Rubromycosis is a dermatomycosis that affects the skin of the feet, hands, inguinal-femoral folds and other areas. Manifestations of rubromycosis are hyperemia, dryness, hyperkeratosis, cracking, flaky peeling of skin areas. The lesion of the nail plates is characterized by their thickening, increased fragility, and the development of subcutaneous hyperkeratosis. Diagnosis is carried out by a dermatologist-mycologist on the basis of external examination and laboratory results (bacteriological seeding, scraping for pathogenic fungi). Rubromycosis therapy includes treatment of the affected skin and nails, oral administration of antimycotic drugs
Rubromycosis is a mycotic skin disease, the causative agent of which is the fungus Trichophyton rubrum, whose high enzymatic activity causes damage to the skin of the feet, sometimes the skin in large folds and even more rarely, downy and long hair are affected by rubromycosis. The causative agent of rubromycosis is divided into gypsum-like, fluffy and velvety, the gypsum-like type of fungus is the most aggressive and mainly causes foot lesions. Rubromycosis accounts for 60-80% of all cases of fungal foot diseases. According to the localization feature in dermatology, rubromycosis of the feet, hands (including nails) and generalized form.
Infection occurs through contact with a sick person, but due to the high virulence of rubromycosis, infection through the use of common household items is also common. The use of antibacterial drugs, cytostatics and hormonal drugs promotes inoculation of the causative agent of rubromycosis. Violation of vascular tone and circulatory disorders in the lower extremities, which will happen in various diseases, for example, with obliterating endarteritis, contribute to the contamination of fungal spores. After the disease, immunity to rubromycosis does not develop. The exact incubation period of rubromycosis has not been established, long-term carriage may develop upon contact with fungal spores, as a result of which a person who does not have clinical manifestations of rubromycosis becomes a source of infection.
Rubromycosis of the feet is diagnosed in 90% of cases of diseases caused by the fungus Tr. Rubrum. After the incubation period, all the interdigital folds are simultaneously affected, then the skin of the soles is involved in the process. Externally, the skin affected by rubromycosis looks infiltrated, dry, diffuse hyperemia is noted, the skin pattern and furrows become clearly visible, pronounced mucoid peeling is noted on the damaged skin, more intense in the places of the skin grooves. In the absence of therapy, rubromycosis spreads to the back and side surfaces of the feet and fingers. Children with rubromycosis of the feet may have exudation, which makes diagnosis difficult. When the process is chronicled, rubromycosis affects the nail plates and spreads to other areas of the skin.
Rubromycosis of the hands occurs by self-infection, less often rubromycosis of the hands is diagnosed initially. The clinical manifestations are the same as with the lesion of the feet, but less intense due to frequent hand washing. In addition, an intermittent roller is observed along the periphery of the lesions, which often passes to the back of the palms.
Rubromycosis of nails is usually diagnosed with existing skin lesions, as a separate disease is extremely rare. Rubromycosis of nails is characterized by simultaneous defeat of all nail plates. Strips of white or yellowish color are formed on the free and / or lateral edges of the nail, the same strips shine through in the thickness of the nail. With the hypertrophic form of the nails, the nail plate is thickened, crumbles and breaks, there is sub-elbow hyperkeratosis, sometimes there are yellowish stripes. With an atrophic form, the nail plate gradually thinns, collapses, and its remnants remain only near the nail roller, sometimes the nail plate separates from the nail bed.
Symptoms of generalized rubromycosis
Generalization of rubromycosis develops after a more or less prolonged existence of limited forms. Diseases of internal organs, endocrine and nervous systems, trophic skin changes, as well as taking drugs from the group of antibiotics, cytostatics and hormones in the absence of adequate treatment of localized forms, are the main cause of the generalization of rubromycosis.
Erythematous-squamous form of rubromycosis is localized on any areas of the skin, accompanied by severe itching and masquerades as other diseases. It is necessary to differentiate this form of rubromycosis with atopic dermatitis, atypical eczema and parapsoriasis. The mycotic nature is confirmed by careful examination, the lesions are located in groups, tend to form rings, arcs, half arcs and garlands. Hyperpigmentation and peeling from the center to the periphery also indicate the mycotic origin of skin changes. Scalloped edges with the presence of an edematous intermittent roller are characteristic signs of rubromycosis. The disease has a wave-like chronic course with exacerbations in the warm season.
The follicular-nodular form of rubromycosis is characterized by deep skin lesions of the feet, hands, shins, buttocks and forearms. The elements are prone to peripheral growth and fusion and acquire an external resemblance to nodular vasculitis and nodular erythema. If the skin of the face is involved in the process, then the clinical manifestations are masked as manifestations of lupus erythematosus.
Rubromycosis of the body affects the interstitial folds, the skin under the mammary glands, in people with overweight and excessive sweating, any natural folds of the skin are affected. The lesions are infiltrated, their surface is yellowish-red or brown, there is peeling from the center to the periphery. An intermittent scalloped roller with the presence of papules and crusts makes it possible to differentiate rubromycosis of the body from candidiasis infection and from microbial eczema. An important diagnostic feature is the absence of maceration, which is observed in candidiasis and the absence of polymorphism of elements as in eczema.
Clinical manifestations, despite mimicry for other skin diseases, are very specific, so a careful examination of the patient allows you to make an accurate diagnosis. To confirm the diagnosis, a cytological examination of the pathological material is carried out. To identify the exact type of pathogen, sowing and cultural examination are carried out, which also helps to determine its sensitivity to drugs. Differential diagnosis should be carried out with psoriasis, microbial eczema, tuberculosis of the skin, and, if the skin of the face is affected, with lupus erythematosus.
If edema and wetness of the affected skin come first, then it is necessary to use local soothing and cooling gels and lotions. Normalization of bowel function and treatment of systemic diseases occupy an important place in the therapy of rubromycosis. When allergic reactions occur, including inhaled mushroom spores, it is necessary to prescribe desensitizing drugs and drugs that reduce the production of histamine – loratadine, fexofenadine and others.
After the inflammatory process subsides, keratolytic drugs are prescribed to detach the thickened epidermis, otherwise antifungal ointments will be ineffective. Soap-soda baths and branches with a scalpel or scissors allow you to clean the surface of the horny masses as much as possible. If patients feel pain when walking, it is necessary to use crutches, since in this case the bandage with aggressive keratolytic substances does not slip on unaffected skin.
After detachment of the thickened skin, treatment of the skin and nails of the affected areas with antimycotic drugs is connected to rubromycosis therapy. Treatment with ointments containing oxyconazole and terbinafine is prolonged from 1 to 6 months, after which a break is necessary and, if necessary, continuation of therapy. For general course treatment, the same drugs are prescribed inside, in tablet forms.
With rubromycosis of smooth skin, epidermal detachment is not required, and therapy with antifungal ointments and oral medications is immediately started. It is recommended to follow a diet with a predominance of protein foods and foods rich in vitamins A and E to improve skin regeneration. Treatment of concomitant diseases is carried out in the background. In the treatment of rubromycosis of nails, antifungal patches and nail polishes are used, preparations that include ointment, plaster and a nail scraper. In some cases, surgical removal of the nail plate is required.
The process of treating rubromycosis is long, and therefore the patient needs patience and full compliance with medication, since irregular pill intake and irregular local treatment only develop resistance to drugs in the causative agent of rubromycosis. Daily change of underwear and bed linen and its washing with the addition of soda and double ironing helps to destroy rubromycosis spores and prevent re-infection. A patient with rubromycosis should have separate household items and avoid direct contact with healthy people.
Prevention of rubromycosis is given special attention due to the prevalence of this disease among the urban population. Employees of baths, saunas, sports complexes and swimming pools are subject to mandatory inspection. And, if you visit such institutions, then a preventive examination by a dermatologist should be mandatory, since it is possible to carry rubromycosis for a long time without clinical manifestations. Individual bath accessories, refusal to wear clothes together within the family reduces the risk of intra-family foci of rubromycosis and other infectious diseases.