Epidermophytia

EPIDERMOPHYTIA, epidermophytia (from Latin epidermis - epidermis and phyton - plant), a fungal disease of the smooth, i.e., hairless, skin of humans. E. primarily affects adults. Two types of E. are distinguished: groin E. (epidermophytia inguinalis, syn. eczema marginatum; see Eczema marginata), caused by Epidermophyton inguinale Sabouraud, and foot E. (epidermophytia pedum), caused most often by Epidermophyton Kaufmann-Wolff. The fungus Epidermophyton was studied and described in detail in 1907 by Sabouraud under the name Epidermophyton inguinale as the causative agent of marginated eczema. The separation of Epidermophyton into a separate group from Trichophyton is justified by the fact that it does not penetrate into hair follicles and does not affect hair. Clinical-epidemiological observations of the last decade speak of the colossal spread of this fungus both in America and in Europe. Clinically, three main forms of foot E. are distinguished: dyshidrotic, squamous, and intertriginous. Dyshidrotic E. is characterized by the appearance on clinically non-inflamed skin of the soles, lateral surfaces of the feet, and on the fingers of groups of slightly itchy vesicles with a dense horny covering. In the future, the picture of the so-called dyshidrotic eczema develops. Squamous E. manifests as plate-like desquamation of the type of the so-called dry plate-like dyshidrosis (dyshidrosis sicca lamellosa). Intertriginous E. is localized in the interdigital spaces of the feet, most often in the 3rd and 4th (the tightest), and clinically differs in nothing from ordinary intertrigo. In a part of these cases, when patients walk a lot or wear tight shoes, the so-called epidermophytial interdigital erosion (erosio interdigitalis epidermophytica) develops. Infection with E. is favored by maceration of the skin of the feet and interdigital spaces of the feet. A significant part of patients links the disease with bathing, which seems very probable, since, on the one hand, soap reduces or even temporarily destroys the acidic reaction of the skin surface, which is a factor favoring the penetration of fungi into the skin, and on the other hand, there is a certain degree of maceration of the skin of the soles and interdigital spaces of the feet. In the bath, the fungus can be on various objects: on the floor, on mats, carpets, etc. Frequent recurrences of foot E. are apparently explained by the fact that the fungus is preserved in underwear, mainly in stockings and socks, which are not subjected to boiling during washing as a rule. Foot E. usually proceeds chronically, at times giving exacerbations, often recurrences. In a part of cases, there are secondary allergic rashes of hematogenous-infectious origin - epidermophytides, occurring mainly on areas of the skin remote from the main foci, mainly on the hands and forearms. Epidermophytides develop mainly as a result of irritation (prolonged walking, irritating therapy, etc.) of the main foci of E. on the feet. Epidermophytides clinically proceed differently: on the palms and fingers of the hands more often in the form of epidermophytid dyshidrotic eczema, on the back of the hands and on the forearms - in the form of dry desquamating eczema. In cases of epidermophytides, positive skin reactions with epidermophythin, as well as with trichophytin (Mashvileisoni, Segal and Sigalova), are obtained. The clinical diagnosis of foot E. can easily be confirmed bacteriologically and culturally. Fungi are easiest to detect in the coverings of vesicles or in the overhanging scales of peripheral areas of desquamating foci. Path.-anat. studies show that the fungus does not penetrate deeper than the horny layer. The prognosis is favorable provided there is persistence on the part of the patient regarding the systematic execution of all therapeutic and preventive measures, otherwise recurrences and exacerbations are frequent. Prevention of foot E. consists of general sanitary-hygienic measures regarding baths, shower rooms, etc. Personal prevention consists in observing the hygiene of the skin of the feet, in particular in their dry maintenance; this includes fighting increased sweating, convenient shoes, drying the interdigital spaces after bathing, etc. Patients suffering from foot E. must regularly boil stockings and socks. Treatment of foot E. differs from the treatment of other dermatomycoses of smooth skin in that too energetic disinfecting therapy cannot be applied to it, since the latter often leads to the occurrence of secondary allergic rashes. In all forms of foot E., local warm baths with potassium permanganate are applied, after which in the dyshidrotic form the vesicles are pricked and, depending on the degree of existing inflammatory phenomena, some or other anti-inflammatory treatment is applied (cold compresses, indifferent ointments); upon subsidence of inflammatory phenomena - benzoyl-salicylic ointments (Acidi salicylici 0.6; Ac. benzoici. 1.2; Lanolini, Vaselini flavi aa 15.0). Boric tar ointment (Acidi borici pulverati subtil. 1.5; Olei Rusci 1.0; Lanolini, Vaselini flavi aa 15.0) acts well in squamous and intertriginous foot E. In intertriginous E., in addition, it is always necessary to wear gauze pads in the interdigital spaces.