The ringworm are superficial fungal skin that manifest as:

areas of partial alopecia

erythematous-scaling

nail disorder.

Epidemiology

Ringworm of the scalp are still among the most common infections in developing countries, and are rare in industrialized countries for improved hygiene. Conversely, the ringworm hairless skin, such as the groin and feet are common even today, being able to spread the mixed use of swimming pools, showers, bathrooms, etc.. Particularly common in military circles, where soldiers keep their personal effects by the beard, combs and other, inside of plastic bags, with the result that the mushrooms are spread, and disseminated through the scarification of the skin, while ' operation of shaving, however, for poor hygiene.

Etiopathogenesis.

The disease is caused by dermatophytes, fungi that the skin, which possess keratolytic, ie to dissolve the keratin they are made of hair and nails and grow easily on the skin. All these leaks or fungi are defined as technically and fungal infections that cause, they have the power to attack keratin, a protein filaments, which is costuituito the stratum corneum of the epidermis, hair and nails. They already have cheratinasi, an enzyme able to dissolve the keratin and allow the growth of fungus.

Belong to the class of Ascomycetes, in turn divided into:

Microsporum

Trichophyton

Epidermophyton

The kind trychophyton, says the same name (from the greek: the hair, the plant) parasitize the body hair and form large spores in hair (macrospores endothrix), or spores such as "chain" to outside the fur (macrospores ectothrix) or small spores (microspores ectothrix), or in and out at the same time. The dermatologist that you visit, uses a simple trick to recognize the fungal lesions: it takes Wood's light, ie light to dark ultraviolet light, the nickel oxide.

Belong to the following species:

T. mentagrophytes, which is characterized by the type microspores ectothrix not visible to the Wood's light, ie with the ultraviolet lamp, which can infect humans with the proximity of domestic animals, particularly children that affect dogs and cats and then scratch the skin, can infect humans and spread the infection on his beard with the razor, even by barbers, especially those who do not observe hygiene standards. It 's a classic contaminate with military barber! It also indicates infection of the groin, especially in sexual relations with prostitutes or walk down town, taking a bath in doccem gym, factory, and always in the barracks, where the medical officer does not do his duty!

T. rubrum, a species macrospores endo-ectothrix, the negative Wood lamp, head of ringworm to feet, axillary and inguinal folds, widespread in Italy.

T. Schoenlein, especially with macrospores endo-and / or ectothrix, weakly positive in the light of Wood, head of ringworm favosa, so that the sulfur-yellow lesions

T. tonsurans, T. T. verrucosum violaceum are other uncommon species, responsible of ringworm of the scalp now difficult to find.

. The genus includes Microsporum fungi that parasitize the hair outside and form n sheath of small spores, hence the name sporum micros and then ectothrix spores.

Distinguish:

M. canis, especially the positive Wood's lamp, which affects our pets, dogs and cats and, therefore, children playing and caressing these animals, especially if the same are not washed and treated by veterinarians! Spread to the scalp and skin of the groin, also, for example, direct infection during sexual promiscuity.

M. gypseum, negative to Wood's light, which can also give the skin of ringworm and groin infections.



The genus Epidermophyton includes, however, one species pathogenic to man 's E. floccosum, head of ringworm of the major folds and feet, very common in Italy. that rarely ever hits the hair and nails.

Usually, the host infected by fungi, for example children, heals spontaneously without treatment at puberty, as fatty acids, ie sebum hair, contrary to what you think (!) Rapprenta a defense and thus greasy hair that appear during the teens and adults, are a protection to the spread of infections fingine. The guest may defend as with cell-mediated activity, ie using defense systems represented by white blood cells. This is evident when initiating cell-mediated reactivity and a state of allergy to the fungi mycelia extracts to determine intradermal, or continue and spread infections in immunocompromised subjects.



. Symptomatology.

The fungal infection manifests as areas of alopecia, namely regions of the scalp where the hair is sparse, broken and there is a fine and flaky dandruff. This may be present especially in children where there are patches of round, oval, with clear limitations and the hair is very fragile or trunks, in affected areas. The patches may be red or even present a surface as "orange peel", Grainy, and may form nodular lesions, filled with pus, "Kerion celsi" The Tigne are beginning to see in Italy in those non-obviously economically less fortunate than us and we speak of ringworm ringworm of the scalp, or there are lesions called "Tigne favose with lesions called" scutuli, "that is characterized by storage of spores, sulfur yellow, hairs and pus logs in context a few millimeters, which if removed, bleed easily. Ringworm of the beard, which occasionally can be seen in the military, said he was on the page of this site on fungus, and which may also be affected farmers and livestock workers in contact with infected animals.

Other times are affected regions of the groin and talk of ringworm of the glabrous skin or herpes circinatus, reddened lesions with heavily itchy, exuding a foul-smelling secretion, with a rim, in fact, red, ie the outside, where infection proceeds to the intact skin is slightly raised and more red, almost look like hives from an injury, if not for the fact that these cone popular, sometimes extending well into the body. Finally we recall the Tigne feet or athlete's foot, injuries affecting the interdigital folds of the feet, especially between the fifth and fourth finger, very painful, malodorous, exuding serous or purulent fluid, overlapping bacterial. Occur in children using the tennis shoes and they do showers in gyms. The lesions may be blistering and peeling. Sometimes are associated with itchy dermatitis. Still remember the Tigne nails or onychomycosis., Starting from the free edge of the nail, which thickens and then splits and continues inward until the same root and nails appear dull and yellowish, without perionissi, ie erythematous and edematous without rib surrounding the nail, as in the form of white.



Therapy.

The treatment of ringworm is not simple and is carried out by expert hands, then to the dermatologist. May be sufficient if only by local lesions affecting skin appendages, for example, Tigne feet, applying anti-fungal ointment for 4-6 weeks, while lesions of the nails or hair care is more intense and involves processing local and a systemic, usually as ketonazolo azole derivatives, fluconazole, itraconazole or griseofulvin, but is considered a toxic drug.

Topical antifungals. Azole antifungals clotrimazole, econazolo, ketoconazole, miconazole and sulconazolo are all effective in case of ringworm. The terbinafine cream is effective but more expensive. Other topical antifungals include amorolfina the griseofulvin and undecilenati. Topical preparations for athlete's foot are counter products containing tolnaftato. The antifungal powders have little therapeutic value for treating skin infections and can cause irritation and may be used to prevent reinfection. Use of these drugs is important to avoid contact with eyes and mucous membranes and keep in mind that may cause local irritation and hypersensitivity reactions including burning, erythema and itching. If symptoms are severe should be discontinued treatment.

Systemic antifungal infections

Currently imidazole and triazole antifungal by mouth (especially itraconazole) and terbinafine, griseofulvin are used more often because they have a broader spectrum of activity and require a shorter treatment. The terbinafine was considered the drug of first choice is used for tinea capitis caused by T. tonsurans (unregistered claim); its role in the treatment of Microsporum infections is uncertain. Itraconazole can be administered as intermittent therapy. The griseofulvin is used for tinea capitis in adults and children is effective against infections Tricophyton tonsurans and Microsporum spp.
 

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