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MICROSPORIA (microsporia; syn.: tinea microsporica) is a fungal disease of the skin and hair caused by dermatophytes of the genus Microsporum.

The disease was previously described as ringworm. The causative agent of microsporia Microsporum audouinii was first described in 1843 by D. Gruby, to-ry found a cover on the surface of the affected hair, consisting of small, mosaic spores. Later, other species of the genus Microsporum became known, causing M.

Etiology and pathogenesis

There are 3 groups of pathogens of the genus Microsporum: anthropophilic Microsporum audouinii (Gruby, 1843) and Microsporum ferrugineum (Ota, 1922), which cause M. only in humans; zoophilic, among to-rykh Microsporum canis (Bodin, 1902) - M.'s causative agent in cats and dogs, from which people can get infected; geophilic, for example. Microsporum gypseum (Bodin, 1928), living in the soil, very rarely cause M. in humans and animals. These 3 groups also include Microsporum Vanbreuseghemii, Microsporum nanum, Microsporum cookei, etc., but they are rare; M.'s forms caused by them are very low-contagious and have no epidemiols, meaning. In the pathogenesis of M., factors such as a decrease in the body's resistance (hypovitaminosis, impaired immune processes, etc.), skin trauma, non-observance of personal hygiene rules, and, to a lesser extent, climatic factors play a role.

Epidemiology

Anthropophilic species of Microsporum are highly contagious, cause mass diseases of M., mainly in children in nurseries, kindergartens, schools, and also in families when healthy children come into direct contact with sick children or when using shared linen, clothing, hats, toys, etc. M., caused by Microsporum audouinii, is common in many countries Western Europe, in USA; M., caused by Microsporum ferrugineum, is widespread in China, Japan, India, in the USSR it is observed in certain regions.

Infection of people with M., caused by Microsporum canis, usually occurs from cats, less often dogs, therefore, M. has a special epidemiol in homeless, stray animals. In addition, the fact of carriage of M. canis by healthy cats has been established. People become infected through contact with sick animals, as well as through things and objects contaminated with their wool. Mostly children are sick, but often adults. The rise in the incidence is observed in the autumn season. M., caused by Microsporum canis, is common in many countries; in the USSR it is the most common form of M.

Microsporum gypseum is found in soils of all continents, occasionally causes M. in persons whose work is connected with the earth (flower growers, vegetable growers). This form of M. is poorly contagious.

Pathohistology

Changes of an inflammatory nature are noted in the skin; the degree of their severity depends on the intensity of patol. process in the foci of mycosis. In the stratum corneum of the epidermis, mycelium and dermatophyte spores are found at the mouths of the hair follicles.

Immunity

In the blood serum of patients M., agglutinins, precipitins, complement-binding antibodies are detected, but in small titers. In patients with an infiltrative or suppurative form of M. caused by Microsporum canis, there is an allergic skin reaction to the intradermal injection of microsporin, a filtrate of a culture of the fungus in Sabouraud's liquid medium. Re-infection with M. caused by Microsporum canis is very rare; in case of infection with anthropophilic microsporums, post-infectious immunity does not develop.

Clinical picture

With M. caused by Microsporum canis, the incubation period lasts 3-7 days, after which pink inflammatory spots of round and oval outlines appear on the skin at the site of the fungus (printing fig. 3), usually without pronounced inflammatory phenomena, with clear boundaries, pityrious peeling on the surface; in this case, the defeat of the vellus hair is noted. When the scalp is affected, one, less often several large round foci (printing. Fig. 4), hair in which is broken off 5-8 mm above the skin level and is covered with a white cover of pathogen spores (printing. Fig. 5); around the main foci there are small foci of trichophytoid type (see. Trichophytosis).

In M., damage to the hair of the beard, mustache, eyebrows, as well as eyelashes, rarely nails is possible.

Occasionally there is a suppurative, or infiltrative, M.'s form, edges can be accompanied by allergic rashes, an increase in limf, nodes, an increase in temperature.

With M., caused by Microsporum ferrugineum, the incubation period can last 4-6 weeks. The lesions on the skin can take the form of rings, as if inscribed into one another. When the scalp is affected, there is a tendency for foci to merge and form large lesions, which are more often localized in the marginal zones; in the lesions, along with broken off, there are healthy hairs.

Diagnosis

The diagnosis is established on the basis of a wedge, data confirmed by a lab. research (detection of small, mosaic spores on the hair, in the skin scales - the mycelium of the fungus). To determine the type of fungus, it is necessary to sow the affected hair or skin scales on the Sabouraud medium (see Sabouraud medium) in order to obtain a culture of the fungus (printing. Fig. 6). The luminescent method of research is of great importance in M.'s diagnosis: the affected hair gives a green glow in the rays of Wood's fluorescent lamp.

Treatment

Griseofulvin is prescribed orally in a daily dose of 21-22 mg per 1 kg of body weight. The affected hair is removed with epilation tweezers under the control of a fluorescent lamp. Salicylic-sulfur-tar ointments, iodine preparations are used locally. Periodically, detachment of the stratum corneum of the epidermis is carried out with the help of Arievich ointment (for children, all components are taken in half concentration). For limited lesions of smooth skin, only local treatment is used. The terms of treatment are long and are determined by control tests for fungi.

Forecast and Prevention

The prognosis with timely treatment started is favorable.

Prevention consists in conducting routine examinations of children in children's institutions in order to identify patients with M., hospitalization of identified patients, disinfection in M. foci and the establishment of quarantine (when M. caused by Microsporum ferrugineum, for 6 weeks, when M. caused by Microsporum canis, up to 2 weeks). All family members of the patient and persons in contact with him, both in the family and in the children's team, are re-examined using a fluorescent lamp.

An important measure in the prevention of M. caused by Microsporum canis is the fight against M. in animals (the destruction of stray stray animals - carriers of the fungus), carried out by the forces of vet. supervision and SES, as well as a dignity. propaganda among the population of knowledge about the ways of spreading M.

Bibliography: Arievich AM and Stepanishcheva 3. G. Atlas of fungal skin diseases, p. 56, M., 1951; Kash-kin P.N. and Sh e to l and to about in N.D. Guide to medical mycology, M., 1978; Multivolume guide to microbiology, clinical picture and epidemiology of infectious diseases, ed. H. N. Zhukov-Verezhnikov, t. 10, p. 296, M., 1966, bibliogr .; Feyer E. & dr. Medical mycology and fungal diseases, trans. with Hungarian., with. 370, Budapest, 1966; Sheklakov ND and M and - l and p MV Fungal diseases of a person, p. 165, M., 1970; Emmons C. W. a. about. Medical mycology, Philadelphia, 1977.

A. M. Arievich; V.V. Vladimirov (color drawing).

Microsporia is a highly contagious dermatophytosis caused by fungi of the genus Microsporum.

Etiology and epidemiology of microsporia

The most commonly isolated pathogens of microsporia are the fungi Microsporum canis, which are zoophilic fungi that are ubiquitous in the world that cause dermatophytes in cats (especially kittens), dogs, rabbits, guinea pigs, hamsters, and in more rare cases - in monkeys, tigers, lions , wild and domestic pigs, horses, sheep, silver foxes, rabbits, rats, mice, hamsters, guinea pigs and other small rodents, as well as domestic birds. Infection occurs mainly through contact with sick animals or through objects infected with their wool. Human infection from humans is extremely rare, on average in 2% of cases.

Microsporum audouinii is a common anthropophilic pathogen that can cause in humans mainly damage to the scalp, less often to smooth skin. Children are more often sick. The pathogen is transmitted only from a sick person to a healthy person directly upon contact or indirectly through contaminated care and household items.

Microsporia is characterized by seasonality. Peaks of microsporia detection are observed in May-June and September-November. The onset of the disease can be facilitated by various endogenous factors: sweat chemistry, the state of the endocrine and immune systems. In addition, children have an insufficient density and compactness of the keratin cells of the epidermis and hair, which also promotes the introduction and development of fungi of the genus Microsporum.

Microsporia is a disease with the highest contagiousness of the entire group of dermatophytosis. Mostly children are ill, often newborns. Adults get sick less often, while the disease is often recorded in young women. The rarity of microsporia disease in adults is associated with the presence of fungistatic organic acids (in particular, undicylenic acid) in the skin and its appendages.

IN last years there is an increase in the number of patients with chronic mycosis against the background of severe systemic lesions - lupus erythematosus, chronic glomerulonephritis, immunodeficiency states, intoxication.

Microsporia classification

• microsporia caused by anthropophilic fungi Microsporum audouinii, M. ferrugineum;
• microsporia caused by zoophilic fungi canis, M. distortum;
• microsporia caused by geophilic fungi gypseum, M. nanum.

By the depth of the lesion, there are:

• superficial microsporia of the scalp;
• superficial microsporia of smooth skin (with vellus hair damage, without vellus hair damage);
• deep suppurative microsporia.

Symptoms of microsporia

Microsporum canis affects hair, smooth skin, very rarely nails; foci of the disease can be located on both open and closed parts of the body. The incubation period of the disease is 5-7 days.
On smooth skin, lesions have the appearance of edematous, raised erythematous spots with clear boundaries, rounded or oval outlines, covered with grayish scales. Gradually, the spots increase in diameter, and a towering ridge, covered with vesicles and serous crusts, forms along their periphery. In 80-85% of patients, vellus hair is involved in the infectious process. Eyebrows, eyelids, and eyelashes may be affected. With microsporia of smooth skin, subjective sensations are absent, sometimes patients may be disturbed by moderate itching.

With microsporia of the scalp, lesions are located more often in the occipital, parietal and temporal regions. In the initial period of the disease, a focus of desquamation occurs at the site of the introduction of the pathogenic fungus. In the future, the formation of one or two large foci of rounded or oval outlines with clear boundaries ranging in size from 3 to 5 cm in diameter and several small foci - screenings, ranging in size from 0.3-1.5 cm is characteristic.Hair in the foci is broken off and protrudes above the level skin by 4-5 mm.

Along with the typical clinical symptoms of zooanthroponous microsporia, its atypical variants have often been observed in recent years. These include infiltrative, suppurative (deep), exudative, rosacea-like, psoriasiform and seboroid (flowing like asbestosis), trichophytoid, exudative forms, as well as the "transformed" version of microsporia (with a modification of the clinical picture as a result of changes in the clinical picture) ...

With the infiltrative form of microsporia, the lesion focus on the scalp rises somewhat above the surrounding skin, is hyperemic, the hair is often broken off at the level of 3-4 mm. The cap of the spores of the fungus at the root of the broken hair is weakly expressed.

In the infiltrative-suppurative form of microsporia, the lesion focus usually rises significantly above the skin surface due to pronounced infiltration and the formation of pustules. When pressing on the affected area, pus is released through the follicular openings. Sparse hair is glued together with purulent and purulent-hemorrhagic crusts. Scabs and melted hair are easily removed, exposing the gaping orifices of the hair follicles, from which, like from a honeycomb, light yellow pus is exuded. The infiltrative-suppurative form occurs more often than other atypical forms, sometimes it occurs in the form of Celsus kerion - inflammation of the hair follicles, suppuration and the formation of deep painful nodes.

Due to the absorption of the decay products of fungi and the secondary infection joining, intoxication of the patient's body is observed, which is manifested by malaise, headaches, fever, an increase and soreness of regional lymph nodes.

The formation of infiltrative and suppurative forms of microsporia is facilitated by irrational (usually local) therapy, serious concomitant diseases, as well as late seeking medical help.

The exudative form of microsporia is characterized by pronounced hyperemia and edema, with small bubbles located against this background. Due to the constant impregnation of the scales with serous exudate and sticking them together, dense crusts are formed, when removed, the moist eroded surface of the focus is exposed.

microsporia exudative form

With the trichophytoid form of microsporia, the lesion process can cover the entire surface of the scalp. The lesions are numerous, small, with weak pityriasis peeling. The boundaries of the foci are indistinct, there are no acute inflammatory phenomena. This form of mycosis can acquire a chronic sluggish course, lasting from 4-6 months to 2 years. Hair is thin or there are areas of focal baldness.

trichophytoid form

With the seborrheic form of microsporia of the scalp, the hair is mainly discharged. The lesions of depression are abundantly covered with yellowish scales, when removed, a small amount of broken hair can be found. Inflammatory phenomena in the foci are minimal, the boundaries of the lesion are indistinct.

seborrheic form

Diagnosis of microsporia

The diagnosis of microsporia is based on clinical data and the results of laboratory and instrumental studies:

• microscopic examination for mushrooms (at least 5 times);
• inspection under a fluorescent filter (Wood's lamp) (at least 5 times);
• cultural research to identify the type of pathogen in order to properly conduct anti-epidemic measures;

When prescribing systemic antimycotic drugs, it is necessary to carry out:

• general clinical blood test (1 time in 10 days);
• general clinical analysis of urine (1 time in 10 days);
• biochemical study of blood serum (before treatment and after 3-4 weeks) (ALT, AST, total bilirubin).

Differential diagnosis of microsporia

Microsporia is differentiated with trichophytosis, pink lichen Zhibert, seborrhea, psoriasis.

The superficial form of trichophytosis of the scalp is characterized by small scaly foci of a rounded or irregular shape with very mild inflammation and some hair thinning. The presence of short gray hair, broken off by 1-3 mm above the skin level, is characteristic. Sometimes the hair breaks off above the skin level and has the appearance of the so-called "black dots". In differential diagnostics with microsporia, attention is paid to highly broken off hair with muff-like covers covering hair fragments, asbestos peeling. Of decisive importance in diagnostics is the emerald fluorescence in the rays of the Wood lamp of the affected hair, the detection of elements of the pathogenic fungus and the isolation of the pathogen during cultural research.

The pink lichen of Zhibert is characterized by more pronounced inflammation, a pink tint of the lesions, the absence of sharp borders, peeling in the form of "crumpled tissue paper", the absence of a characteristic emerald glow and the identification of elements of a pathogenic fungus during microscopic examination.

Psoriasis is more characterized by clear boundaries, dryness of lesions, silvery character of scales, absence of muff-like layers of scales on the affected hair.

Microsporia treatment

Treatment goals

• clinical cure;
• negative results of microscopic examination for mushrooms.

General notes on therapy

With microsporia of smooth skin (less than 3 lesions) without affecting vellus hair, external antimycotic agents are used.

The indications for the appointment of systemic antimycotic drugs are:

• multifocal microsporia of smooth skin (3 or more lesions);
• microsporia with the defeat of vellus hair.

Treatment of these forms is based on a combination of systemic and local antimycotic drugs.

Hair in the lesion is shaved off 1 time in 5-7 days or epilated.

Indications for hospitalization

• lack of effect from outpatient treatment;
• infiltrative-suppurative form of microsporia;
• multiple lesions with vellus hair;
• severe concomitant pathology;
• according to epidemiological indications: patients from organized groups in the absence of the possibility of isolating them from healthy persons (for example, in the presence of microsporia in persons living in boarding schools, orphanages, hostels, children from large and asocial families).

Treatment regimens for microsporia:

• Griseofulvin orally with a teaspoon of vegetable oil 12.5 mg per kg of body weight per day

Additionally, therapy is carried out with locally acting drugs:

• cyclopirox cream
• ketoconazole cream, ointment
• isoconazole cream
• bifonazole cream
• 3% salicylic acid and 10% sulfuric ointment
• sulfur (5%) - tar (10%) ointment

When treating an infiltrative-suppurative form, antiseptics and anti-inflammatory drugs are initially used (in the form of lotions and ointments):

• ichthyol, ointment 10%
• potassium permanganate, solution 1: 6000
• ethacridine, solution 1: 1000
• furacilin, solution 1: 5000

The treatment is then continued with the aforementioned antifungal drugs.

Alternative treatment regimens

• terbinafine 250 mg
• itraconazole 200 mg

Special situations

microsporia - Pregnancy and lactation.

The use of systemic antimycotic drugs during pregnancy and lactation is contraindicated.

Treatment of all forms of microsporia during pregnancy is carried out only with topical drugs.

Treatment of children with microsporia:

Griseofulvin orally with a teaspoon of vegetable oil 21-22 mg per kg of body weight per day

Treatment is considered complete with three negative results of the study carried out at intervals of 5-7 days.

Additionally, therapy is carried out with topical drugs:

• cyclopirox cream
• ketoconazole cream, ointment
• isoconazole cream
• bifonazole cream
• 3% salicylic acid and 10% sulfuric ointment, alcohol tincture of iodine
• sulfur (5%) - tar (10%) ointment

Alternative treatment regimens

• terbinafine: children weighing\u003e 40 kg - 250 mg orally once a day after meals, children weighing from 20 to 40 kg - 125 mg orally once a day after meals, children weighing<20 кг — 62,5 мг 1 раз в сутки
• itraconazole: children over the age of 12 - 5 mg per 1 kg of body weight

Requirements for treatment results

• resolution of clinical manifestations;
• no glow of hair under a fluorescent filter (Wood's lamp);
• three negative control results of microscopic examination for fungi (microsporia of the scalp - 1 time in 5-7 days; microsporia of smooth skin with lesions of vellus hair - 1 time in 5-7 days, microsporia of smooth skin - 1 time in 3-5 days).

In view of the possibility of relapses, after the end of treatment, the patient should be under dispensary observation: with microsporia of the scalp and microsporia of smooth skin with lesions of vellus hair - 3 months, with microsporia of smooth skin without lesions of vellus hair - 1 month.

Control microscopic examinations during dispensary observation must be carried out: with microsporia of the scalp and microsporia of smooth skin with involvement of vellus hair in the process - once a month, with microsporia of smooth skin - 1 time in 10 days.

The conclusion about recovery and admission to an organized team is given by a dermatovenerologist.

Prevention of microsporia

Preventive measures for microsporia include sanitary and hygienic, incl. compliance with personal hygiene measures, and disinfection measures (preventive and focal disinfection).

Focal (current and final) disinfection is carried out in the places of detection and treatment of the patient: at home, in children's and medical organizations.

Preventive sanitary and hygienic and disinfection measures are carried out in hairdressing salons, baths, saunas, sanitary passages, swimming pools, sports complexes, hotels, hostels, laundries, etc.

Anti-epidemic measures when detecting microsporia:

• A patient with microsporia, detected for the first time, is notified within 3 days to the department of registration and registration of infectious diseases of the FBUZ "Center for Hygiene and Epidemiology" and its branches, to territorial dermatovenerologic dispensaries.
• Each new disease should be considered as newly diagnosed.
• When registering a disease in medical organizations, organized groups and other institutions, information about the sick person is entered into the register of infectious diseases.
• The journal is kept in all medical organizations, medical offices of schools, preschool institutions and other organized groups. Serves for personal registration of patients with infectious diseases and registration of information exchange between medical organizations and organizations of state sanitary and epidemiological supervision.
• Isolation of the patient is carried out.

• If a disease is detected in children's institutions, a patient with microsporia is immediately isolated and, before being transferred to a hospital or home, current disinfection is carried out.
• Until a patient with microsporia recovers, the child is not allowed to enter a preschool educational institution, school; an adult patient is not allowed to work in children's and communal institutions. The patient is prohibited from visiting the bathhouse, swimming pool.
• In order to maximize isolation, the patient is allocated a separate room or part of it, personal items (linen, towel, washcloth, comb, etc.).
• In the first 3 days after the identification of the patient in preschool educational institutions, schools, higher and secondary special educational institutions and other organized groups, the medical personnel of these institutions examine the contact persons. Contact persons in the family are examined by a dermatovenerologist.

• The inspection is carried out prior to the final disinfection.
• Further medical observation with a mandatory examination of the skin and scalp using a fluorescent lamp is carried out 1-2 times a week for 21 days with a note in the documentation (an observation sheet is kept).
• The current disinfection in the outbreaks is organized by the medical organization that established the disease. The current disinfection before hospitalization, recovery is carried out either by the patient himself or by the person caring for him.
• Responsibility for performing routine disinfection in organized teams and medical organizations rests with its medical personnel. The current disinfection is considered to be organized in a timely manner if the population begins to carry it out no later than 3 hours after the identification of the patient.
• The final disinfection is carried out in the foci of microsporia after the patient leaves the outbreak for hospitalization or after the patient has recovered, treated at home, regardless of the duration of hospitalization or recovery.

• In some cases, the final disinfection is carried out twice (for example, in the case of isolation and treatment of a sick child in the isolation ward of a boarding school: after isolation - in the rooms where the patient was, and after recovery - in the isolation ward). If a child attending a kindergarten or school falls ill, final disinfection is carried out in the kindergarten (or school) and at home. In a general education school, the final disinfection is carried out according to epidemiological indications. The final disinfection in the outbreaks is carried out by a disinfection station. Bedding, outerwear, shoes, hats, carpets, soft toys, books, etc. are subject to chamber disinfection.
• An application for final disinfection in home centers and isolated cases in organized groups is submitted by a medical worker of a medical organization of a dermatovenerological profile.
• When 3 or more cases of microsporia are registered in organized groups, as well as for epidemiological indications, a medical worker from a medical organization of a dermatovenerological profile and an epidemiologist from institutions of state sanitary and epidemiological supervision are organized. At the direction of the epidemiologist, final disinfection is prescribed, the amount of disinfection is determined.

• The medical worker who has established the disease is working to identify the source of infection (contact with sick animals). Animals (cats, dogs) are sent to a veterinary hospital for examination and treatment, followed by the presentation of a certificate at the place of treatment and observation of a patient with microsporia. In case of suspicion of a stray animal, information is transmitted to the relevant animal capture services.

IF YOU HAVE ANY QUESTIONS REGARDING THIS DISEASE, PLEASE CONTACT DOCTOR DERMATOVENEROLOGY Kh.M. ADAEV:

EMAIL: [email protected]

INSTAGRAM @ DERMATOLOG_95

Arising when a person is infected with fungi of the genus Microsporum. Parasitic microorganisms mainly affect the skin, hair of the head, mustache, beard, eyebrows, pubis and genitals, vellus hair. Rarely are the nails on the feet and hands infected.

Disease-causing fungi are ubiquitous. Favorable conditions for their life are created in regions with a warm, humid climate.

In nature, there are zoophilic, anthropophilic, geophilic fungi Microsporum, almost all species are dangerous to humans.

Geophilic fungi live in the soil, infection occurs when working with the ground, in summer cottages. Anthropophilic fungi are found on human skin.

Zoophilic fungi are spread by animals. The danger of infection with microsporia for humans is posed by stray animals.

Epidemiology, ways of infection with microsporia

Most children suffer from fungal infection, there is an increase in the number of cases of microsporia in newborns.

Adults practically do not suffer from microsporia of the scalp, and when infected, they self-heal due to the presence of organic acids in the hair, which have antifungal activity.

In adulthood, predominantly young women, as well as people suffering from chronic diseases that cause a decrease in immunity, become ill.

The percentage of adults suffering from microsporia has recently been increasing and this is due to the growth of neuroendocrine diseases, HIV-infected people.

With inadequate treatment, the disease acquires a chronic course with sluggish, erased symptoms. This leads to the spread of infection.

Infection of both children and adults with microsporia occurs most often from a sick animal, usually a kitten, less often from a sick dog.

Symptoms

Up to 97% of microsporia infections are caused by the zoophilic fungus Microsporum canis.

The incubation period of this fungus - the time from the penetration of the fungal hyphae into the skin until the onset of symptoms of microsporia, lasts 7 days. Smooth skin of the trunk, limbs and scalp are often affected.

Microsporia of smooth skin

The maximum number of infections in children is observed in early summer and autumn, which is associated with the time of birth of kittens, which are more susceptible to infection than adult animals, and the time they return to school.

The first symptoms of smooth skin microsporia in children appear on the skin as a red spot (as shown in the photo) at the site of infection. Adults can also become infected with a fungal infection, the number of such cases is growing.

The localization of the manifestation of symptoms of smooth skin microsporia corresponds to contact with a sick animal, usually the skin of the face, hands, neck (see photo).

Unusual places of foci of microsporia are also noted, so foci of infection are observed on the skin of the palms, feet, legs, penis, pubis, labia, on the nail plate.

The number of patients with microsporia with genital lesions has increased over the recent period. You can get infected not only through direct sexual contact, but also through a washcloth, soap, towel.

The peculiarity of the microsporia of the smooth skin of the genitals lies in the abundance of blood vessels in this area, which contributes to the spread of the process deeper, complicates the treatment.

A symptom of microsporia in humans is the appearance of redness (see photo). The spot is swollen, slightly rises above the surface of the skin, has a clear outline.

Gradually, a roller is formed along its border, consisting of crusts, bubbles, nodules, the spot takes the form of a ring. The central part of the spot acquires a pale pink color, the skin on its surface peels off.

The size of the ring reaches 3 cm, the number of foci of infection does not exceed 3. The focus of infection does not bother the patient, some discomfort is caused by itching in the affected area.

In persons suffering from atopic dermatitis, the fungus cannot always be recognized in a timely manner, since it has similar manifestations with atopy, and the use of corticosteroid ointments only enhances the spread of fungal infection.

Such patients have papular-squamous microsporia of smooth skin, rashes on the chest, back, face, accompanied by severe itching, significant peeling of the skin.

The skin of the lower leg can also be affected by microsporia, with deep lesions up to 3 cm in diameter, the disease is more common in young women. Microsporia of the feet (shown in the photo) is manifested by characteristic rashes on the soles.

The fungus Microsporum canis can cause damage and destruction of the nail. The first symptom of infection is the appearance of a dull spot on the nail plate close to the roller.

Gradually, the stain becomes white, softens, collapses. Microsporic onychomycosis is difficult to diagnose in a timely manner, since it practically does not bother the patient, the disease becomes a chronic source of infection.

Microsporia of the scalp, caused by the zoophilic fungus Microsporum canis, usually occurs in children 5-12 years old.

The exception is red-haired children. For them, the special chemical composition of organic acids in the secretion of the sebaceous glands of the scalp serves as protection against infection.

The same acids are found in the hair of adults, which explains the cases of spontaneous recovery of children with microsporia when they reach adulthood.

Foci of infection with microsporia in children are located on the crown, crown, in the temporal region (see photo). Initially, the fungal hyphae penetrate the hair follicle and create a kind of cuff around the hair.

After the incubation period, the changes become obvious: the hair in the lesion focus of the fungus breaks off, leaving hemp 4-6 mm high. Usually, there are no more than two lesions, the size in diameter is up to 5 cm.

The stumps of broken hair look as if they were cut, for which the disease got its common name "ringworm".

Hair stumps are dull, covered with a gray bloom. If the hair in the infected area is stroked, it deviates and does not restore its original position.

In the lesion focus, there is swelling, redness, peeling of the skin. Near the main focus of infection, there are often small dropouts of the fungus, small foci up to 1.5 cm in size.

The clinical picture of microsporia of the scalp when infected with an anthropoophilic fungus is somewhat different (shown in the photo). The lesions are small, multiple, with indistinct boundaries.

Areas of infection are localized on the marginal zone of scalp hair growth, often one focus is located in the scalp, and the other on the smooth skin of the face.

Rare types of microsporia of the scalp

Atypical cases of microsporia include seborrheic, deep, trichophytoid, exudative forms of the disease.

With seborrheic microsporia, the hair becomes thinner, covered with yellowish dandruff scales, under which broken hair is found.

The trichophytoid form of microsporia is more common in the elderly, characterized by low broken hair (1-2 mm above the skin) and the presence of long hair in the lesion.

With exudative microsporia, bubbles with exudate are formed in the focus of infection. Serous fluid permeates peeling scales, sticks them together, forming crusts.

With a deep suppurative form of microsporia, the focus of infection acquires a red-cyanotic color, becomes inflamed, and when pressed on it, pus is released.

With this form of microsporia in a person (as in the photo), symptoms of intoxication of the body may be noted, which requires complex treatment.

Diagnostics

Before treating microsporia, such diagnostic measures as luminescent study of the lesion focus under Wood's lamp, microscopic, cultural examination are carried out.

The most accurate determination of the type of pathogenic fungus that caused microsporia and the selection of the correct treatment allows the culture method.

Samples of diseased hair, scales from the lesion focus are applied to a special nutrient medium Sabouraud. In the case of microsporia, the growth of the fungus colony is noted already on the 3rd day. The colony is a white disc covered with a delicate fluff, for which the mushroom was named the fluffy microsporum.

Microsporia treatment

The pathogens of microsporia are highly resistant to antimycotics and require the use of large doses of drugs for treatment.

For the treatment of microsporia, griseofulvin, lamisil are mainly used.

Griseofulvin is taken orally with vegetable oil to enhance bile secretion and dissolve the drug. The medicine is washed down with sour juice - apple, lemon, which enhances the absorption of griseofulvin.

Griseofulvin is hepatotoxic; Carsil and Liv-52 are taken to protect the liver. The course of treatment with griseofulvin lasts up to 2 months according to a special scheme, the maximum daily dose is 1 g.

Lamisil is considered an effective drug in the treatment of microsporia in humans. Lamisil tablets are rapidly absorbed in the digestive tract, act directly on the cells of the fungus, accelerate recovery even with severe suppurative forms of microsporia.

In addition to taking antimycotics, patients with microsporia are treated with external agents. Every week, hair in the lesions is removed by shaving or epilation.

The site of infection is treated with an alcoholic tincture of iodine every day after waking up. In the evening, bifosin or sulfuric ointment containing salicylic acid and tar is rubbed into the sore skin area.

The affected area is cleaned from pus and crusts with the help of compresses with solutions of licorice root, mummy, ichthyol. Make lotions with gibitan. In the treatment of microsporia in children, 1% mycospore creams, travogen, lamisil cream are effective.

Prevention

To prevent microsporia in humans, strict measures are taken to prevent the spread of infection. For each patient with a confirmed diagnosis, a notification is filled out in form 281.

The family of the patient is examined, all persons who come into contact with the patient are also examined by medical workers to detect microsporia infection.

Prevention of microsporia includes examination and treatment, if necessary, of a pet infected with a fungus. Responsible treatment of stray animals that children or parents themselves bring into the house will help prevent infection.

Even in the absence of visible foci of microsporia on the face, ears, paws, it is necessary to examine the animal at the veterinarian under a Wood lamp, to sow wool from different parts of the skin.

The precaution will help keep children away from sick animals and prevent the spread of infection.

Forecast

The prognosis of microsporia with timely treatment and adequate systematic treatment under the supervision of a physician is favorable.

We also offer you to familiarize yourself with other types of dermatomycosis in the following articles.

Thank you

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Microsporia is a highly contagious (highly contagious) infection of the smooth skin, scalp and nails caused by pathogenic fungi of the genus Microsporum. It was on the basis of the Latin name of the causative agent of the infection (Microsporum) that the name of the disease itself (microsporia) was adopted. Microsporia looks like round, red, scaly patches on the skin, bald patches on the scalp, or white and dull circles on the nails.

Microsporia and ringworm (microsporia and trichophytosis)

In addition to the medical name, this fungal disease has another widespread name - ringworm lichen... The term "ringworm" is the traditional designation for a group of diseases of the skin and scalp, in which hair is affected and breaks off, resulting in bald patches. And since even 100 years ago, doctors did not know how to identify the causative agents of infections due to the lack of appropriate methods, all diseases were classified, described and named mainly by their external manifestations. This is why microsporia has been named ringworm.

However, with the development of science and technological progress, doctors were able to identify not only the signs of diseases, but also to isolate their pathogens, which was literally a breakthrough. During this period, it was possible to establish that the disease, which has always been called ringworm, can be caused by two types of pathogenic fungi - Trichophyton and Microsporum. And then the variety of ringworm caused by fungi of the genus Trichophyton began to be called trichophytosis, and Microsporum, respectively, microsporia. But since the external signs and the course of trichophytosis and microsporia are the same, then these two infections have the same common name - ringworm.

Thus, according to modern concepts, microsporia is a fungal infection ( mycosis), affecting the skin, hair and nails, and at the same time is considered one of the varieties of ringworm.

Causative agent of infection

Among the fungi of the genus Microsporum, there are about 20 species that can provoke microsporia in smooth skin, scalp and nails. Most often, microsporia is caused by the following types of fungi of the genus Microsporum:

• M. distorum;
• M. rivalieri;
• M. langeronii;
• M. canis;
• M. nanum;
• M. persicolor;
• M. gypseum;
• M. cookeii;
• Keratynomyces ajelloii.

Moreover, in 90% of cases, the causative agent of microsporia is a fungus of the species Microsporum canis, and the rest of the listed types of pathogenic microorganism are the cause of infection only in 10% of cases.

Methods of transmission of microsporia (how you can get infected)

Infection with microsporia is carried out by contact, that is, when you touch any objects, substances, animals or people who are sick with an infection, are carriers of it, or there are fungal spores on their surface. In order to clearly understand the mechanisms and routes of transmission of microsporia in a population, it is necessary to know the varieties of this fungus that affect the way they spread among people.

So, depending on the main host, all types of Microsporum fungi are divided into three varieties:
1. Zoophilic fungi - the main owners are animals (most often kittens, less often dogs);
2. Anthropophilic fungi - the main owners are people;
3. Geophilic fungi - the main habitat is soil.

Zoophilic, atropophilic and geophilic fungi, when in contact with the human skin, cause the same infectious disease - microsporia, however, the ways of their transmission and, accordingly, the methods of infection are different.

So, transfer zoophilic fungi of the genus Microsporum occurs through direct household contact with infected cats or dogs. And since kittens are most often carriers of microsporia, there are two seasonal peaks in the increase in the incidence of this infection - in the middle of summer and in autumn, when cats give birth. To get infected with microsporia, all you have to do is pet a cat or dog that has the infection or is asymptomatic. People usually get infected from their domestic cats or dogs, which are in constant contact with their owners, sit on their knees, crawl under the covers, etc.

However, zoophilic fungi of the genus Microsporum can be transmitted to humans not only as a result of direct contact with a sick animal, but also indirectly through pieces of its wool. The fact is that cats and dogs suffering from microsporia or being carriers of the fungus can leave small and inconspicuous pieces of wool on various household items (furniture, carpets, beds, sofas, armchairs, clothes, shoes, etc.), in which contains spores of the fungus. A person, touching such pieces of wool containing spores of the fungus, also becomes infected with microsporia.

Thus, the transmission of zoophilic microsporia can be carried out both by direct contact with a sick animal, and by touching objects that have wool and skin scales of an infected animal.

Anthropophilic fungi of the genus Microsporum are transmitted from a sick person to a healthy person through direct close contacts (hugs, kisses, etc.) or when using various objects on which the scales of the skin of an infected person are located (for example, when using a comb, hat, scissors for cutting hair belonging to a person with microsporia). That is, anthropophilic fungi are transmitted in the same way as zoophilic ones, but from person to person, and not from animals.

Infection geophilic fungi of the genus Microsporum occurs through direct contact with soil contaminated with these microbes.

When a person becomes infected with any kind of Microsporum fungus (zoophilic, anthropophilic or geophilic), then in the future he is a source of infection for others, who can be infected with microsporia from him. However, despite the hypothetical possibility of infection in other people, family members of patients with microsporia very rarely become infected.

The ways of transmission of microsporia described above do not completely reflect the picture of how infection with a fungal infection occurs. So, with a simple contact of the fungus on the skin, a person will not get sick with microsporia, since the pathogenic microbe will be destroyed by the normal microflora and the immune system, or simply washed away during the performance of hygienic measures. This means that for the disease with microsporia, it is necessary not only for the fungus to enter the skin, but also the presence of some predisposing factors that will allow it to penetrate the skin and provoke an infection.

To such predisposing factors include the following:
1. Traumatic skin damage;
2. Maceration of the skin;
3. Reduced immunity.

Thus, microsporia is transmitted from an animal or person to another person only if he has these predisposing factors.

Microsporia in children

Microsporia is much more common in children than in adults, due to two main factors. First, children are more likely to come into contact with sick animals, respectively, they have a higher risk of contracting an infection. And secondly, the sebaceous glands of the skin of children do not produce acids that have a detrimental effect on fungi. That is, a fungus that has got on the skin of a child will provoke microsporia with a much greater probability than in an adult in a similar situation, since after puberty, the glands begin to produce acids that have a detrimental effect on microsporia pathogens.

Clinical manifestations, course and principles of treatment of microsporia in children do not differ from those for adults. Therefore, it is inappropriate to consider separately the characteristics of microsporia in childhood.

Types of microsporia (classification)

Depending on the leading factor underlying the classification, there are several options for dividing microsporia into different types.

So, depending on the predominant area of \u200b\u200bthe lesion, microsporia is divided into three main types:
1. Microsporia of smooth skin;
2. Microsporia of the scalp;
3. Microsporia of nails.

In addition, specialist doctors distinguish three forms of microsporia, depending on which type of pathogen caused the infection:
1. Zoonotic microsporia - caused by species of fungi Microsporum belonging to the zoophilic (the main hosts are animals);
2. Anthroponous microsporia - caused by anthropophilic species of Microsporum fungi (the main host is a man);
3. Geophilic microsporia - caused by species of fungi Microsporum related to geophilic (the main habitat is soil).

The division into zoonotic, anthroponous and geophilic microsporia has no clinical significance, since they all have the same symptoms, a similar course, and are treated according to the same principles. This classification is important for epidemiologists, as it allows them to establish the primary sources of infection and to carry out appropriate anti-epidemic measures if necessary.

It is also clinically important to classify microsporias by the type of course, the depth of tissue damage and the response of the immune system to infection. According to these criteria, the following types of microsporia are distinguished:

• Surface form (lesions are located on the surface of smooth skin or under the hair);
• Exudative form (foci are located on any part of the body and liquid discharge is oozing from them);
• Infiltrative-suppurative form (the foci penetrate deep into the tissues, at the site of the lesion there is severe edema with the addition of a secondary bacterial infection, which gives suppuration);
• Nail form (foci are located on the nails);
• Chronic form (a variant of a long-term surface form).

The incubation period of the disease

The duration of the incubation period depends on the type of fungus that provoked microsporia. So, when infected with zoophilic and geophilic species of fungi Microsporum, the incubation period lasts 5-14 days. And when infected with anthropophilic forms, the incubation period of microsporia lasts much longer - from 4 to 6 weeks. But since most often microsporia is provoked by a fungus of the species Microsporumcanis, which belongs to the zoophilic species, in most cases the incubation period of the infection is 1 to 2 weeks.

Symptoms (signs) of microsporia

All varieties of microsporia are characterized by both common signs, symptoms and features of the clinical course, as well as certain nuances that distinguish the forms from each other. Therefore, for a general orientation in the problem, first of all, we will consider those symptoms that are inherent in all forms of microsporia. And only after that we separately focus on the features inherent in various forms of microsporia.

The very first symptoms of microsporia that begin are red spots that form on the scalp or body. If microsporia has affected the scalp, then spots can appear not only under the hair, but also in the area of \u200b\u200beyebrows and eyelashes. With microsporia of smooth skin, spots are formed on any part of the body.

A few days after the appearance of the spots, they become pink and rather pale, and their surface is covered with whitish scales. At the same time, the hair loses its color and breaks off at a height of several millimeters from the skin surface, creating the effect of a short haircut. Because of this, characteristic and well-visible bald spots are formed on the scalp, on which skin with scales and short hair resembling stiff bristles are visible. In some cases, black dots form on bald patches.

Sometimes microsporia of the scalp does not cause the formation of bald spots due to breaking off of the hair, but provokes the formation of a large number of scales, which people mistake for profuse dandruff that appeared completely unexpected for them. Also, in rare cases, microsporia has the appearance of a gray spot on the scalp, in the area of \u200b\u200bwhich hair falls out intensively.

If lichen affects smooth skin, then the initial spots simply turn pale, acquire a grayish color and become covered with scales. Outside the spot, a well-visible and raised roller is formed above the surface of the skin, as if delimiting the affected area from healthy areas. Inside the spot, another spot may form, smaller in size, but exactly the same in structure, which makes the affected area look like a target.

Over time, foci of microsporia on the smooth skin and scalp increase in size and acquire the shape of a regular circle or oval. The size of the lesions can reach 10 cm in diameter. At the same time, their surface is covered with a dense layer of gray scales, which give them the appropriate color. As a result, the border of the spot looks like a red rim, and the inside is painted in a pale gray-pinkish color.

If two or more foci of microsporia are located nearby, then they can merge into it. Scaly patches flake off with varying degrees of intensity. Sometimes peeling is accompanied by severe itching, and in other cases, the stain does not cause any unpleasant sensations in principle.

In children and adults, with localization of foci of microsporia on the scalp, on the face, neck or upper half of the body, body temperature may rise and cervical lymph nodes may increase.

With a severe course of microsporia in the area of \u200b\u200bthe lesion, severe inflammation of the skin develops with edema, exudation and suppuration, which is called scab.

In general, microsporia in children and adults proceeds as described. Let us consider the features and more accurate characteristics of the spots characteristic of various forms of fungal infection.

Microsporia of the skin (microsporia of smooth skin) in adults and children

As a rule, the infection proceeds in a superficial form, which begins with the appearance of a red spot of a round or oval shape, which has clear boundaries and rises above the rest of the skin. It is this spot that is the focus of the lesion. Gradually, the stain grows in size, becomes dense and swollen. The outer border of the spot is converted into a roller that rises above the surface of the skin, consisting of bubbles and crusts. In the center of the spot, the inflammation decreases and the entire area bounded by the outer roller is covered with flaky scales and becomes pale pink in color.

However, the fungus can re-infect an area that is already inside the outer ring. In this case, another one is formed inside the ring, as a result of which the lesion takes on a bizarre target. Such lesions of the "ring in a ring" type are characteristic mainly of anthroponous microsporia.

The total number of foci of microsporia on smooth skin is usually small and amounts to 1 - 3 spots. The diameter of the spots is most often 0.5 - 3 cm, but sometimes the lesions can increase up to 5 cm in radius. Closely spaced spots can merge into one. Lesions can be located on any part of the body, but most often they are located on the face, neck, forearms and shoulders.

As a rule, non-inflamed microsporia spots do not cause any unpleasant sensations. It may sometimes itch mildly. If there is severe inflammation in the lesions, then they are very itchy and painful.

In people with reduced delayed sensitivity reactions, microsporia can proceed in the so-called abortive form. In this case, the lesion has the appearance of a pale pink spot without clear boundaries and bubbles that form a peripheral ridge.

In newborns and children under 3 years of age, microsporia occurs in an erythematous-edematous form, in which the lesion is red, inflamed and edematous with a minimum amount of scales and peeling.

In people prone to atopy (for example, those suffering from atopic dermatitis), microsporia proceeds in a papular-squamous form. In this case, spots appear on areas of the skin characterized by the production of a large amount of sebum, such as the face, chest and back. The lesions are profusely infiltrated (dense, swollen) and lichenified (the skin on them is dense and thickened, with a pronounced pattern and pigmentation disorders).

In young women (up to 30 years old), suffering from increased hair growth on the legs, foci of microsporia usually appear in the form of red and inflamed nodes with a diameter of 2 - 3 cm. This is a deep form of microsporia.

Microsporia of the head (microsporia of the scalp)

Most often, foci of microsporia are located on the scalp in children 5 - 12 years old. In adults, this localization of lesions is rare, since with the onset of puberty, the hair follicles begin to produce acid, which has a detrimental effect on the pathogen of microsporia. And therefore, after the onset of puberty, microsporia in children is cured spontaneously.

A characteristic feature of childhood microsporia is that the infection almost never occurs in babies with red hair.

The microsporia of the scalp is a round or oval lesion with a clear border, most often located at the crown, crown, or temples. Usually on the head there are 1 - 2 lesions with a diameter of 2 - 5 cm. Small secondary lesions with a diameter of 0.5 - 1.5 cm may appear at the borders of the lesions, which are dropouts.

At the initial stages of the disease, a scaly skin area forms in the affected area. In this area, at the roots of the hair, you can see ring-shaped scales surrounding the hairs along the entire perimeter. After a week, the hair itself is also affected, which loses its color, becomes dull, brittle and fragile, and as a result breaks off at a distance of 5 mm from the skin surface. A short "brush" left in place of broken hairs, dull and covered with a grayish bloom, is an accumulation of fungal spores. If the roots of the broken off hair are smoothed in any direction, they will remain in the position that they were given. The skin under the fragments of hair is moderately reddish, dense and covered with a large number of grayish scales.

With the anthroponous form of microsporia, a characteristic feature is the location of lesions on the border of hair growth, when one half of the spot is on the hairy part, and the other half on smooth skin.

The picture described above is a typical course of microsporia. However, in rare cases, the infection occurs in atypical forms, such as:

• Infiltrative form microsporia of the head is characterized by an elevation of the lesion above the rest of the skin. The skin of the lesion is red and swollen, and the hair is broken off at the level of 4 mm.
• Suppurative form microsporia is characterized by a strong inflammatory process, as well as thickening and hardening of the skin in the lesion. In this case, cyanotic-red nodes with pustules on the surface are formed, through which pus comes out when pressed on the affected area.
• Exudative form microsporia is characterized by severe redness, swelling and small vesicles in the affected area. Due to the released inflammatory fluid, the skin scales stick together and form a dense crust that covers the lesion.
• Trichophytoid form microsporia is characterized by multiple small lesions with weak desquamation. The lesions are vague, without clear boundaries and signs of inflammation, and the hair is broken off at a level of 1 - 2 mm.
• Seborrheic form microsporia is characterized by hair thinning in some areas of the head. In the area of \u200b\u200bsuch hair thinning, the skin is visible, covered with a large number of yellowish scales. If the scales are removed, then fragments of a small amount of hair become visible under them.

These rare forms of microsporia of the scalp are almost always associated with an increase in body temperature, inflammation of the lymph nodes of the neck and symptoms of intoxication (headache, weakness, lethargy, etc.).

Anthroponous microsporia

Anthroponous microsporia most often develops in children. On smooth skin, it appears as round or oval lesions with a clear border, inside which numerous scales are visible. The border of the focus is formed by bubbles and nodules.

On the scalp, lesions are located at the border of hair growth in the occiput, crown and temples. As a rule, part of the lesion is located in the hair growth zone, and part on smooth skin. Such foci are small, vague, with clear boundaries and scaling inside the spot. When located close to each other, the foci can merge, forming one large lesion area of \u200b\u200ba bizarre shape. In the area of \u200b\u200bthe lesions, the hair breaks off at the level of 4 - 6 mm and looks short cut.

Zoonotic and geophilic microsporia

On smooth skin, multiple small (0.5 - 3 mm in diameter) reddish-pink scaly patches of a round or oval shape with clear boundaries appear. The inner surface of the spots is covered with flaky scales. Over time, right in the perimeter of old foci, new ones appear, forming a characteristic "ring in a ring" pattern, which is a hallmark of microsporia.

When the scalp is damaged, large foci are formed, located strictly in the hair growth zone. The lesions have a round or oval shape, clear boundaries and are covered with whitish scales. The hair in the lesion is broken off at a height of 6 - 8 mm, and the protruding fragments are covered with a white sheath of fungal spores.

Nail microsporia

Nail microsporia is extremely rare. This form includes lesions on the palms, soles and nails. When the nail is damaged, a dull spot is formed on it in the area of \u200b\u200bthe growth half moon. Over time, the stain turns white, and the nail in this part is fragile, soft and thinned. Quite often, the affected part of the nail is destroyed.

Microsporia - photo

This photograph shows numerous lesions of the microsporia of smooth skin.

This photo shows a focus of microsporia lesion in a child.

This photo shows a focus of microsporia of the scalp.

Diagnosis of microsporia

Diagnosis of microsporia is based on examining the foci, first with the naked eye, and then through a fluorescent lamp. After that, if necessary, to confirm the diagnosis and accurately determine the type of causative agent of the fungal infection, microscopic or cultural studies are performed.

The method of diagnosing microsporia through a fluorescent lamp (Wood's lamp) is very simple - a doctor in a darkened room examines the affected area illuminated by such a device. Skin and hair affected by the fungus gleam bright green in the light of Wood's lamp. The reason for this phenomenon has not been clarified, but it allows you to quickly and accurately diagnose microsporia.

If necessary, the doctor can gently scrape off a small amount of scales from the affected area with a blunt scalpel and examine them under a microscope, conducting a microscopic examination, respectively. Before scraping the scales, the skin in the affected area is wiped with 96% alcohol. After that, only scales are scraped from smooth skin, and fragments of hair are scraped from the scalp. All the collected material is placed on a glass slide, poured with a drop of 20% potassium hydroxide solution and, after 30 minutes, examined under a microscope.

With microsporia, twisted mycelium filaments are visible in the scales, and on the surface of the hair there are numerous spores attached to it like small balls along the entire outer perimeter. Due to spores, the border of the hair is not clear, but blurred.

The cultural method for diagnosing microsporia is used with positive results of microscopic and luminescent in order to identify the type of fungus-pathogen. Sometimes it is necessary to determine the optimal treatment tactics. For the culture method, scales are removed from the affected area and placed on a nutrient medium. In the presence of microsporia, a colony grows on the medium in the form of a flat disc with a fluff on the surface.

In most cases, to diagnose microsporia, it is enough to examine the affected area through a Wood lamp and subsequent microscopic examination.

Microsporia - treatment

General principles of therapy

If only smooth skin is affected by microsporia, and the vellus hair on it remains intact, then treatment with local antifungal drugs (ointments, lotions, sprays) is sufficient, which are applied daily until the lesions disappear.

If the foci of microsporia are located on the scalp or vellus hairs of smooth skin are involved in the process, then the treatment consists of taking antifungal drugs inside and applying them externally to the affected area.

Most effective for oral administration for the treatment of microsporia, antifungal drugs containing the following active substances:

• Griseofulvin;
• Terbinafine (Terbizil, Lamisil, etc.);
• Itraconazole (Orungal, Irunin, etc.).

For external processing for smooth skin and scalp, the following agents with antifungal activity are used:

• Ointments with terbinafine (Lamisil, Terbizil, etc.), clotrimazole, isoconazole and bifonazole;
• Tincture of iodine 2 - 5%;
• Sulfuric ointment 10 - 20%;
• Sulfur-salicylic ointment;
• Sulfur tar ointment.

Taking antifungal drugs by mouth and applying them externally to the affected skin continues for a week after the symptoms of microsporia disappear, in order to avoid a possible recurrence of the infection.

During the entire period of therapy, the sick person should use separate towels, sponges, combs and other personal hygiene and household items, and not pass them on to other people. All things worn by a person suffering from microsporia should be washed with ordinary powder at a water temperature of 60 o C, which is enough to kill the spores of the fungus. And all the items he used should be boiled for 15 minutes in usually water. Boxes, boxes and other containers where things of a person suffering from microsporia were stored should be treated with Terralin antifungal disinfectant.

Microsporia of smooth skin and scalp - treatment

If vellus hair is affected on smooth skin, then treatment consists of taking antifungal drugs inside and applying them externally to the lesions. If the vellus hair is not affected, then only local treatment is carried out, which consists in the external application of antifungal agents. Treatment of microsporia of the scalp is always carried out by the combined intake of antifungal agents inside and their external application to the lesions.

So, the following drugs should be taken internally for the treatment of microsporia:

• Griseofulvin. The dosage is calculated individually from the ratio of 22 mg per 1 kg of body weight. The calculated amount is divided by 3 and taken 3 times a day with a spoonful of oil for 2 to 6 weeks. Once a week, a scraping from the affected area is taken for analysis. After the result of scraping for fungi is negative, Griseofulvin is taken for another 2 weeks at the same dose every other day. Then another 2 weeks in the same dose, tablets are taken every 3 days.
• Terbinafine. Take 250-500 mg once a day for 4-6 weeks.
• Itraconazole. Take 100-200 mg 1 time per day for 4 weeks.

In parallel with the intake of the above drugs inside, the foci of microsporia should be treated daily with external agents. It is preferable to use different means for the external treatment of foci of microsporia in the morning and in the evening. For example, in the morning tincture of iodine, and in the evening - Lamisil or in the morning - sulfuric ointment, and in the evening - Isoconazole, etc.

If there is pronounced inflammation on the skin, then in the first 3 to 5 days of therapy, it is necessary to treat them once a day with Travocort ointment, which contains a hormone with a powerful anti-inflammatory effect. When the inflammation decreases, you should switch to the use of any other antifungal ointment (Travogen, Zalain, Lamisil, Terbizil, Terbinafine, etc.).

Hair with smooth skin should be shaved off once a week or epilated with a special plaster with griseofulvin. With microsporia of the scalp, before starting treatment, you should shave off the hair from the affected area, and do this 1 - 2 times a week until the end of the course of therapy. The head should also be washed 1 - 2 times a week with tar soap or pharmacy shampoo containing selenium sulfide, ketoconazole or povidone iodine.

Treatment of microsporia in children

In children, microsporia is treated according to the same schemes and principles as in adults. However, the optimal drug for oral administration is Terbinafine (Lamisil, Terbizil, etc.), which should be used in the absence of any contraindications. Children's dosages of Terbinafine for oral administration are determined by their body weight:

• Children weighing 10 - 20 kg - Take 3/4 tablets (94 mg) Terbinafine 125 mg 1 time per day;
• Children weighing 20 - 40 kg - take 1.5 tablets (187 mg) of Terbinafine 125 mg once a day;
• Children weighing over 40 kg - take 2 tablets (250 mg) Terbinafine 1 time per day.

These dosages are 50% higher than those recommended by the manufacturer, however, they turned out to be the most effective in the treatment of microsporia according to clinical observations and use in children's hospitals.

Itraconazole and Griseofulvin are not recommended for use in children due to their high toxicity.

External treatment of the affected areas in the treatment of microsporia in children is carried out with the same drugs as in adults. The optimal ointment for children is Clotrimazole or Lamisil.

Prevention of the disease

Prevention of microsporia consists in the timely identification and treatment of sick people, as well as limiting contact with animals. When a family member has microsporia, all other people who have been in close contact with him should undergo a preventive examination using a Wood lamp. All pets should also be examined and, if necessary, treated.

Microsporia: causative agents of infection, routes of infection, signs (symptoms), treatment and prevention - video

For citation:Potekaev N.N. Microsporia. Breast cancer. 2000; 4: 189.

Central Research Institute of Skin and Venereal Diseases, Ministry of Health of the Russian Federation, Moscow

M ikrosporia- a fungal disease from the group of dermatophytosis, in which the skin and hair are affected, and in extremely rare cases, the nail plates. The name of this mycosis comes from the name of its causative agent - a fungus of the genus Microsporumbelonging to dermatophytes. The disease is also known as "ringworm" (the term combines microsporia and trichophytosis), which is due to the peculiarities of its clinical picture.

Etiology

The causative agent of microsporia was first described by Gruby in 1843. The scientist found a cap of small spores on the surface of the affected hair and gave the name to the mushroom Microsporum audouinii in honor of the late Dr. Audouin. However, the author's discovery was not appreciated at its true worth, and highly respected dermatologists (in particular, Bazin) identified microsporia with trichophytosis. Sabouraud managed to restore the truth in 1893, who, having thoroughly studied the biology of the pathogen of microsporia, indicated the signs that distinguish this mycosis from trichophytosis. In Russia, microsporia was first described by S.L. Bogrov in 1912.

More than twenty species of mushroom are currently known Microsporum... Of these, the following are distinguished as pathogens:

. Anthropophilic group - M. ferrugineum, M. audouinii, M. distorum, M. rivalieri, M. langeronii.

. Zoophilic group - M. canis, M. nanum, M. persicolor.

. Geophilic group - M. gypseum, M. cookeii, Keratynomyces ajelloii.

Of the listed species, only M.canis (seu lanosum) in recent years, it has become practically the only causative agent of microsporia. It is no coincidence that it is called a cosmopolitan mushroom.

Once on the skin, the pathogen penetrates into it and begins to multiply. When located near the mouths of hair follicles, the spores of the fungus germinate, leading to damage to the hair. Quite quickly spreading over the surface of the latter, mycelium hyphae destroy the cuticle, between the scales of which spores accumulate. Thus, the fungus surrounds the hair, forming a sheath, and tightly fills the follicular apparatus.

Epidemiology

Microsporia is the most common mycotic infection among dermatophytosis, not counting mycoses of the feet.The disease is ubiquitous. In Russia, up to 100 thousand patients with microsporia are annually registered. Mycosis is highly contagious, children are more often affected. In the last two decades, an increase in the incidence of microsporia in newborns has been noted. Adults rarely get sick - mostly young women. The rarity of adult microsporia disease, especially with lesions of the scalp, and usually the onset of spontaneous recovery at the onset of puberty, is explained by the presence of fungistatic organic acids (in particular, undicylenic acid) in the hair of adults. Patients with lesions of the scalp are especially dangerous in epidemiological terms. This is due to the fact that this form of mycosis, firstly, is most often diagnosed out of time, and, secondly, its therapy is fraught with certain difficulties. Unfortunately, the data of the latest epidemiological studies conducted in Russia indicate an increase in the number of patients with hair lesions.

As already stated, the most common pathogen of microsporia is Microsporum canis - zoophilic fungus, which is found in 90-97% of patients. The main source of the disease is cats (usually kittens), less often dogs. Infection occurs through direct contact with a sick animal or objects infected with wool or scales. Once in the soil with affected hair or scales, M.canis retains viability only for 1-3 months. Thus, the soil is only a factor in the transmission of infection and does not serve as its natural reservoir. Intrafamilial spread of infection is not uncommon. In this case, infection occurs, as a rule, from one animal. Transmission of zoonotic microsporia from diseased family members is possible, but this is quite rare. There are isolated observations of families in which three generations were sick with this mycosis. It should be emphasized that in such situations, women and children of younger age groups, including newborns, are at greatest risk of infection.

Clinical manifestations in animals characterized by patches of baldness on the face, outer surfaces of the auricles, as well as on the front, less often the hind legs. A green glow is detected under Wood's lamp. Often, clinically healthy cats can be myc carriers, and then only a luminescent study helps to identify the fungus. However, situations are possible when the fact of carriage cannot be confirmed by either clinical or luminescent examination. In such cases, and they are observed in 2-3% of carriers, the wool is sown from various sites.

The incidence of zoonotic microsporia varies throughout the year. Seasonal fluctuations are associated with offspring in cats, as well as more frequent contact with animals during the summer. The rise in incidence begins at the end of summer, the peak falls in October-November, and decreases to a minimum in March-April. The emergence of epizootics of microsporia in cats and kittens in a number of districts and cities leads to the formation of epidemic foci among children.

Clinic

Since the main causative agent of microsporia in our time is Microsporum canis, then when describing the clinical picture of the disease, more attention will be paid to the zoonotic form rather than the anthroponous one.

The incubation period for zoonotic microsporia is 5-7 days ... The nature of the clinical picture of the disease is due to the localization of lesions and the depth of penetration of the pathogen. Allocate microsporia of smooth skin and microsporia of the scalp.

Microsporia of smooth skin

At the place of introduction of the fungus appears edematous, raised erythematous patch with clear boundaries ... Gradually, the spot increases in diameter and infiltrates. On the periphery, a continuous rising ridge is formed, represented by small nodules, bubbles and crusts. In the central part, inflammatory phenomena are resolved, as a result of which it acquires a pale pink color, with pityriasis peeling on the surface (Fig. 1a). Thus, the focus looks like a ring. As a result of autoinoculation of the fungus in the central part and the repeated development of the inflammatory process, bizarre foci of the ring-in-ring type are formed (Fig. 1b). Such iris-like figures are more common in anthroponous microsporia. The process often involves vellus hair, which complicates the treatment of the disease. The number of foci with microsporia of smooth skin is usually small (1-3). Their diameter ranges from 0.5 to 3 cm. Places of localization of the rash can be both open and closed areas of the skin, since a sick animal is often warmed under clothes, taken to bed. However, most often the lesions are located on the skin of the face (Fig. 1c), neck, forearms and shoulders. There are no subjective sensations or mild itching worries.

In newborns and young children, as well as in young women, due to a hyperergic reaction, it is often observed erythematous-edematous form microsporia, in which pronounced inflammation and minimal flaking are noted.

Papular-squamous the form is found when microsporia is localized on seborrheic areas of the skin - on the face, chest and back. The lesions are characterized by infiltration and lichenification, accompanied by significant desquamation and itching. Since this form of microsporia is usually observed in persons with signs of atopy (in particular, in patients with atopic dermatitis), mycosis is often masked by manifestations of the main process and is not always diagnosed in a timely manner. The use of local corticosteroid drugs only increases the spread of mycotic infection.

In young women with hypertrichosis in the lower leg area, follicular-nodular elements with a diameter of 2-3 cm may appear - the so-called deep shape microsporia of smooth skin.

Localization of single foci of microsporia in atypical places for it can sometimes lead to difficulties in diagnosing the disease. TI Meerson, in particular, described an isolated focus of zoonotic microsporia on the skin of the penis trunk in an 18-year-old patient.

A rare variety of microsporia should be attributed damage to the skin of the palms, soles and nail plates... On the palms, less often on the soles, dyshidrotic and / or squamous-keratotic rashes are observed. Microsporic onychomycosis is characterized by an isolated lesion of the nail, usually its proximal part. Initially, a dull spot is formed, acquiring a white color over time. The nail in the area of \u200b\u200bleukonychia becomes softer and more fragile, and subsequently it can collapse like onycholysis. When examining the affected nail under a Wood lamp, a bright green glow is detected. Microsporic onychomycosis, not diagnosed in time, can cause reinfection and further spread of the disease among others.

Microsporia of the scalp

The defeat of the scalp occurs mainly in children 5-12 years old ... In the last 20 years, there has been a 20-fold increase in the incidence of this form of microsporia in newborns. It is generally accepted that the rarity of this form in adults is explained by the presence of fungistatic organic acids in their hair and the water-lipid mantle of the skin. This fact indirectly confirms the spontaneous recovery of children during puberty, when there is a change in the composition of sebum. Perhaps the difference in hair thickness between children and adults matters. It is noteworthy that microsporia of the scalp is practically not found in children with red hair.

Foci of microsporia of the scalp are located mainly on the vertex, in the parietal and temporal regions (Fig. 2). Usually there are 1-2 large lesions ranging in size from 2 to 5 cm, with rounded or oval outlines and clear boundaries. On the periphery of large foci, there may be screenings - small foci with a diameter of 0.5-1.5 cm. At the onset of the disease, a desquamation site forms at the site of infection. In the early days, the fungus is localized only at the mouth of the hair follicle. Upon closer inspection, you can see a whitish ring-shaped scale surrounding the hair like a cuff. On the 6-7th day, the process applies to themselves hair that becomes fragile breaks off 4-6 mm above the level of the surrounding skin and look as if trimmed (hence the name "ringworm"). The remaining stumps look dull, covered with a grayish-white cap, representing the spores of the fungus. If the stumps are “stroked”, they deviate in one direction and, unlike intact hair, do not return to their original position. The skin in the lesion, as a rule, is slightly hyperemic, edematous and moderately infiltrated, its surface is covered with grayish-white small scales.

With microsporia of the scalp due to anthropophilic fungi, there are numerous small foci with minimal inflammation and indistinct boundaries. A characteristic feature of anthropophilic microsporia is its localization in the marginal zone of hair growth, when one part of the lesion is located on the scalp, and the other on smooth skin.

To atypical, rare variants of microsporia of the scalp include infiltrative, suppurative (deep), exudative, trichophytoid and seborrheic forms.

When infiltrativein the form of a microsporia, the focus on the scalp somewhat rises above the surrounding skin, is hyperemic, the hair is often broken off at a level of 3-4 mm. It should be emphasized that with this type of microsporia, a cap from the spores of the fungus at the root of the broken hair is weakly expressed.

When suppurative form against the background of significant inflammation and infiltration, soft bluish-red nodes are formed, the surface of which is covered with pustules. When pressed through the follicular openings, pus is released. Such clinical manifestations correspond to the picture of kerion Celsi (honeycomb Celsius) - infiltrative-suppurative trichophytosis. The formation of the infiltrative and suppurative forms of microsporia is facilitated by irrational (usually local) therapy, the presence of serious concomitant diseases, and a late visit to the doctor.

Exudative microsporia of the scalp is characterized by severe hyperemia and edema, with small bubbles located on this background. Due to the constant impregnation of the scales with serous exudate and sticking them together, dense crusts are formed, when removed, the moist eroded surface of the focus is exposed.

The listed three forms of microsporia of the scalp are often complicated by regional lymphadenitis, and in patients with suppurative microsporia, symptoms of intoxication can also be observed.

When trichophytoid in the form of microsporia, numerous small foci with weak pityriasis peeling are scattered on the scalp. The borders of the foci are indistinct, there are no acute inflammatory phenomena, the hair is broken off at a level of 1-2 mm above the surrounding skin. Along with broken off, there are healthy hair. Trichophytoid microsporia is more common in persons of older age groups, aggravated by serious concomitant diseases.

When seborrheicmicrosporia of the scalp, mainly hair loss is noted. The foci of rarefaction are abundantly covered with yellowish scales, when removed, a small amount of broken hair can be found.

Late diagnosis, inadequate therapy of atypical forms of microsporia lead to further changes in clinical symptoms, dissemination of rashes and chronicity of the process, irreversible alopecia in a patient and dispersal of infection in the environment.

Diagnostics

To confirm the clinical diagnosis of microsporia, fluorescent, microscopic and cultural studies are used.

Luminescence research

The method is based on detecting a bright green glow of hair affected by fungi of the genus Microsporum, when examined under a Wood lamp. At the same time, both long and vellus hair glow. The reason for this phenomenon has not yet been established. The fluorescent study must be carried out in a darkened room. The lesions are pre-cleaned of crusts, ointments, etc. When examining fresh foci, the glow may be absent, which is associated with insufficient damage to the hair. In such situations, the hair should be epilated from the intended place of introduction of the fungus, and the glow can be found in its root part. When the fungus dies, the glow in the hair remains.

The luminescent method is used to:

Identification of the pathogen;

Definitions of affected hair;

Evaluation of the results of therapy;

Control over persons in contact with the patient;

Determination of infection or mycarriage in animals.

Microscopic examination

To confirm the fungal etiology of the disease, the scales from the foci are subjected to microscopic examination with lesions of smooth skin, and when the scalp is involved in the process, fragments of hair. Immediately before the collection of pathological material, the lesion on smooth skin must be treated with 960 alcohol. Then with a blunt scalpel, the scales are carefully scraped from the periphery of the lesion. On the scalp with tweezers, hair fragments are also removed from the marginal zones of the focus. Then the pathological material is placed on a glass slide in a drop of 20% potassium hydroxide solution. Microscopic examination is carried out after 30-40 minutes.

In scales from foci on smooth skin, convoluted filaments of septic mycelium are found. Microscopic examination of the affected hair reveals many small spores (2-3 microns) on its surface (lesion of the ectothrix type). In this regard, the borders of the hair look like blurry. The spores surrounding the hair are randomly arranged, like a mosaic.

Cultural research

Carrying out cultural diagnostics with positive results of luminescent and microscopic studies is required to identify the causative fungus. The method allows you to determine the genus and type of pathogen and, therefore, to carry out adequate therapy and prevention of the disease. The pathological material (scales, hair) is placed on the Sabouraud medium. Colony growth Microsporum canis (the main pathogen of microsporia) is noted on the 3rd day after sowing. By the 10th day, the colony reaches a diameter of 4-5 cm and is represented by a flat disc covered with a whitish, delicate fluff, which spreads like rays along the walls of the test tube. The reverse side of the colony is yellow.

Treatment

In the treatment of microsporia of smooth skin without damage to vellus hair use external antimycotic drugs. On the foci of mycosis in the morning, 2-5% tincture of iodine is applied, and in the evening it is smeared with antifungal ointment. Use traditional 10-20% sulfuric, 10% sulfur-3% salicylic or 10% sulfur-tar ointments. Modern ointments are applied twice a day: clotrimazole, ciclopirox, isoconazole, bifonazole and others. An allylamine drug has proven itself well terbinafine (lamisil) , produced in the form of 1% cream and spray.

Terbinafine has a fungicidal effect (i.e., leads to the death of the fungus) and is the most active antimycotic agent against dermatophyte fungi. The drug inhibits the function of svalene epoxidase, thereby disrupting the synthesis of ergosterol, the main component of the fungal cell membrane. At the same time, the amount of squalene, a high molecular weight hydrocarbon, increases inside the cell. These disorders lead to the death of the fungal cell. The sensitivity of swale epoxidase in fungi is 10,000 times higher than in humans, which explains the selectivity and specificity of the action of terbinafine in relation to the fungal cell. The drug can be used once a day. It should be emphasized that, having a keratophilic ability, lamisil accumulates in the stratum corneum of the epidermis and is present here for a long time in fungicidal concentrations. This circumstance explains the persistence of a pronounced antifungal effect even after discontinuation of the drug. Convenient dosage form terbinafine spray provides contactless application of the drug to large areas of the affected skin. Terbinafine cream and spray are quickly absorbed and do not leave marks on clothes.

With a pronounced inflammatory reaction it is advisable to prescribe combined preparations containing additional corticosteroid hormones. Such remedies include ointments mycosolone and grasscourt .

With the addition of a secondary bacterial infection useful cream triderm . With severe infiltrationof the lesion focus, as well as with deep forms of microsporia, preparations containing dimexide , which is known to have conductive properties. In particular, in such situations, a 10% solution of quinosole is widely used (quinosole and salicylic acid at 10.0 each, Dimexide 72.0, distilled water 8.0). The solution should be applied 2 times a day until the clinical manifestations resolve and the fungi disappear.

With the defeat of vellus, and even more so long hair, it is necessary to carry out systemic antimycotic therapy of microsporia.

In the treatment of microsporia of the scalp, the drug of choice is still griseofulvin - a chlorine-containing antibiotic produced by a mold Penicillium nigricans... Griseofulvin, produced in the form of tablets of 125 mg, is prescribed at the rate of 22 mg per 1 kg of the patient's body weight. The drug is taken daily in 3-4 doses during meals with a teaspoon of vegetable oil, which is necessary to increase the solubility of griseofulvin and increase the duration of its action (a-tocopherol contained in oils inhibits the metabolism of griseofulvin in the liver). For children under 3 years of age, it is preferable to prescribe griseofulvin in the form of a suspension, 8.3 ml of which corresponds to 1 tablet (125 mg) of the drug. Continuous therapy is carried out until the first negative result of the analysis for mushrooms, after which griseofulvin is taken in the same dose every other day for 2 weeks, and then 2 more weeks 2 times a week. The general course of treatment is 1.5-2 months. In the course of therapy, it is necessary to shave off your hair weekly and wash your hair 2 times a week ... It is recommended to simultaneously rub any antifungal ointment into the area of \u200b\u200bthe hearth. In parallel with the oral administration of antimycotic, manual hair removal can be carried out with a preliminary application of 5% griseofulvin plaster to the lesion.

Of the side effects of griseofulvin, headache, allergic rashes, feelings of discomfort in the epigastrium should be noted; granulocytopenia and leukopenia are less common. Unfortunately, due to hepatotoxicity, griseofulvin is contraindicated in children with hepatitis or liver disease. The drug is also not prescribed for kidney diseases, gastric ulcer and duodenal ulcer, neuritis, blood diseases, photodermatosis.

In recent years, a worthy alternative to griseofulvin has been terbinafine (lamisil) ... The local forms of the drug have already been mentioned earlier. In the treatment of microsporia of the scalp, terbinafine is used in the form of tablets, available in doses of 125 and 250 mg. The drug has a high safety profile, which is largely due to the peculiarities of its mechanism of action. Squalene epoxidase, which terbinafine inhibits, is not associated with the cytochrome P-450 system, so the drug does not affect the metabolism of hormones and other drugs. Since terbinofine is lipophilic, after oral administration, it quickly reaches the dermal layer of the skin, overcomes it and accumulates in the lipids of the stratum corneum of the epidermis, hair follicles and hair.

In the treatment of microsporia of the scalp in children, the dose of terbinafine is set depending on body weight. The manufacturer recommends prescribing the drug with a child's body weight less than 20 kg at a dose of 62.5 mg per day; children weighing from 20 to 40 kg - 125 mg; more than 40 kg - 250 mg. However, our experience shows that these doses are often insufficient, since we obtained the maximum therapeutic effect by changing the officially recommended treatment regimens. In this regard, the doses of terbinafine we offer are 50% higher than those recommended by the manufacturer: 94 mg / day (3/4 tablets of 125 mg) for children weighing 10-20 kg and 187 mg / day (1.5 tablets 125 mg) - 20-40 kg. With a body weight of more than 40 kg, terbinafine is prescribed at 250 mg / day. For adults, terbinafine is prescribed at a dose of 7 mg per 1 kg, but not more than 500 mg per day.

Terbinafine is taken once a day. The drug is well tolerated. Patients may be disturbed by a feeling of fullness in the stomach, minor abdominal pain. Compliance with a diet aimed at stopping flatulence relieves patients of discomfort.

Prevention

Prevention of microsporia consists in the timely identification, isolation and treatment of patients with microsporia. In child care facilities, periodic medical examinations should be carried out. A child identified with microsporia must be isolated from other children and sent for treatment to a specialized mycological hospital. For each sick person, a notification is filled in according to the registration form 281. Things belonging to the patient with microsporia are subject to disinfection. Relatives and persons in contact with the patient are necessarily examined. Particular attention should be paid to pets, as they are often the source of infection. Animals sick with microsporia are either destroyed or they are given full antifungal treatment. An important role in the fight against microsporia is assigned to the bodies of health education, as well as veterinary supervision of stray animals.

Literature

1. Mohammad Yusuf. Clinical and epidemiological features of microsporia in modern conditions and the development of treatment with new drugs. Author's abstract. diss ... candidate of sciences. M., 1996

2. Fakhretdinova Kh.S. Clinical and epidemiological features of modern microsporia. Author's abstract. diss ... doct. medical sciences. M., 1999.

3. Sheklakov N.D., Andriasyan S.G. Some ecological features of Microsporum canis and the incidence of zooanthroponous microsporia. Vestn dermatol. 1979; 2: 18-23.

4. Stepanova Zh.V., Davydov V.I. Carriage of fluffy microsporum by clinically healthy animals. Vestn dermatol. 1970; 3: 42-6.

5. Esteves J. Acromia parasitaria devida ao M. Felineum. Trab. Soc. Derm. Vener. 1957; 15:43.

6. Meerson T.I. Atypical localization of smooth skin microsporia caused by Microsporum canis. Vestn dermatol. 1985; 5: 70.

7. Stepanova Zh.V., Klimova I.Ya., Shapovalova F.S. Onychomycosis due to fluffy microsporum. Vestn dermatol. 1997; 4: 37-9.

8. Feyer E., Olah D., Satmari Sh. Et al. Medical mycology and fungal diseases. Budapest. 1966.

9. Potekaev N.S., Kurdina M.I., Potekaev N.N. Lamisil with microsporia. Vestn. Dermatol. 1997; 5: 69-71.

Terbinafine -

Lamisil (trade name)

(Novartis Consumer Health)

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