Ringworm
The content of the article:
- Causes and risk factors
- Forms of the disease
- Stages
- Ringworm symptoms
- Diagnostics
- Ringworm treatment
- Possible complications and consequences
- Forecast
- Prevention
Ringworm is a household name for a highly contagious fungal infection (mycosis) of the skin and scalp (very rarely, with this disease, the nail plates are also involved in the pathological process). The term "ringworm" combines two very similar disease symptoms - microsporia (microsporosis) and trichophytosis (trichophytosis), since it is possible to identify a specific etiological factor only with microscopic examination, and the clinical picture in both cases is identical.
Ringworm is a skin disease caused by a fungus of the genus Microsporum
In pediatric practice, ringworm is the most common mycosis, which is explained by the small amount of fatty acids, which are a specific protective factor, in the secretions of sweat and sebaceous glands in children. Ringworm is rare in infants and adults (less than 10% of total infections). The annual incidence is over 100 thousand episodes.
Ringworm is a disease that has been known for many centuries, but it was not until 1843 that its causative agent was first described by the Hungarian physician David Gruby. The discovery was received with skepticism by the medical community, since the disease, presented as microsporia, has traditionally been identified with trichophytosis. The difference between the causative agents of these two diseases was convincingly proved only 50 years later.
The industrial revolution that unfolded in Europe and America at the turn of the 18-19 centuries led to intensive migration of the population, a huge influx of refugees, the formation of slum areas where ringworm, especially among the child population, became widespread. Children who had signs of ringworm on their heads were excluded from schools, limited in contacts until complete recovery. The main radical treatment was considered to be complete disposal of the scalp until the moment of recovery.
The name "ringworm" is due to the characteristic lesion pattern: in limited areas, the hair breaks off close to the skin or falls out, which gives the impression of clipped areas.
Synonyms: microsporia, microsporosis, trichophytosis, trichophytosis, dermatophytosis, dermatophytosis.
Causes and risk factors
Ringworm is caused by infection with imperfect fungi, dermatophytes of the genus Microsporum or Trichophyton. On the territory of Russia, the most common are Trichophyton rubrum, Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum canis, Microsporum aureum. Currently, the overwhelming number of ringworm cases (up to 90-95%) are provoked by Microsporum dermatophytes.
Depending on the habitat, these fungi are subdivided into geo-, anthropo- and zoophilic (the natural reservoir is soil, humans or animals, respectively).
Ringworm develops as a result of fungal infection with dermatophytes
The bulk of ringworm infections occurs through tactile contact with an infected animal: most often with dogs or cats, mainly kittens (7-8 cases out of 10), less often - with guinea pigs, hamsters, horses, rats, cattle. In addition to direct contact, you can become infected by contact with household items that have particles of skin or hair of a sick animal. The infected animal has a characteristic appearance: areas of bare skin among the unchanged coat of hair on the muzzle, ears, front or hind legs.
Less often, infection with pathogenic fungi occurs from a sick person using common combs, towels, bed linen, hats, etc., which is especially important for places of consumer services (for example, hairdressing salons) or places of permanent and temporary stay (schools, kindergartens, pioneer camps, boarding schools).
The peak incidence occurs in the summer and early fall, the minimum risk of contracting ringworm is observed in winter and spring.
Factors that increase your risk of contracting ringworm:
- children's age (from one to 14-15 years old);
- stay in places where a large number of people gather;
- immunodeficiency states;
- tactile contact with street animals;
- work on livestock farms;
- sharing of household items;
- exchange of personal belongings, hats, hygiene items.
Forms of the disease
Depending on the localization of the pathological process, ringworm is isolated on the head and on smooth skin (trunk, hands, feet, inguinal dermatophytosis, etc.).
According to the degree of tissue damage by pathogenic fungi, a superficial form of the disease and a deep, infiltrative-suppurative form are distinguished.
In accordance with the clinical manifestations, ringworm is conditionally divided into the following forms:
- erythematous-edematous - peeling is minimal, inflammation, local edema are pronounced;
- papular-squamous - infiltration in lesions with thickening of the skin and increased skin pattern; this form is typical for persons prone to allergic reactions;
- infiltrative - an edematous focus that rises above the surface of unchanged skin;
- suppurative;
- exudative - local edema, infiltration with a large number of small vesicles filled with transparent contents;
- seborrheic - multiple scales;
- atypical - impetigous, squamous and others.
Different forms of ringworm
In rare cases, ringworm becomes protracted, then they talk about chronic trichophytosis or microsporia. With a reduced immune response, an abortive form of the disease with blurred symptoms is possible.
In foreign medicine, a slightly different classification of ringworm has been adopted:
- ectotrix infection or anthropozoonotic microsporia of the scalp;
- endotrix infection, anthroponous trichophytosis of the scalp;
- favus (scab);
- kerion (infiltrative-suppurative form).
Stages
During the course of the disease, two stages are distinguished:
- The incubation period is from several days (usually 5-7) to several weeks (2-4 weeks, in rare cases longer).
- The period of extensive clinical manifestations, ending, as a rule, with the extinction of symptoms without a tendency to relapse of the disease.
Ringworm symptoms
Ringworm symptoms on the scalp and on smooth skin differ. Typical signs of scalp lichen:
- single or multiple lesions, usually small in size (up to 5 cm), isolated, rounded, located among unchanged hair, small foci of dropout are possible near the main defect with a diameter of several millimeters to 1-1.5 cm;
- changes in the structure of the hair (dry, brittle, easily pulled out of the follicles, a white bloom is determined at the base of the hair shaft);
- a peculiar smell ("mouse" or "barn") from the lesions;
- for ringworm in the form of a favus, the formation of an initial focus in the projection of the hair follicle in the form of a yellowish point, which grows, turns into a dirty yellow or whitish-gray crust (scutula, or scutellum), is characteristic, after its removal, a characteristic depression remains.
Initially, the fungi take root at the hair follicle orifice without causing active symptoms (incubation period). The only manifestation of the disease at this time is the presence of a white "cover" on the hair shaft in the immediate vicinity of the skin. Approximately 5-7 days, as the follicle and hair thickness are colonized by dermatophytes, the hair structure changes, they begin to break off at a distance of several millimeters from the scalp, while the remnants of the hair shafts are covered with a whitish bloom. When smoothing hair fragments, they do not restore their original position, remain deflected in one direction or another. The affected skin is moderately hyperemic, edematous, covered with small scales.
In the case of infection from a person (anthropophilic dermatophytosis), a characteristic feature is the borderline location of the focus: the lesion is partially localized on the scalp, partially on smooth skin.
Typical manifestations of ringworm on smooth skin:
- a small rounded focus (less often - several) in the immediate place of contact, rising above the level of the skin, edematous, hyperemic;
- a gradual increase in the area of the lesion, infiltration, the formation of a roller-like eminence along the periphery, which provides a characteristic appearance of the ring;
- the central zone of the focus within a few days acquires a pale pink color, is compared with the level of unchanged skin, is covered with pityriasis scales, later the process is resolved along the edges of the defect;
- re-infiltration is possible, the formation of a ring in the ring.
In the vast majority of cases, local manifestations of ringworm are not accompanied by severe itching, symptoms of intoxication, the general well-being of patients does not suffer.
The infiltrative-suppurative form of ringworm occurs, as a rule, in immunocompromised patients or with incorrect (more often independent) treatment of the disease. The lesions in this case are intensely hyperemic (pronounced red-pink color), edematous, covered with small vesicles with purulent contents, the pyogenic flora also penetrates the hair follicle. Opening, the bubbles become covered with crusts, which are tightly adhered to the underlying skin, bleeding easily in case of accidental injury. When pressing on the hair follicle or when removing the affected hair with tweezers, purulent contents are released.
Diagnostics
In order to diagnose ringworm, in addition to examination, instrumental research methods are used:
- luminescent study of previously cleaned lesions under a Wood lamp (characteristic glow);
- microscopy of hair fragments or scales (detection of crimped filaments of septate mycelium or small spores of a characteristic type);
- cultural research (bacteriological inoculation of particles of the affected material on the culture medium of Sabouraud).
In order to diagnose ringworm, a fluorescent study is used under a Wood lamp
Ringworm treatment
Topical antifungal agents play a major role in treating ringworm on smooth skin. In the case of severe inflammatory changes, preference is given to combined preparations containing glucocorticosteroids, antibacterial components. The drug of choice for the treatment of ringworm of the scalp is griseowulfin, a chlorine-containing antibiotic of the penicillin series.
In addition to medication, it is recommended to shave the hair weekly until complete recovery (usually 1.5-2 months), rubbing an antifungal ointment into the scalp.
Antifungal ointments are used to treat ringworm
In addition to specific etiotropic therapy, drugs of the following groups are used:
- antihistamines;
- fortifying;
- immunostimulating;
- local antiseptics to prevent secondary infection.
Possible complications and consequences
A complication of ringworm can be:
- accession of a secondary infection;
- irreversible focal baldness.
Forecast
With timely diagnosis and complex treatment, the prognosis is favorable.
Prognostically, ringworm in children is most favorable, the disease in this case, as a rule, proceeds sharply, resolving without consequences, the general well-being does not suffer. Chronization of the process is possible in women and adolescents, which, nevertheless, is quite rare.
Prevention
- Avoiding tactile contact of a child with street animals.
- Monitoring the health of a pet if it has access to an open environment.
- Refusal to share hygiene items, clothing, hats.
- Timely diagnosis of ringworm and early isolation of the patient.
- Periodic preventive examinations in places of permanent or temporary stay of children.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
