Fungal skin disease in children is a heterogeneous group of lesions of the skin, agents which are pathogenic microscopic fungi. Fungal skin diseases in children may lead to peeling, itching, cracks in skin; loss of hair, loss of nails. Diagnosis of fungal skin diseases in children includes inspection, fluorescent testing, microscopy and culture of scrapings on the microflora. A comprehensive treatment of fungal skin diseases in children is carried out using external and systemic antifungal means, desensitizing and corticosteroid drugs, Immunostimulants, physiotherapy.
Fungal skin diseases in children are developing at defeat smooth the skin and its appendages (hair and nails) parasitic fungi. In dermatology, the share of fungal infections account for 37-40% of all skin diseases. There is a tendency to growth of number of children with fungal skin disease developed simultaneously with other dermatoses atopic dermatitis, eczema, psoriasis, pyoderma. The danger of fungal diseases of the skin is toxic and sensitizing action of fungi on the child's body, which triggers the development of allergic reactions, weakened immunity, the burden of chronic disease.
On depth of defeat fungal skin diseases in children are divided into keratomycosis (pityriasis versicolor), dermatofitia (microsporia, trichophytosis, favus, epidermophytia, rubromycosis); candidiasis; deep mycoses.
Keratomycosis are characterized by lesions of the Horny layer of the epidermis without the development of inflammatory reactions, damage to hair and nails. Dermatofitia are accompanied by weak or strong inflammatory changes in the skin within the epidermis, damage of hair and nails. Dermatophytes (fungi of the genera Trichophyton, Microsporum, Epidermophyton) are the main causative agents of fungal skin diseases in children. Superficial candidiasis – the second most common detection among the fungal skin diseases in children are caused by pathogenic fungi of the genus Candida (usually C. albicans) affecting skin and mucous membranes.
The advantage of dermatomycosis among all fungal diseases due to the constant close contact of the skin with the environment. The causative agents of fungal skin diseases in children widely distributed in nature, have a great variety and high resistance to external factors. Fungal skin diseases in children are usually observed in the form of sporadic cases, outbreaks are more typical of dermatophyte scalp.
A source of anthropophilic dermatomycosis is a sick man, zoophilic (microsporia) - sick animal (stray cats and dogs, cows, horses), rare geophysical – soil. Infection occurs by direct contact of the child with skin and hair of the patient or through everyday objects, fungi and their spores (towels, washcloths, combs, toys, caps, shoes). Often fungal skin diseases children infected in swimming pools, showers and baths, on the beach, in hairdressing salons, organized children's groups.
Features of children's skin (hydrophilicity, increased vascularization, reduced bactericidal activity of sweat and sebaceous glands, easy vulnerability), the immaturity of the immune system facilitate the penetration of the pathogen into the epidermis, contributing to the rapid development of fungal diseases in children.
The decrease in the protective forces of an organism of the child can be triggered by poor ecology, stress, prolonged use of antibiotics and chronic infections. With a weak immune system opportunistic fungi, which inhabit normal on the baby's skin, can transform into a pathogenic form and cause disease fungal (e.g. Malassezia furfur is the causative agent of multi-colored lichen).
The nature and severity of the symptoms of fungal skin diseases in children depend on the type and virulence of the pathogen, localization, and lesion size, the reactivity of the organism. Of fungal infections of the skin in children the most common and contagious are microsporia and trichophytosis (ringworm), which are mainly affecting the smooth skin and scalp.
microsporia in most cases (99%) is called zooantropophilic fungus Microsporum canis, rarely anthropophilic M. ferrugeneum. It occurs usually in children of preschool and younger school age; proceeds with the formation of few, rounded, well-defined lesions. Within the lesion the skin is covered with small grayish-white spots. On the smooth skin microsporia manifested concentric erythematous-squamous plaques, surrounded by a cushion of small blisters and scabs.
In children of early age often marked by superficial trichophytosis of the scalp, which is called trichophytons anthropophilic (Trichophyton tonsurans and T. violaceum), which is accompanied by loss of color, elasticity and Shine to the hair, the formation of clear, covered with small elements. The clinical signs of trichophytosis smooth skin resemble symptoms microsporia. For infiltrative-suppurating forms characteristic of perifolliculitis and deep follicular abscesses.
Pityriasis versicolor is seen in young children; characterized by the appearance on the skin of the back and chest cream, light brown or yellowish-pink spots irregular in shape, prone to peripheral growth. The disease is slightly contagious, it has a chronic relapsing course; the affected skin does not tan (secondary leukoderma).
With the defeat of the fungus Achorion schonleini developed a rare fungal skin disease in children - favus (scald) usually occurs on the scalp the formation of sculling - dry thick crusts of a yellowish or light brown with raised edges and center, which emit an unpleasant stagnant smell. Affected by fungus the hair, become like tow. Favus can result in solid scar with skin atrophy and loss of hair follicles.
Rubromycosis, which is caused by anthropophilic pathogen T. rubrum, occurs in children aged 7-15 years; appears dry skin feet and hands, clear pink-red, in small pockets with scalloped-edge; damage to the nails.
When epidermophytia in the folds and on the soles of the feet, there is a slight redness, peeling, cracks, and vesicles, hyperkeratosis, which are accompanied by itching.
For various types of onychomycosis is characterized by thickening, modifying shape and color of the nail plate from its gradual destruction, onycholysis, lesions of the nail shaft.
Candidiasis in children is most often manifested by thrush - a white coating on the tongue, gums, cheeks. Vesicular rash and extensive superficial ulceration, accompanied by itching and burning may also occur in the natural skin folds.
After suffering a fungal skin disease in children does not occur stable immune system and can be re-infected by the same species of mushroom.
To identify the fungal diseases of the skin requires a holistic examination of the child at the children's dermatologist.
Microscopy of a clinical material (hair, flakes of epidermis, the Horny masses from the nail bed) allows to detect the presence of mycelium, hyphae or spores, to confirm fungal infection of the skin in children and to determine its tissue form. Sowing scraping on universal and selective media helps to distinguish the pure culture of fungi and determine their drug sensitivity; bacterioscopy of smears of cultures and biochemical analysis – to conduct phenotypic identification of the causative agent.
Examination of baby's skin under a wood's lamp reveals a Golden-yellow glow scales with multi-colored lichen, bright green - when microsporia, weak – with the defeat of the trichophytons.
Fungal skin diseases in children should be distinguished from dermatitis with similar symptoms, including psoriasis, neurodermatitis, eczema, erythrasms, vitiligo, seborrhea, syphilitic leukoderma etc.
The treatment of fungal skin diseases in children in the outpatient and in the absence of effect, the presence of comorbidity and severe - in a specialized hospital. In the treatment of fungal skin diseases in children using monotherapy or a combination of external and systemic antimycotic means, antihistamine and glucocorticoid drugs, immunostimulants, multivitamins, physiotherapy.
Perform daily processing of skin lesions with antiseptic solutions (furatsilina, potassium permanganate, boric acid); the treatment is performed and the stop plates nail; hair in the lesion is removed, remove the cover.
In fungal infections skin folds, hands and feet in children using antifungal pastes, ointments, creams, emulsions with terbinafine, naftifin, clotrimazole, miconazole, ketoconazole; sulfur-tar, salicylic, naphthalane ointments. When joining a bacterial infection prescribe antimycotic ointments containing antibiotics and corticosteroids. In severe and widespread dermatophytics, lose hair and nails additionally shows receiving systemic antimycotics (griseofulvin, Itraconazole, fluconazole). If necessary, a treatment of fungal infections of the skin and nails, surgical removal of the nail plate.
The physical therapy of fungal skin diseases in children includes medicinal electrophoresis, pulsed magnetotherapy, darsonvalization, UHF-therapy.
The treatment of fungal skin diseases in children is long and continues until resolution of clinical manifestations and negative control tests on fungi.
A fungal skin disease in children have a persistent course and require long-term systematic treatment, but with strict observance of the recommendations have a favorable prognosis. Fungal diseases of skin in children become chronic periodic form and can continue into adulthood.
Preventing the spread of fungal skin diseases in children includes quarantine measures in institutions; disinfection of premises, household items, clothes, shoes, manicure and hairdressing supplies; the elimination of contact of the child with the animals, adherence to the rules of personal hygiene, proper care of the skin, normalization of immunity.