How Common Is Ringworm in Children?

Ringworm is a superficial fungal skin disease that occurs in the epidermis, hair, and fingernails.

Ringworm

Ringworm is a superficial fungal skin disease that occurs in the epidermis, hair, and fingernails.

Causes and causes of ringworm

The cause of ringworm on the skin is always caused by carelessness in life and daily life, infection with fungi, recurrence caused by external attack of wind, dampness, and heat, depression in the skin, and kinky skin. If the disease occurs on the scalp and hair, it is alopecia areata and fat sore; if the disease is on the toes, it will be foot moisture; if it is on the palms, it will be lilies; if it will be on the body surface and femoral area, For Vitiligo, Ringworm, Yin ringworm and so on. Such as the appearance of rashes, itching and desquamation are mostly caused by wind and heat; if seepage and nourishment, itching and crusting are mostly caused by hot and humid; if skin hypertrophy, dryness, itching, mostly caused by Depression and dryness, qi and blood discord, skin nutrition loss.

Causes of ringworm

Superficial mycosis is a skin disease caused by pathogenic fungi that are parasitic to keratinous tissues. The pathogens can be divided into:

One. Dermatophyte: Dermatophytes that are parasitic on the keratinous tissue of the skin are collectively called dermatophytes. The bacteria are further divided into the following three genera based on their different tissue invasion and cultural characteristics:

(1) Trichophyton: invades skin, hair and nails. Thirteen species of this genus have been identified that can cause human disease. F. trichophyton, Trichophyton rubrum, Trichophyton punctatus, Trichophyton purple, Trichophyton gypsum, etc. are common; their culture characteristics are rod-shaped macromolecular spores with smooth walls.

(II) Sporophytes: Invasion of hair and skin, rust-colored microspores, wool-like microspores, etc. are more common in China; these culture characteristics are spindle-shaped macromolecular spores with thorny walls. Eight species have been reported to cause human disease.

(3) Epidermophyton: invades the skin and nails. This genus is only a kind of floccus epidermophyton that can cause human disease, and it is seen as pestle-shaped or pear-shaped macromolecular spores in culture.

Dermatophyte bacteria of the above three genera can cause tissue reactions after infection of the human body to cause erythema papule, blisters, scales, hair loss, hair loss, and deck changes. According to the difference of the invading parts, it can be clinically divided into tinea capitis, tinea corporis, tinea corporis, tinea pedis, and onychomycosis.

two. Keratomyces: The pathogenic fungus that parasitizes on the surface of the cornea or hair shaft can be called keratomyces. This type of ringworm is divided into two types, namely corneal type and hair type. The former includes Trichophyton versicolor, Corynebacterium rubrum, Trichophyton mannii and Trichophyton versicolor; the latter type includes Trichophyton axillary.

Because keratomyces is parasitic on the surface of human tissues, it generally does not cause inflammatory reactions in the tissues, even if it is very slight.

Ringworm Epidemiology

Superficial mycotic diseases are widespread and spread throughout the world. They are also common in China. Incidence, according to reports from several hospitals in Shanghai, this type of skin disease accounted for the second or third place in the total number of dermatology outpatients, and some even ranked first; a certain army based on the 1985 Air Force Hospital survey of the incidence of officers and men in the Yunnan-Guizhou frontline Information: The hospital conducted a physical examination of 2,370 officers and men of a group army. As a result, it was found that there were 1,414 people suffering from superficial mycosis, accounting for 59.66% of the total number of people being examined. The 1st and 2nd hospitals affiliated to our school had a first outpatient diagnosis during 1955-1964 According to the statistics of 40,731 cases, 6,108 cases of this type of disease accounted for 15.98%. The occurrence of superficial mycosis is related to the type of bacteria, the resistance of the individual and the environment, but the reason why this type of skin disease is so widespread and the incidence is so high may be related to the following factors:

One. Fungi are extremely viable: The fungus does not contain chlorophyll and photosynthetic ability, and only survives by parasitic or saprophytic. The fungus likes humid and warm environment, the most suitable growth temperature is 25-26 , and it can grow under the pH value 3.0 10.0. Although it has weak resistance to high temperature (above 45 ), it has strong adaptability to temperature below 4 . It also has considerable resistance to ultraviolet rays and radiation. It can be seen that the fungus does not require harsh living conditions. Therefore, people can cultivate and detect pathogenic fungi from the atmosphere, the bodies of animals and plants, human feces, the floor and the soil. In short, the fungi have a strong ability to live and are almost everywhere in nature, so fungi The chance of infecting humans naturally increases.

two. Carriers are the main cause of the spread of superficial fungal germs: because people don't know enough about the harmfulness of ringworm, they don't pay attention to it, and they often let the disease develop. In terms of tinea pedis, most patients are not very sick, only slightly itch, so they never seek medical treatment actively; some patients are not actively treated even if they have more obvious symptoms. Some patients, although cured after treatment, often relapse because the source of infection is not controlled and there are no preventive measures. The three types of people exemplified above are carriers of bacteria, and their ultimate consequences are: they may cause their own infection and attract ringworm elsewhere; they can be transmitted to the surrounding population through various channels.

three. The spread of pathogenic fungi is widespread and difficult to prevent: the spread of the disease is quite widespread. Pathogens can be widely spread through public goods such as slippers, bathtubs, foot basins, towels, haircutting tools, etc. It can be seen that the above public places must have strict management systems and disinfection measures, otherwise it is not easy to control their incidence.

four. The body's own resistance also has an important role in the epidemic of the disease: although some people think that the fungal infection is low, even in the toes, if it is not locally damaged, it is still not easy to develop the disease. But it is well known that people who do not pay attention to personal hygiene; patients with systemic diseases, such as diabetes, malignant tumors, etc .; long-term use of corticosteroids, immunosuppressants and antibiotics due to the disease. The above situation will undoubtedly promote the occurrence of ringworm.

Fives. The external environment also has an important relationship with the epidemic of ringworm: fungi like to grow and reproduce in humid environments, so the disease occurs in the toes, and it is more common in hot and humid areas and hot summers.

From the above description, it can be seen that superficial mycosis is contagious, and can be transmitted by itself or others. The infection mode of this disease: one is direct contact infection. For example, the onset of tinea capitis is usually caused by direct contact with children suffering from tinea capitis or animals with ringworm disease. The second is indirect contact infection, such as those who have often used it. Ringworms may occur on things like slippers, pillow towels, and foot wipes.

Clinical types and symptoms of ringworm

One. Tineacapitis

The disease occurs in superficial mycosis of the skin and hair of the head. In China, tinea capitis is basically divided into four types, namely yellow ringworm. Tinea versicolor and Tinea versicolor. And psoriasis.

(A) yellow ringworm

The pathogen of yellow ringworm is yellow ringworm and its Mongolian variant. This disease is referred to as fat sore in Chinese medicine. It is commonly called "bald sore" in China, and it is commonly called "stomach bun" in the south. It is mainly prevalent in rural areas. It is more common in children aged 7 to 13 and the ratio of male to female is 9: 1. Can happen.

The disease occurs in the scalp. The initial lesions are pimples or pustules. Later, the scabs become dry and crusty, and the color is pale yellow. Loquat can spread and grow in size, such as soybeans or larger. At this time, the appearance of the pupa is similar to a dish, with a slightly raised perimeter and a slightly depressed center, with hair penetrating between them. The so-called yellow ringworm pupa is composed of the yellow ringworm group, sebum, scales, and dust. It is an important feature of yellow ringworm and is helpful for diagnosis. It also suggests that the disease is highly contagious at this time and often requires isolation and treatment. The quality of this soup is like bean dregs, it is easy to crush, and it smells of rat odor, which is another characteristic of this disease. Adjacent salamanders can be fused with each other to form a large gray-yellow thick salamander. If the scabs are scraped off, it can show a flushed wet surface or superficial ulcers. If not treated, it can damage the hair follicles and leave atrophic scars after healing. .

Infected hair at the lesion was dry, withered, and curved, and there were scattered hair loss, but no symptoms were found. No matter how serious the patient's scalp is around, a normal hair band of about 1 centimeter wide still remains at the hairline, where the hair is not tired.

The symptoms of yellow ringworm are itch and the course is lingering. If it is not treated, it will not heal in adults. Those with erosion and purulent disease may be accompanied by cervical lymphadenopathy. In addition to the head, the face, neck, torso, and nails are occasionally affected. In severe cases, it can also cause allergic reactions. At this time, the rash that appears throughout the body is called ringworm fungus rash.

The disease can be examined with filtered UV light to show dark green fluorescence on the affected area. Microscopic examination of the diseased hair shows intramycosis, and spores or staghorn hyphae can also be found on the examination of the yellow ringworm.

(Two) white ringworm

Tinea versicolor is mainly caused by rust-colored microsporum in China. It often causes epidemics in town nurseries or elementary schools. Almost all are childhood.

Scalp lesions are scaly patches, small ones such as broad beans, large ones like coins, which spread and expand into pieces over time, mostly irregular shapes. The inflammatory response at the lesion was not significant, but the realm was clear. The disease is dry and tarnished, and it is often dominated by hair breaks, which is constantly different from alopecia areata. It is often broken at a distance of 2 to 5 mm from the scalp, and the white hair sheath can be seen outside the hair shaft of the affected area near the scalp. This substance is also formed by fungi and is considered one of the characteristics of the disease.

Deer irradiated the diseased area with filtered ultraviolet light can show bright green fluorescence. Microscopic examination of the hair showed external spores, and fungal microscopy in the early stages of taking dander were also positive. 97% of the cultures were rust-colored microspores, and the rest were other microspores.

Patients consciously itch or have no obvious symptoms, the course of the disease is chronic, and without treatment, they often heal by puberty. This may be related to the strong sebum secretion and increased local free fatty acid concentration in young people to inhibit fungi. After healing, new hair can be regenerated without leaving scars.

(Three) black ringworm

The pathogenic bacteria of the disease are Trichophyton purple or Trichophyton punctatus. It mainly affects children, and its incidence is behind that of ringworm and yellow ringworm.

Head damage is similar to that of tinea corporis, and also shows scaly patches, but the lesion area is smaller and the number is larger than that of tinea corporis. In addition, the onset of the disease is slightly different from that of tinea corporis, which is mainly a low-level hair break, which is often broken at 1 to 2 mm from the scalp, and some even break at the scalp. At this time, observing the hair of the affected area, there were only black-spot-shaped residual hair roots.

The disease showed no fluorescence on filtered UV lamp tests. The microscopic examination of the diseased hair showed endospores, and mycelia were also found in early dander. 80% of the cultures were Trichophyton purple, and 20% were Trichophyton spp.

The disease is less infectious than yellow ringworm and white ringworm. Feel itchy or uncomfortable. The course of the disease is slow. After healing, a few scars remain, and the hair is partly bald.

(4) Psoriasis

Psoriasis is caused by an animal-fungi fungus such as Plasmodium microsporum or Wool-like microsporum infection.

The skin lesions are mostly massive ridge-like bulges, the inflammation is severe, and the hair follicles in the affected area are purulent, and the pus can be squeezed out of them. The hair at the lesion is easily broken and bald, and the remaining hair is extremely loose and easy to pull. After healing, scars often remain, and fungal microscopy and culture with the disease are positive.

The subjective symptoms of the disease often report pain or mild itching. It is often accompanied by swollen cervical lymph nodes. Some patients also develop systemic symptoms such as fever and loss of appetite.

Tineacorporis

Except for the head, palms, groin, femininity, and nails, skin diseases caused by dermatophytes on smooth human skin are collectively referred to as body ringworm. Also known as ringworm or ringworm. The common pathogens of this disease are Trichophyton rubrum, Trichophyton gypsum, Trichophyton flocculentum, Trichophyton purple, and the pathogenic bacteria of tinea capitis.

Tinea corporis is more common in children, followed by adolescents. The clinical manifestations of this disease are related to the types of pathogenic fungi and individual responses. The rash starts as erythema or pimples, and then the damage gradually expands telecentrically to the surrounding area. The center of the lesion has a tendency to heal and becomes a ring shape over time. The edge of the ring is slightly higher than the adjacent normal skin, where the inflammation is more obvious, with small pimples, blisters or scales attached to it. Sometimes the center of the ring

A rash may appear, and the new skin lesions gradually expand into a ring shape. This occurs in succession and forms a multi-layered concentric ring, which is particularly bright. The number of skin lesions in this disease varies, and the number is not fixed. Most of the lesions are 1-2 or several. The whole body is less common and the distribution is not symmetrical. However, if the patient has immunodeficiency disease or long-term use of corticosteroids and immunosuppressive agents, the skin rash may appear to spread throughout the body.

In addition, the so-called "atypical body ringworm" is often encountered in clinical practice, which is caused by the original application of corticosteroid cream to the lesions. After a period of treatment, the typical symptoms of the protozoan ringworm lesion were destroyed, replaced by a more severe inflammatory response, the lesion area expanded rapidly, the shape was less regular, and the boundary was unclear, which made it difficult to identify the ringworm. This is because the use of corticosteroids reduces the local skin immunity and causes pathogenic fungi to spread. In this regard, inexperienced doctors are difficult to make a correct diagnosis.

Patients with ringworm can consciously feel itching. After itching, bacterial infection may occur. Scraping the surrounding scales for microscopic examination may reveal mycelia or spores.

Third, tinea cruris (Tineacruris)

This disease can be seen as a special type of body ringworm that occurs on the inner side above the thigh. Its pathogenic bacteria are floccus epidermal ringworm, which is common. Other dermatophytes can also cause disease.

Jock itch is overwhelmingly adult men and rarely seen in women. Often unilateral, can also be symmetrically distributed on both sides. In severe cases, the skin lesions can spread up to the lower abdomen, spread back to the hips, and extend down to affect the other parts of the thigh.

There are several differences between this disease and tinea corporis: one is that the shape of the jock itch is rarely round or oval, and is mostly irregular or curved; the other is that the tinea corporis lesions are often lichenoid or acute And subacute eczema-like changes; three are more likely to be complicated by bacterial infection of jock itch; four are itch more consciously.

Jock itch is usually caused by tinea pedis or tinea pedis, and the condition is related to seasonal changes. It usually recurs or worsens in summer and can be relieved in winter. The course of the disease is lingering and must be treated patiently to recover, otherwise it is easy to relapse.

Fourth, athlete's foot (Tineapedis)

Athlete's foot is the most common superficial mycotic fungus caused by a fungal infection of the foot, which is called beriberi or moisture in China. The main pathogens of this disease are Trichophyton rubrum, Trichophyton floccus, Trichophyton gypsum and Trichophyton rose. In addition, it is frequently reported by Candida albicans.

Athlete's foot is the most common pathogenic bacteria. Children and elderly patients are rare, which may be related to the lack of activity and dryness between the toes.

This germ is more common in the toes, especially the third toe seam. This is related to the skin in the above parts being in close contact, moist, not ventilated, and poor sweat evaporation. Athlete's foot skin lesions are generally divided into the following three types:

(1) Blister type: deep blister with large needles to millet can be seen between the toes and the soles of the feet. The blister wall is thick, scattered or densely distributed, and adjacent rashes can be fused to form larger blister. The blisters are naturally absorbed and turn into scales after drying.

(II) Interphalangeal erosion type: It is common in the interphalangeal region, and the affected area is wet and sweaty. The rash was impregnated at first, and the epidermis was damaged due to itching or rubbing, and finally turned into erosion and flushing. Can be accompanied by exudate often issued unpleasant stench.

(C) keratosis type: quite common, easy to invade the soles of the feet, the sides of the toes, and the heel. Skin lesions appear as scales, thickened horny, rough and hard, with cleft palate, which is especially severe every winter.

The above three types of skin lesions are often mixed at the same time, but they are mainly based on the kind of skin lesions, which is called this type of athlete's foot. For example, the blister type is marked by blisters, and a few erosions or scales can also be seen.

The disease is consciously itchy, especially the blister type and the interphalangeal erosion type. The onset of athlete's foot is related to the season. Often light in winter and heavy in summer. In the summer, secondary bacterial infections are prone to allergic reactions and cause ringworm fungus rash. At this time, it can be accompanied by systemic symptoms such as fever.

Five, ringworm (Tineamauns)

Tinea pedis is a superficial mycosis that occurs on the palm of the hand, and has the same performance as the "Liriodendron wind" of the motherland medicine. It can be primary, but most come from the athlete's foot itself. The pathogenic bacteria are the same as those of athlete's foot, and the clinical manifestations are similar to those of athlete's foot. Because the hand is exposed, the ventilation is much better than the foot, so the clinical fingerless erosion type appears, but only the blister type and keratosis type are seen. Occasionally, erosions occur, but they are often caused by Candida infections, not by dermatophytes.

Six, onychomycosis (Tineaunguium)

Onychomycosis is caused by a dermatophyte infection of the nail, commonly known as onychomycosis; if the lesion of the nail caused by non-dermatophyte is called onychomycosis. Onychomycosis is often confused with onychomycosis.

Onychomycosis lesions begin at the distal nail, lateral margin, or nail fold. Appears as abnormal nail color and morphology. It is mostly off-white and tarnished; the deck is significantly thickened and the surface is uneven. Its texture is loose and keratin and debris are often deposited under the nails. Sometimes the deck can be separated from the nail bed. In addition, a special type can be seen clinically, namely fungal white nails. This type of performance does not thicken, but a spot-like white turbidity occurs on the nail surface, and then gradually expands to the whole nail. The onset of onychomycosis is slow, and if untreated, it can last a lifetime. The clinical features of onychomycosis are thickened decks, horizontal grooves visible on the surface, and sometimes brown. Still shiny, but without sub-keratin and crumb deposits common to onychomycosis. At the same time, more often accompanied by paronychia, manifested as redness and swelling around the nail, and conscious pain and tenderness. Jiagou often has a little exudation, but no suppuration is seen. The pathogenic bacteria of this disease is Candida or Aspergillus, which requires a fungal culture to confirm.

Seven, tinea versicolor (Tineaversicolor)

Tinea versicolor has purple spots and white spots alternately, so Chinese medicine named Zibaidianfeng. In view of the rash of summer sweating rash, also commonly known as sweat spots. The disease is caused by Trichophyton versicolor, which is parasitic on the epidermis. The bacterium is lipophilic, and its previous culture often failed, but there are many reports of successful culture in China. It has also been suggested that from the perspective of fungal classification, the tinea versicolor should not belong to the category of fungi. Then, the skin disease caused by it should not be called ringworm, so it is recommended to change the name to pityriasis versicolor.

Tinea versicolor is common in the neck and chest and back. Sometimes, the proximal end of the upper limb is also affected. The basic damage is spot rash, which is as big as soybeans. The new rash is tan or tan, and the old lesions are grayish white. Traces of bran-like scales are attached to the surface of the lesion, and adjacent skin diagnoses can fuse into larger irregular lesions. Generally no conscious symptoms, occasionally a little itching when sweating.

8. Dermatophytides

Ringworm fungus rash refers to a rash that occurs in the rest of the body through the blood circulation of the fungus or its product, and is a kind of allergic reaction. The disease must have the following conditions: there is an active primary fungal lesion; a fungal negative is found at the lesion of ringworm fungus; the condition of ringworm fungus improves with the control of the primary active fungal lesion until it subsides; the ringworm test must be positive If negative, diagnosis of ringworm can also be ruled out.

Ringworm fungus rash can be divided into two types: generalized and localized. The former rash is a lichenoid rash, that is, symmetrical and disseminated pimples appear throughout the body, consistent with the hair follicles, about the size of the needle to the miliary; the latter type is mostly a vesicular rash that is characterized by bilateral palms There are scattered or clustered deep blistering on the face and the abdomen, ranging in size, the blister wall is not easy to rupture, and a few can develop into larger blister, such as soybeans larger than the size.

The disease consciously feels itchy and unbearable, especially the limitation type is more obvious. In addition, there may be other types of rash, such as erythema polymorpha, nodular erythema, etc. are rare.

Diagnosis and identification of ringworm

Superficial mycosis can be diagnosed generally based on history and clinical manifestations. If necessary, the following auxiliary inspections can be carried out:

First, fungal microscopy: Select a few scales or disease on the edge of the lesion. Place on a glass slide, add a drop of potassium hydroxide solution, and cover the glass. Then heat it on an alcohol lamp for a while to promote keratin dissolution. Finally, microscopic examination was performed. A positive fungal test can confirm the diagnosis, such as negative can not rule out the diagnosis of ringworm.

Fungal culture: The conventional medium is sabourauad medium. Scales, hair, or vesicles from the lesion are inoculated and cultured in a 25-30 ° C incubator. Colony growth can usually be seen in about 5 days, and strain identification can be performed subsequently. Negative cultures can be reported if they grow aseptically after three weeks of culture.

3. Filtered UV lamp inspection: This lamp, also known as a wood lamp, is a UV lamp that passes through a glass device containing nickel oxide. In the dark room, certain fungi can be seen, and colored fluorescent light is generated under the irradiation of filtered UV lamps. . This can provide an important reference for the diagnosis of superficial mycosis, especially tinea capitis, according to the presence of fluorescence and different colors. In addition, this light is helpful for group inspections such as nursery schools.

Superficial mycosis must be distinguished from many skin diseases.

First, tinea capitis should be distinguished from psoriasis, seborrheic dermatitis, and alopecia areata: Psoriasis is more common in adults and less common in children. In addition to head lesions, it is often involved in the trunk and limbs. The lesions were plaques with thick silvery white scales on the surface. The hair at the lesion is brush-like, but there is no pathological change in it, that is, no hair loss, hair loss, dryness, dryness and bending are seen. Beard, underarms, central torso, and pubic area. The rash is erythema, pimples, and oily scales on the surface. Spotless elephants and strange itching were found; alopecia areata, commonly known as "ghost shaving." Before the onset, there were many mental disorders, and the lesions showed a garden-like hair loss, with a clear state. There was no inflammatory reaction or scale in the hair loss area. No subjective itching. All the above-mentioned skin disease hair fungus tests were negative.

Second, ringworm must be distinguished from pityriasis rosea and psoriasis: pityriasis rosea occurs frequently on the trunk and near the extremities. The rash is widespread and symmetrically distributed, mainly as erythema. Balanced with bran-like scales on the surface. Fungal microscopy was negative; psoriasis was more common in winter and relieved in summer. Refer to the above for the content of the identification.

Third, jock itch should mainly be distinguished from neurodermatitis and chronic eczema: except for neurological rash and chronic eczema fungal tests, the two diseases have not seen damage to the edge slightly higher than adjacent normal skin, and there is no phenomenon of severe summer and mild winter .

Fourth, hand, foot and ringworm should be distinguished from eczema and sweat herpes: eczema often involves the back of the hands and feet and the extension of the fingers and toes, often symmetrically distributed. Acute rash is a pleomorphic lesion. Chronic patients often see obvious infiltration, which can be mossy, dark red, and the boundaries are generally clear. Sweat herpes occurs on the sides of the fingers and the edges of the palms, often with hyperhidrosis. The above disease fungal tests were negative.

Ringworm Treatment

First, systemic treatment

(1) Kefoconazole: This medicine is usually taken orally to replace griseofulvin. Ketoconazole is a synthetic broad-spectrum antifungal imidazole. Its antifungal mechanism is by inhibiting the synthesis of ergosterol, which is an important component of the fungal cell membrane, causing the fungal cell membrane to lose its normal function, causing the membrane's permeability to increase, and finally causing the fungus to denature and even die. According to clinical practice, this medicine has a good effect on superficial mycosis.

Indications: Mainly used for tinea capitis, followed by generalized systemic ringworm, severe jock itch, and onychomycosis.

Contraindications: Abnormal liver function, this drug is contraindicated in pregnant and lactating women.

Dosage: Adult, 200mg, once / day. Children weighing less than 20 kg, 50 mg, 1

Times / day; 20-40 kg, 100 mg, once / day; more than 40 kg can be taken as an adult dose.

(2) Other imidazole drugs: Itraconazole is 5-10 times more effective than ketoconazole. The minimum dose for treating dermatophyte is 100 mg per day.

Second, local treatment

Superficial mycosis that does not involve hair or deck can be effective with topical therapies, but requires patience and persists in applying the medicine for a long time. Two groups of drugs are commonly used.

(1) Unique medicine for external use: The special-effect drug Ketongling Potion can be used, and the affected area can be applied externally.

(B) Specific broad-spectrum antifungal agents: The most widely used family currently has a common imidazole ring, that is, imidazole drugs such as thioconazole (fioconazole), miconazole (oxiconazle) Econazole, ketoconazole, Bifonazole and clotrimazole (Iotrimazoie) are often made into 1-2% creams for clinical applications.

3. Specific treatment methods for various superficial mycosis

(A) Tinea capitis

China has summarized a good set of "five-character therapy", that is, taking (medicine), washing (head), tincture (medicine), treating (fat), and eliminating (toxic). Based on this experience, we can choose to take ketoconazole orally and take it for 4 weeks according to the above dosage; wash your hair daily during the treatment period; adhere to the appropriate antifungal ointment for nephew for 1 to 2 months; haircut once a week until cured ; The daily necessities of patients, such as hats, towels, pillow towels, combs, etc. must be disinfected regularly.

(Two) ringworm, jock itch, tinea pedis

It should be firmly believed that local treatment of this type of ringworm can be effective, but different types of ringworm drugs must be used according to different conditions and different skin lesions.

1. Ringworm medicine is complicated by infection, and the infection should be controlled first.

2. When the swelling and exudation at the lesion are obvious, 3% boric acid water or 0.02% furacin solution can be used for wet compressing, and the swelling and exudation can be reduced, and then an external medicine effective for treating ringworm is selected.

3. If the affected area shows erosion and a small amount of exudation, it must be transitioned to external use of Coptis chinensis Zinc Oxide Oil for 2 to 3 days before changing the appropriate ringworm ointment as appropriate.

4, when the lesions are keratotic scales, the ointment or cream is appropriate.

5. If there is cracking on the damaged area, avoid using tincture and external tincture, still choose ointment or cream.

6, rash mainly erythema, pimples, can choose tincture or ointment and cream.

7. For skin lesions on the face and inner thigh, it is forbidden to use high-concentration exfoliating agents to avoid irritation and dermatitis.

8. As long as the dosage form is selected correctly, it is advisable not to change external medicine frequently. Use each ointment for at least one week.

9. For those who are stubborn or have extensive skin lesions and are difficult to cure with local therapies, consider taking ketoconazole orally, 200 mg once daily for 4 weeks.

(Three) onychomycosis

In principle, the disease should also be treated locally, but due to the thick deck, general drugs are not easy to penetrate, so it can not be treated with ordinary ringworm treatment. Try to remove the deck before topical application, and then topical antifungal. The common methods are described as follows:

(1) Nail scraping method: Use a knife to scrape the brittle part of the sick nail as much as possible every day, and then apply 5% iodine tincture, 30% glacial acetic acid, or Wechsler's solution, and stick it 1 to 2 times a day until it is cured. .

(2) Method of dissolving nails: first protect the skin around the nails with adhesive tape, then apply 25-40% urea ointment on the deck, and finally cover with plastic film and fix with adhesive tape. Change the dressing every 2 days. When the deck softens and feels floating, remove the deck with tweezers. Then, change the dressing daily as usual. After the wound is healed, apply ringworm ointment externally until a good nail is developed.

If the above methods fail to treat or there are a large number of patients, you can also consider administering ketoconazole orally. The dose is the same as above, and it usually takes about six months to cure.

(D) Tinea versicolor

The disease is easy to cure, but it often recurs. Traditional medicine, such as 20-40% sodium thiosulfate solution, 2.5% selenium sulfide emulsion can be effective for external use. In addition, imidazole creams can also obtain satisfactory results.

(5) Ringworm fungus rash

Systemic treatment of this disease can be treated in accordance with the principle of treatment of allergic skin diseases; antifungal drugs are not required for local application, and it is especially forbidden to use ringworm drugs that are more irritating. You can use mild zinc oxide oil for external application or 3% boric acid water for wet application. In addition, active ringworm lesions must be actively treated.

Ringworm Fuling Decoction can treat acute scrotal eczema

1 The clinical data are all outpatient cases, 21 cases are married, 11 are unmarried, the oldest is 58 years old, the youngest is 17 years old, the longest course is 19 days, the shortest is 4 days. All of them meet the diagnostic criteria for acute eczema in the "Clinical Criteria for the Diagnosis and Improvement of Clinical Diseases" [1], which are characterized by sharp itching of the affected area and pleomorphic lesions, and dense erythema, pimples, blistering, erosion, exudation, and knotting., etc., the lesions were slightly swollen, the boundaries were unclear, and most of them were symmetrically distributed.
2 Treatment methods: Oral and external washing of Fuling Decoction, prescription composition: 20 grams of Poria, 15g of Sophora flavescens, 10g of Coriander seed, 20g of Coix chinensis, 15g of Scutellaria baicalensis, 10g of white fresh skin, 15g of gentian, 15g of Cork, 10g of Salvia Knee 10g. Take 1 dose daily, decoction twice, and wash the affected area with decoction. One week of continuous treatment is one course of treatment, and the efficacy is judged by one to two courses of treatment.
3 Observation of curative effect 3.1 The standard of curative effect is formulated according to the evaluation standard of curative effect of eczema in "Clinical Criteria for the Diagnosis and Improvement of Clinical Diseases" [1]. Cure: the rash subsided, leaving pigmentation and no itching; improvement: the rash and inflammation subsided significantly, and the itch was reduced; unhealed: no change in symptoms.
3.2 Treatment results 25 cases were cured, no recurrence was observed during one year follow-up, 5 cases improved, 2 cases failed, and the total effective rate was 94%. No toxic side effects were found during treatment. The longest course of treatment is 2 courses, and the shortest course is 1 course, with an average of 1.5 courses.
4 Typical case patient, male, 29 years old, came to the clinic on December 8, 1997. A rash of the scrotum was found 4 days ago, itching was unbearable, and the scope of the rash gradually expanded. He came to our hospital for treatment. Physical examination revealed dense erythema and pimples on the scrotum skin, basal flushing, mildly swollen lesions, unclear edges, and partial erosion and crusting. The body temperature was 36.7 ° C, the urine was normal, the tongue was red, the fur was yellow and greasy, and the veins were cramped. The card is a hot and humid bet, which is treated with Tufuling Decoction. Take 1 dose daily and 4 doses at once, and instruct to scrub the affected area with decoction of medicine residue. After 4 doses, the symptoms are greatly reduced. The original prescription continued with 5 doses, the rash subsided, it was not itchy, and there was a small amount of pigmentation. No recurrence was observed during one year of follow-up. ^[1]

Ringworm prevention

I. Make efforts to do a good job in health promotion and education, and popularize common sense and measures for the prevention and treatment of ringworm.

2. Actively treat patients with ringworm, especially tinea capitis and tinea pedis, to fully mobilize the masses and carry out mass prevention and treatment.

Pay attention to personal hygiene and not share daily life with patients