Skin Fungal Disease: Symptoms, Types, Causes, Treatment---Health tips fit - health tips fit

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Wednesday, 17 June 2020

Skin Fungal Disease: Symptoms, Types, Causes, Treatment---Health tips fit

Fungal skin disease

1.     Definition:
Fungal dermatosis can also be called dermatophytosis. It refers to a large class of infectious diseases of human skin, mucous membranes and skin appendages caused by medical fungi. It is a common and frequent disease in dermatology.

they have real nuclei, produce spores, absorb nutrients in parasitic or saprophytic ways, only a few groups are single cells, and there are branched or unbranched filaments, which can perform sexual reproduction and (or) asexuality Organisms that reproduce cell walls with chitinous microfibers or cellulose or both.

Nearly 200,000 kinds of fungi are found, of which only a few fungi are quite toxic and can invade the human body. Most fungi are usually harmless, and they are only invasive when the host's immunity is impaired, even threatening the patient's life.

   fungi can be divided into two categories according to their morphology, namely yeast and filamentous fungi, the latter is divided into dermatophytes and non-dermatophyte fungi.

   Fourth, the classification of mycosis:
There are five manifestations: invasive infection, opportunistic infection, fungal allergy, fungal poisoning and fungal carcinogenesis

   According to the infection site, it can be divided into three categories: superficial mycosis, subcutaneous tissue mycosis and systemic mycosis.

1.   Superficial mycosis
refers to fungal infections limited to the epidermis, skin appendages and mucous membranes. The main pathogenic microorganisms are dermatophytes and Candida, most of which are mild, easy to diagnose, and have good efficacy;

  Deep fungal disease: refers to those involving the dermis and below, internal organs, blood and systemic fungi

1. Infection, the main pathogenic microorganisms are Candida, Aspergillus Cryptococcus and Mucor, etc. Most of them are opportunistic infections. Most patients have more serious basic diseases or immunosuppression. If they cannot be diagnosed early and timely and effective treatment can be life-threatening .


   Head ringworm

1.     Definition:
It is a kind of dermatophytosis that affects the scalp hair follicles. It can usually cause inflammatory or non-inflammatory hair loss, which mainly occurs in pubertal children.

   2. Pathogenic microorganisms 

There are three main types of hair in patients with tinea capitis under the microscope, namely, hair type, hair type and yellow ringworm, reflecting the pattern of fungi invading the hair shaft, but no matter which mode, the clinical manifestations are basically hair loss and scales. Often accompanied by inflammation.

   3. Clinical manifestations

The clinical manifestations of tinea capitis are diverse. The clinical manifestations of tinea capitis can be divided into 4 types: yellow ringworm, black ringworm, white ringworm, and pustules.

Yellow ringworm, or tinea 
 mainly occurs in children, and its typical skin lesions are yellow ringworm scab and yellow ringworm hair. The former is that the spores of yellow ringworm bacteria multiply in the pustules that invade the scalp, forming a circular dish Caused by the yellow scab, the center is slightly concave, the boundary is obvious, 2-5 mm in diameter or larger, a hair passes through the center, can be fused into a piece, or even cover the entire scalp, can smell and an unpleasant rat smell taste. The tissue dissolving action of Xanthomonas can destroy hair follicles, so atrophic scars are often left after the treatment of yellow ringworm, leading to permanent hair loss.

   Black ringworm  in children and adults.
At the beginning, the lesions were mainly papules, which gradually spread to the surroundings, forming a ring-shaped lesion of the size of a coin. There is a tendency to heal in the center, and a few scales can be seen. With the course

Progression, the hair gradually loses its luster, bends and even breaks, so-called "black spots" marked by broken hairs are formed at the mouth of the hair follicle, and the intra-articular spores filled with full-length disease can be seen by microscopic examination, but the disease may be broken at a high position.

White ringworm:
 early ringworm-like skin lesions, marginal uplift, caused by the spread of papules or blisters/pustules formed by the invading part of the bacteria to the surroundings at an equal distance, and later evolved into plaques mainly with scales, without Obvious edge uplift; most or all of the hair in the plaque is broken 2 to 4 mm away from the scalp, and the outer periphery is covered with a gray-white bacterial sheath; microscopic examination shows a pile of densely distributed extracellular spores; sometimes small "spots.

   Pus tinea:
mainly caused by some protozoan or soil-friendly dermatophytes, the mechanism is that the patient produces a delayed allergic reaction to fungal antigens. The clinical manifestations are obvious inflammatory reactions. The initial occurrence is dense inflammatory follicle papules and small pustules, which quickly progress to large or larger bumps and abscesses in walnuts. They are often single, clear, and have a fluctuating touch. Local hair is loose and easy to remove, and scars can form after healing.

   Fourth, diagnosis and differential diagnosis

 1. Mycological examination

(1)                       Microscopic examination:
 yellow ringworm scab or disease should be taken for examination. The spores and staghorn hyphae of different sizes filled with visual field can be seen in the scab. The disease shows the type of the hair, and the number of hyphae and bubbles in it It is related to the progression of the disease stage; black ringworm chooses point-like broken hair or tarnished hair, which can be seen that the intra-articular hyphae fill the entire hair; white ringworm collects broken hair with a sheath, and the dense microspores outside the hair are seen embedded in Hyphae can also be seen in the hair, so tinea versicolor is actually inside and outside the hair.

   (2) Cultivation:
The disease, dander or pus can be taken for routine inoculation and culture. Yellow ringworm

The uniformly diseased microorganism is Xanthomonas fuliginea, black ringworm is mainly caused by Trichophyton violaceum, Trichophyton brevis and Trichophyton mentagrophytes, while tinea versicolor is caused by Microsporum canis and Microsporum gypsum, Occasionally rust-colored microspores. The identification results of the bacterial species are decisive for the diagnosis of tinea capitis.

   2. Differential diagnosis

This disease should be distinguished from skin diseases such as scalp seborrheic dermatitis, dandruff, atopic dermatitis, eczema, pityriasis, psoriasis, alopecia areata, pyoderma, and trichotillomania. Important indication, and  examination is the key basis.


   1. The principle of treatment: "five-character therapy", that is, "take, wipe, wash, shave, cook". Due to the severe inflammation of psoriasis, small amounts of glucocorticoids can be taken as appropriate, and antibiotics should be selected for those with bacterial infection. External treatment of tinea capitis alone is ineffective, because the medicine is difficult to reach the hair follicle, so oral antifungal preparations are needed.

2. The current gold standard for treatment is still oral griseofulvin. Ordinary micronized griseofulvin is taken orally at 3 to 15 mg/kg·d in three meals, because fat meals can enhance absorption; if it is taken ultrafine For micronized preparations, the dosage should be 10-15 mg/kg·d. Domestic scholars suggest that the course of treatment is 2 to 3 weeks, while foreign counterparts believe that at least 6 to 8 weeks. The drug is satisfactory and safe for most patients, and can be well tolerated by children. 

1. For the capsule preparation, it is not suitable to disassemble and subdivide it mechanically, so as not to affect the bioavailability. The method of changing the dose every other day can be used. For example, if the child needs to take 150 mg/d, the first day can be 100 mg, the next day 200 mg, and the next day 100 mg, Rotate in turn.
 jock itch

1.   Definition:
Tinea and tinea corporis refers to dermatophyte infections on the smooth skin epidermis. Tinea tinea pedis refers specifically to tinea corporis that occurs in the groin, perineum, perianal and buttocks.

   2. Pathogenic microorganisms 

Dermatophytes are often parasitic on the stratum corneum of human epidermis, rarely invading the sub epidermal structure, but in recent years, reports of deep infections of dermatophytes have increased.

   3. Clinical manifestations

   first appeared as red papules or small blisters, followed by the formation of scales, and then gradually expanded into a ring-shaped skin lesion with a marginal uplift and a clear boundary. The center of the skin lesions tended to recede while the margin was abducted. The lower edge of jock itch is often significant, and the upper edge is not clear. Scrotal involvement is rare; ring-shaped lesions are sometimes single, sometimes multiple ring-shaped lesions can be seen, which can overlap or be scattered, with varying degrees of itching.

   Fourth, diagnosis and differential diagnosis

  Diagnosis is mainly based on clinical manifestations combined with mycological examination results.


   The affected area should be ventilated and dry. It is mainly used outside the treatment, and various types of antifungal drugs  can be applied. The dosage forms include

  Water, cream, gel and ointment should be selected according to clinical manifestations and infected parts. Use fungicidal drugs  for short-term treatment, only 1 to 2 weeks, and fungal inhibitors  should be appropriately extended; the generalized lesions can be taken orally Binafin or itraconazole or fluconazole.

   Hand ringworm, tinea pedis

1.     Definition:
Hand ringworm and foot tinea (tinea pedis) refer to dermatophyte infections that occur on the hands and feet except on the back side.

   2. Pathogenic microorganisms 

The pathogenic microorganisms are mainly Trichophyton rubrum, followed by Trichophyton mentagrophytes and Trichophyton floccus. The special anatomical part of the palm and plantar part makes it more susceptible to dermatophytes. It is now tended to be recognized that ringworm has a high genetic susceptibility, especially keratotic hyperplasia and nails caused by Trichophyton rubrum Ringworm, genetic factors and environmental conditions are equally important.

   3. Clinical manifestations

   Athlete's foot can be clearly divided into three types clinically, namely impregnated erosion type, blister type and keratohyperplastic type. Such classification is closely related to the infected pathogenic microorganisms.

1.     Impregnated erosion type:
also known as inter-rubbing type, mainly caused by Trichophyton rubrum, Trichophyton mentagrophytes and floccus epidermidis, chronic process, clinical features are mainly sweating, itching, odor, 4. 5 Impregnation and erosion between toes can sometimes be secondary to bacterial infections, severe cases can cause lymphangitis, cellulitis or erysipelas.

2. Pimple blister type:
mostly caused by Trichophyton mentagrophytes, the course is a subacute process on the basis of a chronic mild disease, the clinical manifestations are itching, blisters, pustules, sometimes seeing fissures, skin lesions can be from the inter-toe area Expanding around, this type is easy to stimulate ringworm rash.

1.   Keratoproliferative type:
 Most of the pathogenic microorganisms are Trichophyton rubrum, and a few are flocculent epidermophyton. The clinical manifestations are mainly characterized by like scales and hyperkeratosis. They are often associated with onychomycosis and have a slow course of disease. It is common to have flaky silvery white scales on the thickened erythema base spreading over the entire plantar and lateral margins, often with chapped in winter. Hand ringworm is clinically mainly blistered and hyperkeratotic. Athlete's foot often affects both feet, and tinea pedis is usually unilateral.
 Fourth, diagnosis and differential diagnosis

  Diagnosis also needs to combine clinical manifestations with mycological examination. The dandruff that can scrape the active edge of the skin lesion is directly microscopically inspected with 10% or 20% KOH film. It is worth pointing out that negative results cannot completely rule out the diagnosis.
The principle of    is that the medicine and course of treatment should be selected according to the clinical type and severity of hand, foot and ringworm. For those with obvious exudation, first apply a wet compress to converge. There is no obvious erosion. Only erythema scales or papules can be used with various antifungal creams or gels. For keratotic hyperplasia, keratin exfoliants such as Wei's ointment or the above creams can be used. Packets, those with bacterial infections or tendencies should be treated with antibiotics in a timely manner. Oral antifungal drugs, such as terbinafine , itraconazole, or fluconazole, should be given to generalized or chronic prolonged types for 2 to 4 weeks.

A real fungal disease

   1. Definition:

   Dermatophytes, yeasts and molds cause fungal infections of the deck and sub-nail tissues called onychomycosis. This disease has not received much attention from doctors and patients because of its slow course, difficult to cure, and no obvious pain.

 2. Pathogenic microorganisms 

The pathogenic microorganisms of onychomycosis include dermatophytes, yeasts and molds, among which dermatophytes are the most common. This is because dermatophytes have keratinase, which is more invasive to the keratin-rich deck; yeast and mold It can also cause nail infection alone, but it is mostly secondary to nail hydration or trauma, or it can cause a mixed infection with dermatophytes.

   3. Clinical manifestations

   Onychomycosis can be clinically divided into 5 types, that is, distal lateral sub-nail type, proximal sub-nail type, white superficial type, in-deck type and full nail damage type.

1.   Distal lateral sub mandibular type:
the most common clinical. Mostly caused by dermatophytes, trichophyton mentagrophytes, epidermophyton flocculata, Candida and molds can be isolated. The foot is more susceptible, and the infection begins at the anterior and/or lateral edges of the nail, and is often accompanied by infection of the adjacent skin. The destruction of the deck is mainly keratinized hyperplasia, which is manifested by the change of the nail's color, texture and thickness, and sometimes the separation of the deck and the nail bed; often the single nail is first affected, and then the other healthy nails are affected by neglect.

2.   Proximal inferior nail type:
 The infection starts from the proximal end of the deck and occurs more frequently in the fingers. It can be combined with paronychia. At this time, it is mostly caused by Candida infection, and dermatophytes are also detected. There is no obvious hyperkeratosis on the deck, which can be shown as white spots and uneven surface, showing a malnourished appearance.

3.   White superficial type:
 mainly caused by Trichophyton mentagrophytes and Cladosporium. The diseased nails showed white spots, clear borders, smoother surface, yellowish color after a long time, and the texture was crisp and easy to break. Since this type of fungus only invades the upper deck, external medicine treatment is expected to receive good results.

4.   Full nail dystrophy type:
 It is actually developed from the above types. Depending on the pathogenic microorganisms, it can be manifested in different appearances of the diseased nails, thickened and discolored whole nails, or incomplete incomplete nails. This type is more common in the elderly or those with susceptible factors, and treatment is more difficult.

   Fourth, clinical diagnosis

   At present, the laboratory diagnosis of onychomycosis is still mainly through microscopic examination and cultivation. As long as the hyphae or spores are found in the debris of the removed nails, the diagnosis is established. The selection of materials is very critical, which is related to the accuracy and reliability.


   Now terbinafine and itraconazole have been widely used in the treatment of onychomycosis, the new topical drugs amorolfine and ciproterone have also been on the market, the current problem is how to treat onychomycosis reasonably and effectively. The newly advocated new concept of treatment of onychomycosis is individualized treatment and secondly combined treatment.

   Deep Fungal Disease

   1. Concept: It is an acute, subacute, or chronic infection caused by Candida. involving the skin, mucous membranes, and internal organs. Candida can be divided into superficial  and deep (viscera) candidiasis according to the site of candida involvement.

   2. Epidemiology: Candidiasis is widely distributed worldwide. Population epidemiological survey results show that a large percentage (30% to 50%) of normal people can isolate Candida from the oral cavity and digestive tract, and the rate of Candida infection in the reproductive tract of normal women is as high as 20%, indicating that Candida is a human body One of the normal flora.

3. Causes

There are many susceptible factors for deep candidiasis, mainly due to various reasons that impair the immune function of the patient, and the factors that cause the resistance to decline are:
·        barrier destruction;
·        dysbacteriosis;  environmental changes in the body;
·        immune function Not waiting.

At least 8 species of Candida can cause human infections, among which Candida albicans is the most common and most pathogenic. There are two sources of infection: endogenous and exogenous. Deciding whether to get sick depends on the pathogenicity of the bacteria and the resistance of the host.

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