Trichophytosis is a fungal disease that affects the skin and hair, and sometimes the nails.
The causative agent is the mushroom Trikhofiton. Infection occurs through contact with a sick person, as well as his belongings (hats, combs, scissors, bedding, etc.). Transfer to hairdressing, kindergartens, boarding schools, schools. Rodents (mice, rats) and cattle (mainly calves) also serve as carriers of the fungus.
Infection of a person, as a rule, occurs through contact with hay, dust contaminated with infected fur, less often with direct contact with an animal. The disease is recorded more often in the autumn, which corresponds to periods of agricultural work.
There are superficial, chronic and infiltrative-suppurative trichophytosis.
Surface form of trichophytia
The incubation period is 1 week. Depending on the location of the focus, surface trichophytosis of the scalp and smooth skin is isolated. The defeat of the nails with the surface form is extremely rare.
Superficial trichophytosis of the scalp occurs in childhood. As an exception, it happens in infants and adults. The disease is initially characterized by single and later multiple foci of 1-2 cm, with irregular outlines and fuzzy boundaries. The lesions are located in isolation, without the tendency to merge with each other;the skin in the area of the foci is slightly edematous and reddened, covered with scaly-shaped scales of grayish-white color, the layering of which can give the center a whitish appearance.
Sometimes redness and swelling increase, bubbles, pustules, crusts join. Within the foci of the affected hair lose their color, shine, elasticity, partially bend and twist. Their thinning is noted due to breaking off at the level of 2-3 mm from the skin surface. Sometimes the hair breaks off at the root, then they have the appearance of “black dots”. “Hemp” hair dim, covered with a grayish-white “patina”. Sometimes only scaling is observed on the affected area . In such situations, a careful examination can identify the “hemp” hair.
Superficial trichophytosis of smooth skin can be isolated or combined with damage to the scalp. Its predominant localization is the open areas of the skin – the face, neck, forearms, and the body. This form occurs at any age, equally often in men and women.
The disease begins with the appearance of one or several edematous and therefore pink-red spots slightly protruding above the level of the surrounding skin. Unlike foci on the scalp, the spots have correctly rounded outlines and sharp borders. Their surface is covered with scales and small bubbles, quickly drying in crusts. Over time, the inflammation in the center of the lesion subsides, and the lesion takes the form of a ring. Itching is absent or mild.
Chronic trichophytosis occurs in adolescents and adults, mainly in women, and is characterized by scanty manifestations. Adult patients usually do not show up for a long time, which is due, on the one hand, to a slight severity of the disease manifestations and, therefore, low patient attendance, on the other hand, the rarity of this fungal disease at the present time.
As a rule, the disease is detected during the examination of the “epidemiological chain” to determine the source of infection of children in the family. In chronic trichophytosis, the scalp, smooth skin and nails, usually the fingers, are affected in isolation or in various combinations with each other.
The favorite location is mainly in the occipital region and is manifested only by a slight, scaly, whitish peeling. Places, scales are located on a barely noticeable lilac background. Broken hair in the form of “black dots” are found with difficulty. However, the “black spots” may be the only sign of the disease. This form of chronic trichophytia of the scalp is called black-point . Often on the areas of fallen hair gentle scars are preserved.
Chronic trichophytia of smooth skin is characterized by a lesion of the legs, buttocks, forearms, and elbows, less commonly of the face and torso. Occasionally the process takes ubiquitous distribution. The centers are represented by patches of pinkish-bluish color without clear boundaries, with a flaky surface. Edge roller, vesicles, pustules are absent. With the defeat of the palms and soles there is a slight redness, peeling, increased skin pattern. A continuous thickening of the stratum corneum is possible, as a result of which deep grooves and even cracks in the areas of skin folds are formed on the palms and soles. When trichophytia palms and soles never formed bubbles.
Chronic trichophytosis is often accompanied by lesions of the nail plates. In the initial period of the disease in the area of the nail appears a spot of whitish-gray color, which gradually increases in size. Further the nail plate becomes dull, dirty-gray color with a yellowish shade; its surface is bumpy. Fingernails thicken, deform, crumble easily.
Infiltrative-suppurative form of trichophytia
The incubation period for infiltrative-suppurative trichophytia is from 1-2 weeks to 1-2 months. It begins with the appearance of one or more pale pink scaly spots with rounded outlines and clear boundaries. The edge roller is made of plaques, small bubbles, crushing into crusts. In the future, foci increase in size, inflammation increases, they rise above the level of healthy skin. When merging foci form freakish figures, their surface is covered with plaques, vesicles, abscesses and crusts. Gunfly hair is involved in the process . With the localization of lesions in the growth zone of long hair there are “hemp” broken hair.
In the future, inflammation in the foci localized in the scalp, beard and mustache grows, redness and swelling increase, sharply differentiated hemispheric bluish-red color is formed, the bumpy surface of which is covered with numerous expressions. Hair partly fall out, loose and easily removed.
A very characteristic feature is the sharply widened mouth of the hair follicles, made of pus, which is released when pressed in the form of abundant drops and even streams. The consistency of nodes at the beginning becomes, over time, soft. These foci on the scalp resemble honeycombs, and in the area of the beard and mustache – wine. On smooth skin flat plaques prevail, sometimes very extensive, transforming gradually into pustules. Developing suppuration leads to the death of fungi. They are stored only in the scales along the edge of the lesions, where they are detected by microscopic examination.
With infiltrative-suppurative trichophytosis, there is often an increase in lymph nodes, sometimes there is general malaise, headaches, and an increase in body temperature.
Diagnosis is carried out by a dermatologist with the help of laboratory and instrumental methods of research.
Microscopic examination. Foci of superficial and chronic trichophytia on smooth skin are scraped off with a blunt scalpel scales and “hemp” of broken vellus hair. Broken hair is removed with tweezers. Microscopically, in flakes from lesions on smooth skin, convoluted filaments of mycelium are found. Microscopic examination of a large increase in the affected hair has clear boundaries and is filled with large spores of the fungus, which are located in parallel longitudinal chains.
Cultural research. The growth of the colony is noted on the 5-6th day after sowing in the form of a white lump.
In the treatment of trichophytosis of smooth skin without affection of vellus hair, external antifungal agents are used. On the lesions in the morning put 2-5% tincture of iodine, and in the evening smeared with antifungal ointment. Apply 10-20% sulfuric, 10% sulfur-3% salicylic or 10% sulfur-tar ointment. Widely used modern antifungal ointment – Lamisil, mikospor, ekzoderil, clotrimazole etc. At the phenomena of significant inflammation apply combined preparations containing hormones..
When multiple lesions on the skin, especially with involvement in the process of vellus hair, as well as in the defeat of the scalp requires systemic antifungal therapy. The main drug used in the treatment of trichophytia is griseofulvin . Griseofulvin is taken daily until the first negative analysis, then for 2 weeks every other day, and then another 2 weeks with an interval of 3 days. During therapy, the hair is shaved off.
Simultaneously with the intake of a systemic drug, local antifungal therapy is carried out. With the defeat of fluff hair, epilation is carried out with preliminary detachment of the stratum corneum. Milky salicylic resorcinol collodion is used for detachment.
In chronic trichophytia of the scalp to remove the “black spots”, detachment of the stratum corneum is performed according to the Arievich method: milicy salicylic ointment is applied for 2 days, then the dressing is removed and 2-5% salicylic ointment is applied under the compress. Using the blunt scalpel, the horny layer of the skin is removed, and with the help of tweezers, the “black spots”. The detachment is carried out 2-3 times.
For infiltrative-suppurative trichophytia, the removal of crusts is carried out using 2-3% salicylic ointment. Disinfectant solutions (furatsilin, rivanol, potassium permanganate, ichthyol solution), as well as absorbable ointments, in particular sulfur-tar, are used.
Prevention of trichophytia
Prevention consists in timely detection, isolation and treatment of patients with this disease. Periodic medical examinations in children’s institutions are required. Relatives and persons who came in contact with patients are examined. Special attention should be paid to domestic animals (cows, calves), as they often serve as a source of infection.