Ringworm is a mycotic lesion of smooth skin, hair, nails by fungi of the genus Trichophyton. It is characterized by the formation of inflammatory foci with clear boundaries, peeling. The affected hair becomes brittle, breaks off above the skin level and sticks out in the form of stumps. The disease is highly contagious. Deep skin lesions lead to deterioration of the general condition, the formation of abscesses. Treatment is carried out with antimycotic agents, which are prescribed topically and orally. In advanced cases, persistent baldness may remain in place of the hair.
Ringworm is a mycotic disease of the skin and its appendages caused by a fungus from the genus Trichophyton, can be anthropophilic when the source of infection is a person and zoophilic – this form of ringworm occurs when in contact with infected animals. Ringworm is a highly contagious fungal disease, the incidence in all age groups is approximately the same, but in children of primary and school age, ringworm is diagnosed more often.
The source of infection is people with ringworm, animals and household items seeded with fungus spores. Infection with zoophilic ringworm occurs due to contact with sick animals, homeless animals are particularly dangerous. The risk of getting sick increases with constant contact with animals – on livestock farms, in veterinary hospitals and when feeding stray dogs and cats.
With chronic sluggish forms of ringworm, which is especially common in middle-aged women, the infection affects all family members through the use of common combs, pillows and household items. Factors such as crowding, neglect of personal hygiene rules and frequent contact with unprotected skin increase the likelihood of intrafamily infection. After the spores of the fungus get on the skin or scalp, their germination begins with the formation of mycelium, which leads to further damage to both the dermis itself and its appendages.
The symptoms of ringworm depend on the form of the disease, the type of pathogen and the characteristics of the patient’s body, although the superficial, infiltrative and infiltrative-suppurative forms represent the sequential development of one pathological process. And in the absence of adequate treatment, the superficial form can turn into infiltrative-suppurative.
Superficial ringworm occurs on the scalp and on smooth skin, externally manifested by rounded lesions, sharply limited from healthy skin. The incubation period is about a week, after which clinical manifestations begin – areas of grayish-pink skin of small size with uneven outlines and slight peeling. In the lesions, most of the hair is broken off at the skin level or 2-3 mm from it, if the hair on the head is dark, then you can see dark dots – hair stumps. Sometimes the hair on the affected trichophytic area is twisted and bent, in some cases the hair is covered with a grayish-white coating, which consists of fungal spores. Itching and any other subjective sensations are absent. On the periphery there are bubbles, purulent nodules and crusts in the form of a border. Bran-like peeling is most intense in the center of the focus, closer to the periphery is practically not observed. If there is no peeling or intensive hair breaking, but there are hemp characteristic of ringworm, then an additional examination should be carried out to exclude or confirm the diagnosis of “Ringworm”.
Chronic forms of superficial ringworm begin in childhood and its difference is that it does not pass by puberty, although it is caused by the same pathogen. The pathogenesis of chronic form is the lack of vitamin A in the body, endocrine disorders of the functions of the genital glands and other endocrine glands and autonomic nervous disorders (vegetative-vascular dystonia), which reduce the body’s protective reactions. The lesions are localized in the occipital and temporal areas of the head, there is a small focal or diffuse peeling. There are areas with broken hair, with long-term ringworm, areas of skin atrophy with small delicate scars appear. Sometimes barely noticeable scales on the scalp, the color of which acquires a lilac hue, are almost invisible, black dots from broken hair are also found only upon careful examination.
Smooth skin affected by chronic ringworm, cyanotic with the presence of gray thin scales. Most often, the skin in the buttocks, inner thighs, forearms and elbows is affected, ringworm is less common on the face and on the upper part of the trunk, the widespread spread ringworm the body is observed in isolated cases. The skin pattern is pronounced, there may be a thickening of the stratum corneum of the skin, which is why furrows appear on the palms and soles in places of skin folds, furrows eventually transform into cracks. With lesions with ringworm of the palms and soles, blisters never form. Blisters, crusts and nodules are also not characteristic of chronic ringworm.
Sometimes the infection passes to the nails, although nail ringworm can occur without skin damage. Nails thicken, become lumpy, rough to the touch, grayish-white spots and stripes can be noticed on the free edge of the nail. The supra-elbow plate is not inflamed, there is no itching and unpleasant sensations.
Infiltrative-suppurative forms are caused by a zoophilic type of fungus, such forms of the disease are more common in people living in rural areas. On the scalp, a bluish-red infiltrate protruding above the skin level appears up to 8 cm in diameter, if there are several infiltrates, then when they merge they form an extensive purulent conglomerate of bizarre shapes. At the same time, the inflammation has clear boundaries and does not spread to neighboring areas of the skin, the focus of inflammation is usually round or oval in shape.
The surface of the infiltrate of ringworm is often ulcerated. Around it there is a roller consisting of plaques, small bubbles and dried crusts. After a while, a pustule forms around each hair, after the final formation of which, the hair in the lesion loosens and begins to fall out. From the expanded hair follicles, when pressed or accidentally pressed, droplets and sometimes trickles of pus are released, the area affected by ringworm is very painful when touched. With the infiltrative-suppurative form of ringworm, fluffy hair is also involved in the process, but unlike long hair, they do not break off. The surface of the scalp with ringworm is similar to honeycombs, and if the suppurative-infiltrative form is observed in the beard and mustache, then the affected areas resemble wine berries. After 7-10 days, the infiltrate begins to soften.
Suppurative forms of ringworm may be accompanied by symptoms of intoxication: general weakness, increased body temperature, enlargement and soreness of regional lymph nodes, loss of appetite. In the absence of treatment, suppurative forms self-resolve, since the developed suppuration is detrimental to the mycelium of fungi, but mycotic cells persist on the periphery and in scales along the edge of the lesion. In some cases, suppurative forms of trichophytosis are complicated by abscesses.
A dermatologist makes a diagnosis based on the clinical manifestations and features of the patient’s vital activity (contact with animals, an outbreak in kindergarten). If necessary, a patient can be referred to a mycologist. Microscopic examination of the scraping on fungi reveals mycotic cells and overgrown mycelium. If it is necessary to make a differential diagnosis, then a cultural study is carried out with the identification of the pathogen. In atypical cases of ringworm, repeated diagnostic procedures are necessary.
Treatment and prevention
Therapeutic tactics depend on the type of trichophytosis and, if there is such a possibility, it is necessary to limit yourself only to local drugs.
When treating ringworm of smooth skin without involving downy hair in the process, it is advisable to use alternating antifungal ointments and iodine-containing solutions for skin treatment. So, in the morning, the affected areas are lubricated with an iodine solution, and in the evening an application is made with ointments containing terbinafine, bifonazole, naphthyphine. If the inflammatory phenomena on the part of the skin are more pronounced, then combined hormone-containing drugs are indicated for the local treatment of ringworm.
If ringworm of smooth skin has a large number of foci and downy hair is involved in the process, then in addition to local therapy, course treatment is indicated by taking antifungal drugs orally, for example, itraconazole, fluconazole and other triazole derivatives. It is recommended to shave or cut the hair in the lesions. Infiltrative-suppurative forms of trichophytosis, in addition to taking a systemic drug and local antifungal therapy, require therapy of suppurated infiltrate, the crusts are softened with salicylic ointment or potassium permanganate solution, after which they are carefully removed, at the stage of infiltration resolution, resorbing ointments such as ichthyol and Vishnevsky liniment are shown.
Prevention of trichophytia consists in timely detection of foci of the disease with isolation of patients and quarantine of contact persons. Systematic examinations in kindergartens make it possible to identify children with trichophytia and prevent the spread of infection. Avoiding contact with stray animals, examining pets, including those that do not come into contact with wild ones, reduce the risk of infiltrative-suppurative forms of trichophytosis.