD4 + lymphocytes does not exceed 100 • 1 O6 / L. Differential diagnosis of disseminated histoplasmosis, cryptococcosis and mycobacterial infections based on only clinical data is difficult, so the anamnesis of travel is extremely important here. The diagnosis is based on blood culture, bone marrow examination, or biopsy of affected organs.
Coccidioidomycosis, endemic in the southwestern United States (Arizona, New Mexico and Texas), and blastomycosis, endemic in the northern states of the United States, are very rarely seen as imported diseases.

Fungal skin diseases

Dr. Hooman-Khorasani
Posted in Uncategorized

Fungal skin diseases, unfortunately, recently – this is a very common phenomenon, widespread everywhere. It is quite difficult to deal with it and you can’t do without the help of a dermatologist. The fungus is expressed in different ways: peeling, skin discoloration, severe itching, inflammatory changes. Infection occurs when using household items infected with a fungus or in contact with the person who is their carrier.

All fungal skin diseases are divided into main groups:  

1. Dermatophytosis

2. Deep mycoses

3. Candidiasis

4. Keratomycosis

Dermatophytosis – affects the nails, hair and horny layers of the epidermis, expressed in a bright inflammatory reaction. This group includes: favus, microsporia, epidermophytosis and trichophytosis.

Deep mycoses are the most dangerous, since the fungus affects not only the skin and mucous membranes, but also the internal organs and the human nervous system.

Candidiasis – fungi that affect the skin, mucous membranes of the oral cavity, internal organs.

Keratomycosis is a group of fungi that is not manifested by absolutely no sensations and inflammations of the skin, which affects exclusively the horny layers of the skin. The diseases of this group include multi-colored lichen, erythrasma. Only a doctor can give recommendations regarding the treatment of fungal diseases, since when self-medicating, you can not heal the fungus, which at any opportunity attacks your body with renewed vigor.

How to recognize nail fungus?

Dr. Hooman-Khorasani
Posted in Uncategorized

If you notice that the nails on your hands or feet have changed color, become opaque and suddenly begin to thicken, then they may have overtaken a fungal infection. This disease is called onychomycosis. The word comes from two Greek ónyx – nail and mýkes – mushroom . Dermatomycetes (a group of fungi parasitizing on the skin), mold and yeast can cause damage.     

It is believed that nail fungus is a secondary infection. Initially, the skin of the feet or hands is affected. The probability of infection is affected by climatic conditions, age, gender, concomitant diseases, and even the profession. 

Climate

Fungal infection most often develops in conditions of heat and humidity. This contributes to the tropical and subtropical climate. But it is also quite common in temperate and cold climates. This is due to the need to wear warm shoes, which creates the same conditions of elevated temperature and humidity. 

Age

Most often, nail fungus is found in adults and the elderly. Recently, there have been cases of diseases in children and adolescents. It is believed that every 10 years, the risk of contracting onychomycosis increases 2.5 times. Contributing factors are a decrease in the rate of growth of nails, malnutrition of the nail bed, vascular disorders that appear with age.

Floor

Men suffer from nail fungus, especially on the legs, 1.5-3 times more often than women. But, oddly enough, women are more likely to see a doctor for help. 

Accompanying illnesses

The most common factors predisposing to the occurrence of onychomycosis are circulatory disorders in peripheral vessels, obesity, foot deformities, immunodeficiency states and diabetes mellitus. In diabetes, the likelihood of illness rises to 30%. The use of certain drugs, such as corticosteroids, antibiotics, and antitumor drugs, also affects.

Profession

It is noted that residents of megacities with developed industries are more likely to be affected by fungal infections of the nails than the inhabitants of rural areas. By occupation, miners, workers in the metallurgical industry, and technical personnel of nuclear power plants are most affected. One hundred is associated with factors such as dust, ionizing radiation, gas contamination, high temperature, etc. Also at risk are bath workers, massage therapists, laundry staff, medical staff, military and athletes.
If you do not belong to these professional groups, it does not mean that you are protected from nail fungus. Visiting pools, baths and saunas, public showers, massage rooms also puts you at risk.

Symptoms of nail fungus

Modern foreign and Russian dermatologists use the following classification of the disease:

  1. Distal or distal – lateral onychomycosis. The most common form of nail fungus. The defeat begins with the edges of the nail. The fungus penetrates under the free (far, distal) edge or lateral (lateral) fold. The main processes in this infection do not occur in the nail plate itself, but under it in the nail bed. The nail loses its transparency, becomes yellowish or whitish. The edge of the nail begins to crumble, thinning. Although the nail looks thickened due to the fact that under it there is an excessive development of a layer of the skin called horny (hyperkeratosis). For a long time, such a lesion can occur in the form of a marginal one. It most often looks like white strips going down from the free edge of the nail.  
  2.  Proximal subungal onychomycosis. This is a rare form of the disease. The fungus is introduced from the side of the posterior skin roller, where the cuticle is removed during manicure and pedicure. Then the lesion covers the matrix of the nail (its visible part is the hole). In the classic version of this kind of onychomycosis, a white spot first appears in the region of the hole, and then it spreads to the entire nail, reaching its free edge. 
  3. White superficial onychomycosis. It appears in the form of white spots, stripes on the nail plate, going from the back roller to the free edge. Over time, they become larger, grow and become yellow. 
  4. Total dystrophic onychomycosis . Total – means covering the entire nail. Dystrophic – in this case means the destruction of the nail plate. She looks very thickened, yellowish – gray, uneven. It can be destroyed partially or completely. In most cases, subungual hyperkeratosis of varying severity is observed.  

Do not wait for the manifestation of all the signs of fungal damage to the nail, and especially its final stages. If you find yourself with similar signs, then this is an occasion to consult a specialist.

Diagnostics 

In addition to the external signs of nail fungus, the doctor will also consider laboratory data on scraping the affected tissues. The laboratory will conduct a microscopic examination, identify the pathogen. Then they will sow to more accurately determine which variety of fungi caused the disease. 


Nail fungus treatment

Fungal infection is very persistent, it is necessary to take its treatment extremely seriously. After all, this is not just a cosmetic defect, but a disease.
Currently, the media is a huge amount of advertising of antifungal drugs. Basically, they are all external effects (ointments, gels, solutions).

Be skeptical of advertising slogans about a quick and absolute cure, since these tools do not completely cure nail fungus. They provide only symptom relief. Therefore, the most relevant and effective is a systematic approach to this problem.

Not only external but also internal agents (tablets) are used. Such a complex treatment can only be prescribed by a doctor. According to recent data, the most effective are those containing terbinafine and itraconazole. The treatment is long. The course of drugs can take from 6 to 12 weeks, depending on the severity of the disease. The result will be visible when a healthy nail is fully grown. It takes several months. Among other things, antifungal drugs have contraindications. 

Be sure to consult your doctor. Do not self-medicate to avoid unpleasant consequences. 

Feet are a haven for two hundred different mushrooms

Dr. Hooman-Khorasani
Posted in Uncategorized

Can you imagine that our legs are a haven for almost 200 species of different mushrooms? As it turned out, mushrooms also have their favorite places on the human body. Human skin is home to many harmless mushrooms that can cause infection if they start to multiply. Favorite places for mushrooms between the toes, under the nails and on the heels. This information can well help specialists in solving problems of skin diseases, especially in people involved in sports.

In the UK, almost three out of every hundred people suffer from fungal infections of the nails, and the most common symptom of the disease is a thickening of the nail and a change in its color. When scientists examined mushroom samples taken from the ear canal, from the heel, thighs, neck, place behind the ear, from the forearm, and many other areas of the body, they found that fungal riches vary significantly in each of these areas. The highest concentrations of mushrooms are on the heel, which turned out to be home to almost 80 species of mushrooms.

This knowledge of mushrooms and how to deal with them through improved cleanliness and hygiene can help stop the spread of many dermatological diseases.