Trichophytosis (a synonym for ringworm) is a disease of a person (skin, nails and hair) and animals caused by fungi of the genus Trichophyton. Distinguish between trichophytosis superficial, chronic and infiltrative-suppuration. The incubation period is 5-7 days with superficial trichophytosis, with infectious-suppuration - sometimes up to 2 months.
Surface trichophytosis is transmitted from person to person with direct contact or through objects used by the patient (caps, combs, etc.). Children are more often ill, high contagiosity.
The defeat of the scalp manifests itself in the form of small (sometimes large) rounded spots with fuzzy boundaries without sharp inflammatory phenomena covered with whitish scales. Hair in the foci of lesion thinning, lose shine, break off at a height of 1-2 mm above the skin level in the form of "hemp"; Twisted, thinned hair remains sometimes visible only under the magnifying glass. On the smooth skin appear rounded inflammatory spots with a roller of bubbles along the periphery and peeling in the center. Itching is usually absent. The defeat of nails in patients with trichophytosis of children occurs in 2-3%, in adults - in 20-30% of cases. Clinical picture of nail damage - see Onychomycosis .
Trichophytosis (ringworm). Fig. 2. Black-spotted form of trichophytosis of the scalp. Fig. 3. Suppurative trichophytosis is the celio of Celsus.
Chronic adult trichophytosis occurs more often in people with peripheral vascular system insufficiency (acrocyanosis, erythrocyanosis ) and gonadal hypofunction. At the head of the follicles of the scalp (occipital, temporal areas), hair that has been broken at the skin level, the so-called black points of Zakharyin, diffuse or fine-frontal peeling and small foci of skin atrophy are observed (Fig. 2). On the palms and soles, buttocks, extensor surfaces of the joints, shins, the erythematous-squamous foci are incompletely limited, slightly stagnant, with a tendency to merge with each other. There are no subjective sensations.
In infiltrative-suppuration trichophytosis, human infection occurs from animals (mice, cows, sheep, etc.). The process begins with inflammation of the follicles of the scalp, beard, mustache. Gradually, a massive infiltrate with outlined edges is formed, covered with crusts and numerous holes, from which thick yellowish pus is squeezed out. The focus becomes bumpy, increases in size, acquiring a cyanotic color and hemispherical shape, there is the so-called kerion of Celsus (Figure 3). Around the keryon, other foci of infiltrate, pustules, furuncle-like nodes are observed.
Among the rare varieties of trichophytosis, furuncle-like trichophytosis and septic trichophytosis, affecting the human brain, lymph nodes, mucous membranes, bones (ribs, feet), etc. are described. Their origin is usually associated with endocrine, nervous and other disorders in the body. The course is chronic.
The diagnosis is based on the clinical picture, morphology of the fungus under microscopic examination in caustic alkali and culture on the Saburo medium.
Treatment . When trichophytic smooth skin - in the morning, lubricate 2-5% with alcoholic iodine solution, in the evening, rub Wilkinson's ointment, 10% sulfur-tar and others for 10-12 days. With infiltrative-suppurating trichophytosis - lotions from Burov's liquid (1 tablespoon per 1 glass of water), open the abscesses and rinse the cavities with a solution of potassium permanganate , remove the hair in the lesions with forceps (see Epilation ), then foci lubricate with iodine tincture and rub chamois -Oil ointment.
If the scalp is affected, the treatment is performed in a specialized hospital, griseofulvin is administered 0.125 g 4-6 times a day (for 15-20 days), then a day before the full effect (on average 1-1.5 months); children - at the rate of 20-22 mg per 1 kg of weight. In the presence of contraindications to the use of griseofulvin - 4% epilinoy plaster (see), followed by the use of sulfur-tar ointments and 2-3% tincture of iodine. In rare cases - X-ray therapy . In the treatment of chronic hyperkeratotic trichophytosis use a mixture of: Ac. salicylici - 6 grams, Ac. lactici - 3 g, Vaselini - 91 g, and hair shaft epilation in lesions; in the future - 2% tincture of iodine and 10% sulfur-tar paste ointment to the full effect.
Treatment of nails - see Onychomycosis.
Prevention : timely and thorough treatment of patients, examination of all family members of the patient, examinations of children and attendants in children's groups, isolation and treatment of all identified patients; current and final disinfection in foci of mycosis (see Disinfection, dermatomycosis). Control over the work of hairdressers. Sanitary and veterinary measures to combat cattle fungi. Sanitary-educational work.
Children's groups of children who have recovered can be admitted after three negative tests for fungi.