Microsporia: causes, clinical manifestations and treatment features. Microsporia (ringworm) of the skin and nails in children and adults - pathogens, routes of infection, symptoms, treatment and prevention, photo What is microsporia

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On the scalp There is usually a large and several small low-inflammatory foci with peeling, whitish “stumps” of hair, broken off at a height of 3-6 mm (up to 8 mm) above the skin level. The fragments of hair are surrounded by grayish-white sheaths consisting of many spores (the position characterizing microsporia - “large single foci with small spores” - has not lost its significance). Some of the broken hair may be covered with crusts. Characteristic is the location of the lesions at the edge of the scalp and their partial transition to smooth skin. Eyebrows and eyelashes may be affected. Thus, unlike trichophytosis, with microsporia the affected hair breaks off slightly higher, the fragments are surrounded by a sheath of many spores (unlike the small-spored trichophyton of the “ectotrix” type, microsporum spores are not arranged in chains, but lie in the form of a mosaic).

Lesions can be lubricated with Fitex solution - 2 times a day (morning and evening) without a bandage. After the symptoms disappear, treatment is continued for another 2 weeks. (not used in children under 2.5 years old; used with caution in older children).

It is effective to use “Zalain”, local dosage forms “Lamisil”, “Lamicon”, “Exifin” - 1% cream, gel, aqueous-alcohol solution, spray - 1-2 times a day for 1 week. Preparations based on imidazole derivatives are widely used. Dosage forms with clotrimazole (1-2% cream, ointment, solution, lotion) are applied 2 times a day for 3-4 weeks. (known under the names “Antifungol”, “Apokanda”, “Dermatin”, “Dignotrimazol”, “Yenamazol”, “Candibene”, “Candide”, “Canesten”, “Kansen”, “Clotrimazole”, “Lotrimin”, “Ovis” new", "Faktodin", "Fungizid-ratiopharm", "Funginal"). Good results were noted from 1% cream, lotion, aerosol “Pevaril” (apply 2-3 times a day, lightly rubbing). Lotion is preferable for the hairy parts of the body, aerosol is for prevention (course of treatment - 2-4 weeks). Ecodax and Ekalin creams are used in a similar way. Local preparations of miconazole are shown - “Daktarin” (2% cream, solution in a package with a solvent), “Daktanol” (2% cream), “Mikogel-KMP”, “Miconazole-cream” (2%), “Fungur” (2 % cream), which can be used for fungal-bacterial (Gr(+)) associations: the drugs are applied 2 times a day, rubbing until completely absorbed (2-6 weeks; after the symptoms disappear, treatment is continued for another 1-2 weeks). Apply 1% cream, "Mikospor" solution (1 r/day, rubbing in; course 2-3 weeks), "Bifonal-gel", "Bifunal-cream", creams - "Travogen" (1 r/day, 4 weeks .), “Mifungar” (1 r/day before bedtime, 3 weeks + another 1-2 weeks after recovery for the purpose of prevention), “Nizoral” (apply 1-2 r/day until symptoms disappear + a few more days; if ineffective within 4 weeks, the drug is discontinued). It is possible to use cream, gel, solution "Exoderil" (1-2 r/day for 2-4, up to 8 weeks), creams "Fetimin", "Loceril" (1-2 r/day, 2-3 weeks. ), cream, Batrafen solution (2 times a day, 2 weeks). Use 1% cream, lotion, paste "Tolmitsen" (2-3 r/day, until symptoms disappear + a few more weeks), "Hinofungin" and other tolnaftate preparations - 1% cream, gel, oil solution (2 r/day , 2-3, up to 4-8 weeks). A 5% ointment with mebetizol is recommended; this substance can also be taken orally in the form of capsules with an oil solution (V.P. Fedotov et al., 1998). Sometimes they use 2% cream, suspension drops “Pimafucin” (applied 1 to several times a day - until symptoms disappear + another 1 week). The use of drugs based on undecylenic acid and its salts remains important - ointments “Mikoseptin”, “Undecin”, “Zinkundan”, alcohol solution “Benucid” (also contains 2% benzoic acid); use 2 times a day, rubbing, course 2-6 weeks. A certain effect is achieved by treating the skin with surfactant-containing antiseptics - solutions “Antifungin”, “Gorosten” with decamethoxin (2-3 times a day, 2-3 weeks), 0.05-0.1% benzalkonium chloride, 0.02% benzethonium chloride, 0.1% octenidine, 0.004-0.015% dequalin, 0.05% cetylpyridinium chloride, 1-2% cetrimide, 0.5% alcohol or 1% aqueous solutions of chlorhexidine. Ointments containing substances from this group include Palisept (1-2 r/day), 0.5% miramistin, with 0.5-1% cetrimide. The use of local preparations with griseofulvin remains important, it is possible with the addition of 10-15% dimexide: 2.5% liniment is applied in a thin layer in a daily dose of no more than 30 g (until the disappearance of clinical symptoms and 3 negative results of microscopic examination + another 2 weeks) . V.F. Kravtsov, T.A. Kryzhanovskaya (1987) recommend applying a thin layer of BF-2 glue to the lesions and surrounding skin - 3 times with an interval of 10-15 minutes; after 10-12 hours, the film from the glue is removed with tweezers, the lesion is lubricated 2 times a day with a 5% solution of griseofulvin in 90% dimexide. A positive effect (antifungal, antimicrobial, regenerative) was noted from the drug "Uresultan"; the solution (0.25%, for children - 0.125%) is rubbed into the affected areas 2 times a day; if the gun is affected, use a solution with dimexide; the duration of treatment is 5-7 days, if the cannon is affected - 12-14 days (M.N. Maksudov, O.I. Kasymov, 2001).

Enhanced antimycotic activity different combination drugs with antifungal agents and components with other types of action - ointments 2% salicylic-20% sulfur-15% tar, "Sulfosalicin", "Wilkinson", "Clotrisal-KMP", emulsion "Psoralon", "Milk of Vidal", gel “Pantestin-Darnitsa”, etc. For single superficial lesions, the film-forming composition “Amosept” can be used (applied 3-5 times for 15-20 s, covering 1-2 cm of the surrounding skin; treatment is repeated 3-4 times / day ).

When the gun is hit(which can cause relapses) the following compositions are recommended: 1) salicylic acid 10.0, lactic acid 8.0, resorcinol 7.0, elastic collodion up to 100.0; applied 2 times a day for 3-4 days, after which 2% salicylic ointment is applied under a compress, followed by removal of the rejected areas of the stratum corneum. The procedures are carried out until the vellus hair is completely removed; 2) 5% griseofulvin plaster (griseofulvin 5.0, salicylic acid 2.0, birch tar 5.0, lead plaster 60.0, lanolin 22.0, wax 6.0); applied for 4-5 days, followed by manual hair removal of vellus hair, only 1-2 times. Treatment can be supplemented with griseofulvin liniment (griseofulvin 5.0, dimexide 20.0, lanolin 10.0, distilled water 65.0). The lesions are lubricated 2 times a day, the remaining scales are removed once every 7-10 days with 3-5% milk-salicylic collodion after preliminary shaving of the hair. The method is indicated for intolerance to griseofulvin orally, as well as together with it (M. Yatsukha, 1995).

Recommended use of drugs ketoconazole, especially nizoral (“Oronazole”, “Sostatin”, “Ketoconazole”) - 1 tablet orally. (200 mg), less often 2 tablets. (400 mg) per day or 7 mg kg/day with meals with a spoonful of vegetable oil (for children weighing 15-30 kg, "/2 tablets/day, for 4 weeks, for hair damage - 5- 8 weeks; no more than 200 mg/day).According to some data, nizoral at a dose of 5-7 mg/kg is less effective than griseofulvin and has serious side effects, but its use as an alternative method is justified in case of contraindications or impossibility of using Orungal , Itracona, Lamisil, Lamicon, Griseofulvin.

If the use of many drugs is contraindicated, the drug K-2 is recommended (crystalline iodine 5.0; thymol 2.0; birch tar 10.0; fish oil 15.0; chloroform 40.0; camphor alcohol 45.0). Before using it, the hair is shaved, the lesions with surrounding skin are lubricated 2 times a day. The drug causes excessive peeling, and therefore, once every 3 days, compress dressings at night with 3-5% salicylic ointment are recommended, followed by washing the scalp in the morning with warm water and soap.

Treatment is carried out under the control of a fluorescent lamp. At the final stages of therapy, for the purpose of prevention, antifungal powders are indicated - “Hinofungin”, “Batrafen”, “Iodoform”, “Aspersept”, “Galmanin”, “Dustundan”, with cyminal.
Possible damage to the nails (which rarely happens with microsporia) is an indication for the use of Orungal, Itracon, Lamisil, Lamicon, Griseofulvin, Diflucan; less often - Nizoral,

Criteria for curing microsporia

Microsporia is an infectious disease that occurs with damage to the skin and its appendages, caused by pathogenic fungi of the genus Microsporum. The first description of the causative agent of microsporia belongs to the Austro-Hungarian scientist Gruby (1843), who worked in Paris. Gruby's work was known, but the cause-and-effect relationship between the discovery of micromycetes and the development of a certain clinical picture was not considered established at that time. This happened much later, thanks to the work of the French dermatologist Sabouraud (1864 - 1938). Among diseases of mycotic etiology in humans, microsporia ranks second in prevalence after mycoses of the feet.

The incidence of microsporia in 2003 in the Russian Federation was 49 cases per 100,000 population (in 2002 - 50.8 cases). The maximum incidence was noted in the Kostroma region (115.6 cases per 100,000 population in 2003) and in the Komi-Permyak Autonomous Okrug (109.2 per 100,000 in 2003), the lowest in the Chukotka Autonomous Okrug (2.8 cases per 100,000 population in 2003).

Microsporia is one of the most common diseases of mycotic etiology in pediatric practice. In Russia, the incidence of microsporia per 100,000 children in 2002-2003 was 243.4 - 237.1. Microsporia was most often recorded in the Far Eastern Federal District (328.7-290.6), less often in the Ural Federal District (181.2-186.9).

Currently, 12 representatives of the genus Microsporum have been described using molecular biology methods: M. ferrugineum, M. audouinii, M. nanum, M.racemosum, M. gallinae, M.fulvum, M. cookei, M. gypseum, M. amazonicum, M. canis, M. persicolor, M. praecox. For clinicians, the following 4 species of fungi are of greatest importance: M. canis, M. audouinii, M. gypseum and M. ferrugineum. The pathogenicity factors of fungi of the genus Microsporum are keratinolytic enzymes.

Dermatomycetes are divided into 3 groups depending on the predominant habitat: geophilic fungi - living in the soil and rarely causing dermatomycosis; zoophilic, which are mainly pathogenic for animals, but can also infect humans; anthropophilic - causing disease in humans and very rarely in animals. Thus, the division is not strict.

The spread of predominantly zoophilic or anthropophilic pathogens determines the epidemiological features of the development of the infectious process. Thus, zooanthroponotic microsporia is not characterized by a chronic course, unlike microsporia caused by anthropophilic fungi.

M. canis is the most frequently registered pathogen of microsporia in Russia. It is one of the most widespread zoophilic fungi in the world, causing dermatophytosis in cats (especially kittens), dogs, monkeys, and less often in other animals.

M. audouinii is also a ubiquitous anthropophilic pathogen. There are descriptions of epidemic outbreaks in France.

M. gypseum is a geophilic, widespread pathogen. Can cause disease in humans, as well as in animals (there are descriptions of cases of the disease in cats, dogs, rodents and horses).

M. ferrugineum is an anthropophilic pathogen distributed in Asia (China, Japan), Eastern Europe, Central and Eastern Africa.

Anthropophilic pathogens (M. ferrugineum and M. audouinii) are transmitted directly from person to person or through household items. Mycosis caused by M. canis is most often transmitted from animals, less often - from person to person or household objects.

M. gypseum is a soil saprophyte and in most cases, the disease in humans occurs after contact with soil or, less commonly, with infected animals.

The most common pathogen of microsporia in Russia is the zoophilic fungus Microsporum canis, the second most common is the anthropophilic fungus Microsporum ferrugineum. Much less frequently, the disease is caused by the geophilic fungus Microsporum gypseum.

There are certain trends in changes in the etiological structure of microsporia during the twentieth century. Until the mid-twentieth century, the predominantly registered pathogens in Europe and in a number of regions of Russia were anthropophilic fungi (Microsporum ferrugineum). Since the early 60s, the zoophilic fungus Microsporum canis has become the main causative agent of microsporia in Russia.

According to I.M. Korsunskaya, O.B. Tarmazova microsporia of the scalp, caused by Microsporum canis, as in Russia, is the most commonly isolated fungus of the genus Microsporum in children in Europe, the USA, South America, Japan, Israel, and a number of Arab countries. At the same time, according to some data, the dominant pathogen of microsporia in the USA and Western Europe is Microsporum audouinii. It is believed that microsporia caused by Microsporum audouinii more often takes a chronic course compared to microsporia caused by Microsporum canis.

When smooth skin is damaged, a hyperemic, somewhat swollen, flaky spot appears, where small vesicles and microcrusts can be located. Along the periphery of the skin lesion, as a rule, there is a hyperemic ridge consisting of papular elements, delimiting the lesion, which takes a ring-shaped form (Fig. 1). Sometimes a new lesion appears inside the ring, resulting in the formation of an “ring within a ring” (“iris”).

When the scalp is affected, the clinical picture may vary depending on the etiological agent causing the disease. If the causative agent is a zoophilic fungus, the number of lesions is usually small (1-2), the lesions are large, usually round in shape, clearly defined, the hair in the lesions is broken off at approximately the same height (5-8mm), there is abundant mealy peeling. When infected by anthropophilic fungi, several small round patches of hair thinning with profuse peeling develop.

Diagnosis of microsporia should include: 1) assessment of the clinical picture of the disease; 2) mandatory full-fledged mycological examination (including KOH test and cultural examination - inoculation on Sabouraud's medium); 3) in case of damage to the scalp, eyelashes, eyebrows and vellus hair, nails - examination under a Wood lamp. A Wood's lamp is a source of ultraviolet rays that pass through glass impregnated with nickel oxide. It was first used in dermatological practice in 1925. Margarot and Deveze. Wood's lamp examination should be carried out in a completely darkened room. External use of iodine tincture, aniline dyes, and various ointments by the patient may complicate the study. There are descriptions of non-fluorescent variants of M. canis, M. audonii, M. gypseum.

Fungi of the genus Microsporum infect only growing hair (in the anagen phase), forming an irregular mosaic of small spores outside the hair shaft (ectothrix-type hair damage).

A rare etiological factor that causes microsporia of the scalp in some cases makes it difficult to make a correct clinical diagnosis. Here is our observation:

A 4-year-old girl was treated for 1.5 months at the hospital at her place of residence for seborrheic dermatitis. During a microscopic examination of skin scales and hair, no fungi were found. When contacting the consultative and diagnostic department of the Research Institute of Medical Sciences. mycology SPbMAPO in the scalp there was a focus of pronounced peeling with a rim of hyperemia along the border with a diameter of up to 2 cm, the hair in it was preserved and sparse. There was no glow under Wood's lamp. In a one-time study, microscopy of skin scales and hair did not reveal fungi, and no culture growth was obtained. In a repeated mycological study, no fungi were found during microscopy; A cultural study revealed the growth of Microsporum gypseum. A clinical diagnosis was made: Microsporia of the scalp caused by Microsporum gypseum. As a result of therapy with griseofulvin, a cure was achieved (Fig. 2).

In this observation, the difficulties in the differential diagnosis of mycosis of the scalp were due to a rare geophilic pathogen, the absence of a characteristic glow under a Wood's lamp, and the negative result of microscopy of skin scales and hair. Only repeated culture examination of the skin and hair made it possible to make an accurate diagnosis.

The rare location of the mycotic process also makes it difficult to make a correct diagnosis.

Damage to eyelashes due to microsporia is extremely rare. Therefore, we considered it possible to present our own observation.

Patient K., 31 years old, applied to the consultative and diagnostic department of the Research Institute of Medical Mycology in July 2004, complaining of increased loss of eyelashes on the upper eyelid of the right eye. Considers himself sick for six months. In February 2004, I was in Thailand, after which my eyelid skin began to itch and my eyelashes began to fall out. For the last three months I have been treated by an ophthalmologist without any effect. She did not consult a dermatologist due to the absence of lesions on the skin. On examination, the eyelashes on the upper eyelid of the right eye are partially absent; a characteristic emerald glow is observed under a Wood's lamp. Microscopy revealed damage to the eyelashes by fungal spores of the ectothrix type, and when inoculated on Sabouraud's medium, growth of a M. canis culture was detected. The source of infection has not been established. As a result of therapy with griseofulvin and external use of Dermgel Lamisil®, recovery was achieved (Fig. 3).

A peculiarity of this clinical observation was the absence of other manifestations of the disease, which made it difficult to make a timely correct diagnosis.

Onychomycosis caused by fungi of the genus Microsporum is characterized by damage to single nail plates, usually occurring after injury. Examination of the nail plates under a Wood's lamp helps to establish the correct diagnosis.

There are acute and chronic forms of microsporia. According to the depth of skin damage - superficial and infiltrative-suppurative forms. In the literature of recent years, there has been a tendency towards increased registration of infiltrative-suppurative forms of microsporia. As the reasons for the increased registration of atypical forms, the authors point to the presence of changes in the immune status of patients and the disruption of the nature of the immune response to antigens of fungal pathogens, and not to an increase in the pathogenicity factors of infectious agents.

The maximum peak incidence of microsporia caused by M. canis occurs in late summer - early autumn. The increase in the incidence of microsporia is facilitated by the increase in homeless animals; violation of rules for keeping pets; sale and purchase of animals without a veterinarian's opinion on their state of health.

Differential diagnosis of microsporia of smooth skin is carried out with pink zhibert, seborrheic dermatitis, atopic dermatitis, ring-shaped erythema, Lyme disease (in the stage of chronic migratory erythema). Microsporia of the scalp is differentiated from seborrheic dermatitis, atopic dermatitis, psoriasis of the scalp, alopecia areata, folliculitis and pseudopelade.

In case of infection of smooth skin by fungi of the genus Microsporum, it is sufficient to treat only with external antifungal agents. If skin appendages (hair and nails) are involved in the pathological process, it is necessary to add systemic drugs. The duration of therapy for microsporia is significantly influenced by the presence of concomitant somatic pathology - helminthic, protozoal infestation, immunodeficiency state.

The most commonly used systemic antifungals are griseofulvin and terbinafine. Griseofulvin, isolated from the mold Penicillium griseofulvum in 1938, has been widely used in clinical practice since 1958. When treating microsporia of the scalp in children, the drug is prescribed at the rate of 22 mg/kg of the child’s weight - a daily dose, in three doses daily, until the first negative test for fungi, then every other day for two weeks and 2 times a week for the next two weeks Microionized griseofulvin used abroad for mycoses of the scalp is used at a rate of 20 mg/kg per day for 6 weeks.

Terbinafine orally can be used in pediatric practice starting from 2 years of age. If the child’s weight exceeds 40 kg, the daily dose of terbinafine corresponds to 250 mg (i.e., the drug is prescribed in the same dose as for an adult), if the child weighs from 20 to 40 kg, the daily dose of the drug is 125 mg, if the child weighs less than 20 kg The daily dose of terbinafine is 62.5 mg.

Although there are separate publications in the domestic literature about the successful treatment of microsporia with itraconazole, officially in the Russian Federation this drug is approved for use only from the age of 12. Abroad, itraconazole in pediatric practice is prescribed in a daily dose of 5 mg per kg of child weight.

Fluconazole for the treatment of mycoses of the scalp is prescribed at the rate of 6 mg per kg per day for 2-3 weeks. Zaitseva Y.S. et al (2005) reported the successful use of fluconazole for microsporia in the pulse therapy regimen of 100 mg per week for 6 weeks.

External therapy for microsporia of the scalp before the advent of general antifungal drugs presented significant difficulties, since the methods used for hair removal (x-ray epilation, hair removal using thallium acetate, epilin patch, Sobolev-Sachs method) were traumatic for the patient and were often accompanied by general toxicity. reactions led to the development of persistent cicatricial atrophy.

Currently, the range of agents used for external therapy of microsporia is very wide: this includes traditional iodine tincture, sulfur-tar, sulfur-salicylic ointments, and ready-made dosage forms. Of the latter, the most commonly used are azole drugs (clotrimazole, ketoconazole, bifonazole, isoconazole, miconazole) and allylamines (naftifine, terbinafine).

An advantageous difference between the original external preparation of terbinafine - Lamisil® (Novartis Consumer Health, Switzerland) is the choice of different dosage forms: this product is available in the form of Dermgel, Spray and 1% Cream. To the important

The advantages of terbinafine include the presence of not only antifungal activity, but also the antibacterial and anti-inflammatory effect of Lamisil®. This fact is of particular interest in the treatment of complicated (infiltrative-suppurative) forms of microsporia. Various dosage forms of Lamisil® can be used for various localizations of the skin process. Thus, Lamisil® spray is more appropriate to use for microsporia of the scalp, damage to large areas of the body, and hard-to-reach places. Lamisil® Dermgel can be applied to the skin of the torso and limbs, as well as to the area of ​​folds. It is most advisable to use this form in cases of severe inflammation, accompanied by weeping and vesiculation. Lamisil® cream is preferable to use in the presence of hyperkeratosis and severe dryness.

The study of issues of etiology, epidemiology, and rational approaches to the treatment of microsporia does not lose its relevance and requires further research in order to develop optimal methods for diagnosing and treating this widespread disease.

Bibliography

Clinical forms of anthropophilic microsporia

Differential diagnosis of anthropophilic microsporia

Microsporia zooanthropophilic

Etiology and pathogenesis of zooanthropophilic microsporia

Clinical forms of zooanthropophilic microsporia

Differential diagnosis of zooanthropophilic microsporia

Diagnosis of zooanthropophilic microsporia

Treatment (trichophytia, microsporia)

Prevention (trichopytosis, microsporia, favus)

Among highly contagious dermatological pathologies, one of the leading places is occupied by microsporia or, as is commonly called, ringworm. It is caused by pathogenic fungi from the genus Microsporum.

Depending on their type, the disease manifests itself as flaky spots on smooth skin, bald spots in the hair on the head, or dull whitish circles on the nail plates.

What is microsporia?

Popularly, microsporia is often called ringworm, since in the affected areas the broken hairs resemble a “brush” - a short haircut.

Microsporia is a type of ringworm.

Now the term “ringworm” refers to two diseases at once - microsporia itself and trichophytosis. The first is caused by fungi of the Microsporum species, the second by fungi of the Trichophyton species, but both of them belong to the same genus and have similar pathogenesis and clinical manifestations.

How is microsporia transmitted?

The disease is transmitted exclusively through household contact - either from a sick person or animal, or through household items that have become infected with fungal spores.

The specific mechanism of infection depends on the type of pathogen. There are three of them:

• zoophilic – carriers are domestic and stray animals;
• anthropophilic – the source of infection is a sick person;
• geophilic - contact with soil containing the mycelium of the fungus or contaminated with its spores.

However, even if it gets on the skin, the fungus does not always cause microsporia. It can simply be washed off with water during hygiene procedures or destroyed by the immune system.

Provoking factors contributing to the development of the disease are:

• the presence of microtraumas, diaper rash, calluses or abrasions on the skin - “entry gates” for fungus;
• weakened immune system;
• dry skin and imbalance of its microflora.

The combination of such conditions allows the fungus to penetrate the skin and begin to actively multiply there.

Microsporia in children

According to statistics, children get ringworm more often than adults. And this is quite understandable. They have more contact with pets. And their sebaceous glands do not yet produce some organic acids that can neutralize the pathogenic fungus. But in all other respects, microsporia in children is no different from a similar pathology in adults.

Types of microsporia

Ringworm is classified according to several criteria. Depending on the location of the pathological process, the lesion is distinguished:

• smooth skin;
• scalp;
• nail plates.

Depending on the source of infection, the following types of fungi are distinguished:

• zoonotic (infection is transmitted through human contact with animals);
• antoponotic (infection is transmitted from person to person);
• geophilic (contact with contaminated soil).

According to the nature of the pathological process:

• superficial form (the lesion does not affect the deep layers of the skin);
• exudative form (liquid emerges from spots on the skin - the result of an inflammatory reaction in the tissues);
• infiltrative-suppurative form (inflammation affects the deep layers of the skin, the affected areas swell and become dense, and pus begins to protrude from the lesion due to the addition of a secondary bacterial infection).

With weakened immunity, long-term microsporia often takes on a chronic form.

Basic and specific manifestations of microsporia

The incubation period of the disease varies greatly, and this period directly depends on the type of pathogen. When infected with a zoophilic or geophilic variety, it is 5-14 days, and with an anthropophilic one - 1-1.5 months.

Despite the fact that microsporia can be caused by different types of fungi, the clinical picture for all forms of the disease is almost the same.

The main symptom is red spots of round or oval shape, which gradually turn pink and become covered with whitish scales. Each such lesion is surrounded by a kind of cushion, which seems to fence it off from healthy areas of the skin. Over time, a new spot may form inside it, and then the affected area becomes similar to a target.

The spots gradually grow in diameter. If there are several lesions nearby, they may merge, forming one large scaly spot. Itching and discomfort most often do not bother patients.

Deterioration of the general condition during microsporia, increased body temperature, and enlarged regional lymph nodes are characteristic only of the infiltrative-suppurative form of the disease.

Microsporia of smooth skin

The disease occurs in a superficial form, mainly on the face, neck or shoulders, 1-3 round red spots with clear boundaries appear. After a few days, they form a border in the form of a dense roller. The spots may increase in size, and if they are located close to each other, they may merge.

The rash does not cause subjective sensations; only occasionally patients may complain of mild itching. As the disease progresses, the lesions turn pale, become pink, and their middle is covered with whitish scales. If infection is repeated, a new spot may form in the center of the area surrounded by the cushion. Then the source takes on the appearance of a target.

Features of the course of the disease in patients of different categories

• Small children. The pathology occurs in an erythematous-edematous form. Red spots swell, become inflamed, but practically do not peel off.
• Persons suffering. Microsporia spots are heavily infiltrated as a result of the inflammatory reaction. The skin in the affected area thickens and becomes dense. A pigmentation disorder may even occur in this area.
• Women prone to hirsutism(excessive hair growth). Pathology can affect the deep layers of the skin. Externally, the lesions look like dense red nodes measuring 2-3 cm.

Microsporia of the scalp

Most often, this form of microsporia occurs in children. This is due to the fact that hair follicles in adults produce acids that can inactivate the fungus.

Clinically, the disease manifests itself as bald spots on the head in the hair. They have a clear border, but sometimes small areas of secondary damage can form nearby.

Initially, a small spot forms on the head, which begins to peel off. If you look closely, you will notice that all the hairs at the root are wrapped in scales in the form of a cuff. After just a few days, the fungus penetrates every hair in the outbreak, as a result of which they become dull and easily break off. A flaky “brush” forms in the affected area. The skin underneath is inflamed and covered with gray scales.

In addition to the classic picture of microsporia, sometimes there are more rare forms of the disease, which are characterized by a rather severe course.

• Infiltrative form. As a result of the inflammatory reaction, the spot turns red, swells and rises sharply above healthy skin.
• Suppurative form. The lesion acquires a bluish-purple hue, and small pustules—vesicles with purulent contents—form on its surface.
• Exudative form. The spots are hyperemic and swollen. On the surface, due to the secretion of serous fluid (exudate), which literally glues the scales together, a hard, thick crust is formed.
• Trichophytoid form. Many small foci of microsporia form on the scalp. They peel slightly and do not have clear boundaries.
• Seborrheic form. Its difference is the thinning of hair in the affected area, and not the formation of a short “brush” with clearly defined boundaries. You can see the fragments of hairs only by removing the yellowish crusts in the hearth.

All these forms of microsporia occur with changes in the general condition of the patient - increased body temperature, enlarged lymph nodes, pain and itching in the affected areas.

Microsporia of nails

It is a rare type of disease. Lesions include the nail plates and possible damage to the skin of the palms and soles. There will be a crescent-shaped spot next to the nail in the growth zone. In this place, the nail plastic becomes soft and fragile, and over time it simply collapses.

Anthroponotic form of microsporia

This is a form of the disease that is only transmitted from an infected person. When smooth skin is affected, round red spots appear. They are always covered with scales, and along the edge are limited by an inflammatory ridge.

Foci of microsporia of the scalp are most often located at the border of hair growth. That is, one half of the spot covers smooth skin, and the other is in the hairy part. The affected areas are very small, flaky, with broken hairs. But they are very prone to merging and often form a large, irregularly shaped spot.

Zoonotic and geophilic forms

The rash on smooth skin appears in the form of multiple small spots with clear boundaries. They are covered with whitish scales. Over time, their diameter increases, and a new one forms inside the old lesion, which has already turned pale.

The spots take on the appearance of a ring within a ring, which is the main distinguishing feature of microsporia from other lichens.

The lesions in the scalp are large in size and have clear boundaries. In their center, all the hairs are broken off, and the “brush” is covered with a kind of white “cover” consisting of fungal spores.

How is microsporia diagnosed?

Making a diagnosis is usually not difficult. The patient's examination consists of a visual examination of the lesion using a Wood's fluorescent lamp and several laboratory tests. In its light, the affected areas take on a bright green hue.

An additional diagnostic method is to scrape scales from smooth skin and collect broken hairs from the lesion located on the head in the hair. Under a microscope, filaments of mycelium will be visible on the scales, and fungal spores on the hairs.

After these two studies, a culture seeding is carried out, which helps to clarify the type of fungus and select the most effective drugs. However, this diagnostic method is used infrequently, since the growth of a fungal colony takes time, at least several days.

Basic principles of treatment

In the fight against microsporia, drugs can be used, both for external use and for oral administration. Which treatment regimen is preferred depends on the degree of skin damage.

If the hairs are not affected, microsporia spots are simply lubricated with ointments, creams or sprays until they disappear. These are mainly drugs with terbinafine (for example, Lamisil, Terbizil), as well as ointments containing sulfur, salicylic acid or tar.

If hairs are involved in the pathological process, experts recommend combining the use of external antifungal agents with oral medications - Griseofulvin, Terbinafine, Itraconazole or their analogues.

If a secondary infection has joined the pathological process, it is best to use combination drugs for external use, which contain not only antifungal, but also hormonal components.

During the course of therapy, the patient must strictly observe the rules of personal hygiene and use certain household items. His things must be washed in water with a temperature of at least 600C. This is quite enough to destroy the fungus and its spores. All surfaces with which the patient has been in contact must be wiped with a disinfectant, and hygiene items must be boiled (if possible).

Features of the treatment of microsporia of the scalp

Therapy for this form of microsporia is only complex. At the same time, external and oral antimycotic drugs are used.

For oral administration, experts prescribe Griseofulvin, Tarbinafine, Itraconazole and other tablets. In addition, all lesions must be lubricated with antifungal agents twice a day. If there is inflammation on the skin, then treatment is carried out with hormonal ointment, since it has a powerful anti-inflammatory effect.

Before you start using an antifungal drug for external use, you must shave off all broken hairs in the affected area. Subsequently, this should be done at least twice a week until the course of therapy ends. When washing your hair during the treatment period, you should use shampoos with an antifungal component or tar soap.

Features of drug therapy in children

The treatment regimen for microsporia in a child is similar to that for an adult. But the choice of oral drugs is very limited due to their rather high toxicity.

Experts often opt for Terbinafine and other drugs that contain it (Lamisil, Terbizil, etc.). If necessary, they can additionally prescribe hepatoprotectors - medications that protect the liver from the effects of various toxic substances. External preparations to combat ringworm are the same as for adults.

Basic preventive measures

Prevention of microsporia, first of all, consists of regular examination of children, teaching them the rules of personal hygiene and limiting contact with stray animals. Such measures contribute to the timely detection of cases of ringworm and the prevention of further spread of the disease.

All persons who live with a sick family member should be examined using a Wood's lamp, and animals in the house should be vaccinated twice with a vaccine against dermatomycosis.

Microsporia is a pathology whose treatment lasts several weeks. Strict adherence to personal hygiene rules is required throughout the entire period. Pets are often the culprit of trouble. However, you should not scold your child for paying too much attention to the animal or urgently get rid of the pet. Patience, attention and proper treatment will help defeat the disease.

The most commonly isolated pathogens of microsporia are the fungi Microsporum canis, which are among the most widespread zoophilic fungi in the world, causing dermatophytes in cats (especially kittens), dogs, rabbits, guinea pigs, hamsters, and in more rare cases - in monkeys, tigers, lions , wild and domestic pigs, horses, sheep, silver foxes, rabbits, rats, mice, hamsters, guinea pigs and other small rodents, as well as poultry. Infection occurs mainly through contact with sick animals or through objects contaminated with their fur.

Infection between humans and humans is extremely rare, occurring on average in 2% of cases.

Microsporum audouinii is a common anthropophilic pathogen that can cause damage to the scalp and, less commonly, smooth skin in humans. Children get sick more often. The pathogen is transmitted only from a sick person to a healthy person directly through contact or indirectly through contaminated care and household items.

Microsporia is characterized by seasonality. Peaks in the detection of microsporia are observed in May-June and September-November. Various endogenous factors can contribute to the occurrence of the disease: sweat chemistry, the state of the endocrine and immune systems. In addition, children have insufficient density and compactness of the keratin of epidermal cells and hair, which also contributes to the introduction and development of fungi of the genus Microsporum.

Microsporia is a disease that is the most highly contagious of the entire group of dermatophytosis. Mostly children, often newborns, are affected. Adults get sick less often, while the disease is often registered in young women. The rarity of microsporia in adults is associated with the presence of fungistatic organic acids (in particular, uncylenic acid) in the skin and its appendages.

In recent years, there has been an increase in the number of patients with chronic mycosis against the background of severe systemic lesions - lupus erythematosus, chronic glomerulonephritis, immunodeficiency states, and intoxications.

• microsporia caused by anthropophilic fungi Microsporum audouinii, M. ferrugineum;
• microsporia caused by zoophilic fungi M. canis, M. distortum;
• microsporia caused by geophilic fungi M. gypseum, M. nanum.

According to the depth of the lesion there are:

• superficial microsporia of the scalp;
• superficial microsporia of smooth skin (with damage to vellus hair, without damage to vellus hair);
• deep suppurative microsporia.

Microsporum canis affects hair, smooth skin, and very rarely nails; foci of the disease can be located on both open and closed parts of the body. The incubation period of the disease is 5-7 days.

Microsporia of smooth skin

On smooth skin, the lesions look like swollen, raised erythematous spots with clear boundaries, round or oval outlines, covered with grayish scales. Gradually, the spots increase in diameter, and a raised ridge, covered with blisters and serous crusts, forms along their periphery.

In the central part of the lesion, inflammatory phenomena resolve over time, as a result of which it acquires a pale pink color with pityriasis-like peeling on the surface, which gives the lesion the appearance of a ring. As a result of autoinoculation of the pathogen and repeated inflammation, iris-like figures “ring in a ring” appear, which are more common in anthroponotic microsporia. The diameter of the lesions is usually from 0.5 to 3 cm, and the number is from 1 to 3; in rare cases, multiple rashes are noted. The location can be any, but most often it is the face, torso and upper limbs.

In 80-85% of patients, vellus hair is involved in the infectious process. The eyebrows, eyelids and eyelashes may be affected. With microsporia of smooth skin, there are no subjective sensations; sometimes patients may be bothered by moderate itching.

Atypical forms of smooth skin microsporia

Erased form form	Hypopigmented form	Erythematous-edematous form
Papular-squamous form	Follicular nodular form With microsporia of the scalp, the lesions are most often located in the occipital, parietal and temporal regions. In the initial period of the disease, a focus of peeling appears at the site of introduction of the pathogenic fungus. Subsequently, the formation of one or two large lesions of round or oval shape with clear boundaries, measuring from 3 to 5 cm in diameter, and several small lesions - screenings, ranging in size from 0.3-1.5 cm, are characteristic. Hair in the lesions is broken off and protrudes above the level skin by 4-5 mm. Atypical forms of microsporia of the scalp Along with the typical clinical symptoms of zooanthroponotic microsporia, atypical variants have often been observed in recent years. These include infiltrative, suppurative (deep), rosacea-like, psoriasiform and seboroid (proceeding like asbestos-like lichen), trichophytoid, exudative forms, as well as a “transformed” version of microsporia (with a modification of the clinical picture as a result of the use of topical corticosteroids). Infiltrative form Deep form Psoriasiform Seboroid form Trichophytoid form Exudative form At infiltrative form of microsporia the lesion on the scalp rises somewhat above the surrounding skin, is hyperemic, and the hair is often broken off at a level of 3-4 mm. The cap of fungal spores at the root of broken hair is weakly expressed. In the infiltrative-suppurative form of microsporia, the lesion usually rises significantly above the surface of the skin due to pronounced infiltration and the formation of pustules. When pressing on the affected area, pus is released through the follicular openings. sparse hair is glued together with purulent and purulent-hemorrhagic crusts. Crusts and melted hair are easily removed, exposing the gaping mouths of the hair follicles, from which, like a honeycomb, light yellow pus is released. The infiltrative-suppurative form is more common than other atypical forms, sometimes occurs in the form of kerion of Celsus - inflammation of the hair follicles, suppuration and the formation of deep painful nodes. Due to the absorption of fungal decay products and the associated secondary infection, intoxication of the patient’s body is observed, which is manifested by malaise, headaches, feverish state, enlargement and soreness of regional lymph nodes. The formation of infiltrative and suppurative forms of microsporia is facilitated by irrational (usually local) therapy, serious concomitant diseases, as well as late seeking medical help. Exudative form of microsporia characterized by severe hyperemia and swelling, with small bubbles located against this background. Due to the constant impregnation of the scales with serous exudate and gluing them together, dense crusts are formed, which, when removed, exposes the moist, eroded surface of the lesion. At trichophytoid form of microsporia the lesion process can cover the entire surface of the scalp. The lesions are numerous, small, with weak pityriasis-like peeling. The boundaries of the lesions are unclear, there are no acute inflammatory phenomena. This form of mycosis can acquire a chronic, sluggish course, lasting from 4-6 months to 2 years. The hair is thin or there are areas of patchy baldness. At seborrheic form of microsporia The scalp is characterized mainly by sparse hair. The areas of discharge are abundantly covered with yellowish scales, upon removal of which a small amount of broken hair can be found. Inflammatory phenomena in the lesions are minimal, the boundaries of the lesion are unclear. The diagnosis of microsporia is based on the clinical picture and the results of laboratory and instrumental studies: microscopic examination for fungi (at least 5 times); inspection under a fluorescent filter (Wood's lamp) (at least 5 times); cultural research to identify the type of pathogen in order to properly carry out anti-epidemic measures; When prescribing systemic antimycotic drugs, it is necessary to: general clinical blood test (once every 10 days); general clinical urine analysis (once every 10 days); biochemical examination of blood serum (before the start of treatment and after 3-4 weeks) (ALT, AST, total bilirubin). Mycoscopic examination for fungi Wood's lamp examination Dermatoscopy Typical trichoscopic appearance of mycosis of the scalp: comma-shaped hair (blue arrow), corkscrew hair (white arrow), i-shaped hair (green arrow), Morse code hair (gray arrow), and zigzag hair (red arrow). Mycosis of the scalp - comma-shaped hair Alopecia areata - exclamation point hair and yellow dots Trichotillomania - normal hair and blackheads Cultural examination The growth of the fungal culture occurs on the 3rd day in the form of a barely noticeable whitish fluff (formation of aerial mycelium); a formed colony is formed on the 23-25th day. Mature colonies are fluffy, round, opaque, dense in consistency, grayish-white in color with closely spaced radial grooves. The reverse side of the colony becomes orange-yellow-brown in color with age. Microsporia of smooth skin the maternal plaque is easily confused with elements of dermatophytosis of the trunk, but unlike them, the edge of the plaque with lichen rosea is not raised Diagnosis is facilitated by the subsequent appearance of multiple rashes peeling appears late and is localized in the center of the rash; dermatophytosis, on the contrary, is characterized by peeling along the periphery papules and nodes merge, forming rings and semirings elements are often purple rather than red no peeling plaques are ring-shaped, but there is no clearing in the center the edge is not raised Usually there are crusts on the plaques, there is no peeling may have a history of diffuse neurodermatitis red papules or plaques, usually without clearing in the center the scales are large (with dermatophytosis of the trunk they are smaller) scraping off the scales results in the appearance of pinpoint drops of blood (Auspitz's sign) Lipoid necrobiosis differs from mycosis of smooth skin in the absence of obvious signs of inflammation and ruptures in the peripheral ridge. It is necessary to do research on mushrooms Bowen's disease (torpid course of the disease) the ring-shaped element in mycosis of smooth skin has a flaky intermittent ridge without a central point at the site of the attached tick no peeling often dark color rapid growth of rashes Lichen planus (purple polygonal papules or plaques) seborrheic zones yellow crusts night itching scabies phenomenon of yellow dust particles during diascopy Predominant localization on the inner surface of the shoulders and forearms, lateral surfaces of the body, on the chest near the nipples, in the popliteal fossae when scraping a smooth papule, pityriasis-like peeling is revealed - a symptom of hidden peeling or scale - a symptom of a wafer Pellagra Subacute cutaneous lupus erythematosus the elements are covered with a thick crust, there is no peeling, the skin around them is red and dense to the touch there is no enlightenment in the center Microsporia of the scalp Superficial form of trichophytosis of the pilar part The scalp is characterized by small scaly lesions of round or irregular shape with very mild inflammation and some hair thinning. The lesions are characterized by the presence of short gray hair broken off 1-3 mm above the skin level. Sometimes the hair breaks off above the skin level and looks like so-called “black dots”. In the differential diagnosis of microsporia, attention is paid to highly broken hair, with muff-like sheaths covering the hair fragments, and asbestos-like peeling. Of decisive importance in diagnosis is emerald fluorescence in the rays of a Wood's lamp of affected hair, detection of elements of a pathogenic fungus and isolation of the pathogen during cultural examination. For Psoriasis of the scalp is more characterized by clear boundaries, dry lesions, silvery scales, and the absence of muff-like layers of scales on the affected hair. round or oval patches of baldness without peeling, inflammation and blackheads often there are pinpoint depressions on the nails patches of baldness without clear boundaries are often observed; within the lesion the hairs have different lengths Petechiae and bloody crusts may be visible on the scalp where the patient’s hair was pulled out. no peeling or blackheads family members can talk about the child’s manipulations with hair (not always) Bacterial folliculitis no baldness or flaking p culture positive for Staphylococcus aureus in culture of scrapings and hair fragments obtained from a patient with dermatophytosis of the scalp, colonies of Staphylococcus aureus are often found (although the pustules themselves may be sterile) Bacterial abscess the likelihood of baldness is lower than with kerion no peeling Culture of abscess contents often reveals Staphylococcus aureus or other bacteria Traction (traumatic) alopecia strong tension on the hair can lead to its pulling out, leaving areas of baldness in the areas where it grew There may be signs of folliculitis, but there is no peeling or blackheads From the anamnesis it often turns out that patients tightly braid their hair or pull it into a ponytail; hair becomes sparse in peripheral areas General notes on therapy For microsporia of smooth skin (less than 3 lesions) without damage to vellus hair, external antimycotic agents are used. Indications for the use of systemic antimycotic drugs are: multifocal microsporia of smooth skin (3 or more lesions); microsporia with damage to vellus hair. Treatment of these forms is based on a combination of systemic and local antimycotic drugs. Hair in the affected areas is shaved once every 5-7 days or epilated. Indications for hospitalization lack of effect from outpatient treatment; infiltrative-suppurative form of microsporia; multiple lesions with damage to vellus hair; severe concomitant pathology; microsporia of the scalp; according to epidemiological indications: patients from organized groups in the absence of the possibility of isolating them from healthy individuals (for example, in the presence of microsporia in persons living in boarding schools, orphanages, dormitories, children from large and asocial families). Requirements for treatment results resolution of clinical manifestations; lack of hair glow under a fluorescent filter (Wood's lamp); three negative control results of a microscopic examination for fungi (microsporia of the scalp - 1 time in 5-7 days; microsporia of smooth skin with damage to vellus hair - 1 time in 5-7 days, microsporia of smooth skin - 1 time in 3-5 days). Due to the possibility of relapses, after completion of treatment, the patient should be under clinical observation: for microsporia of the scalp and microsporia of smooth skin with damage to vellus hair - 3 months, for microsporia of smooth skin without damage to vellus hair - 1 month. Control microscopic examinations during dispensary observation must be carried out: for microsporia of the scalp and microsporia of smooth skin involving vellus hair - once a month, for microsporia of smooth skin - once every 10 days. A conclusion on recovery and admission to an organized team is given by a dermatovenerologist. Griseofulvin orally with a teaspoon of vegetable oil 12.5 mg per kg body weight per day in 3 doses (but not more than 1 g per day) daily until the second negative microscopic examination for the presence of fungi (3-4 weeks), then every other day for 2 weeks, then 2 weeks once every 3 days. Additionally, therapy is carried out with locally active drugs: 3% salicylic acid and 10% sulfur ointment topically in the evening + 3% alcohol tincture of iodine topically in the morning. sulfur (5%)-tar (10%) ointment externally in the evening When treating the infiltrative-suppurative form, antiseptics and anti-inflammatory drugs (in the form of lotions and ointments) are initially used: ichthyol, ointment 10% 2-3 times a day externally for 2-3 days or potassium permanganate, solution 1:6000 2-3 times externally per day for 1-2 days or tacridine, solution 1: 1000 2-3 times a day externally for 1-2 days or furatsilin, solution 1:5000 2-3 times a day externally for 1-2 days. Then treatment is continued with the above antifungal drugs. Alternative treatment regimens terbinafine 250 mg orally 1 time per day after meals (adults and children weighing > 40 kg) daily for 3-4 months or itraconazole 200 mg once daily orally after meals daily for 4-6 weeks. Pregnancy and lactation. The use of systemic antifungal drugs during pregnancy and lactation is contraindicated. Treatment of all forms of microsporia during pregnancy is carried out only with locally active drugs. Griseofulvin orally with a teaspoon of vegetable oil 21-22 mg per kg of body weight per day in 3 doses daily until the first negative microscopic examination for the presence of fungi (3-4 weeks), then every other day for 2 weeks, then 2 weeks once a day 3 days. Treatment is considered complete when three negative results of the study are carried out at intervals of 5-7 days. Additionally, therapy is carried out with locally active drugs: ciclopirox cream 2 times a day externally for 4-6 weeks or ketoconazole cream, ointment 1-2 times a day externally for 4-6 weeks or isoconazole, topical cream once a day for 4-6 weeks or bifonazole cream externally once a day for 4-6 weeks or 3% salicylic acid and 10% sulfur ointment topically in the evening + 3% alcohol tincture of iodine topically in the morning sulfur (5%)-tar (10%) ointment externally in the evening. Alternative treatment regimens for children terbinafine: for children weighing >40 kg - 250 mg once daily orally after meals, for children weighing from 20 to 40 kg - 125 mg once daily orally after meals, for children with body weight<20 кг - 62, 5 мг 1 раз в сутки перорально после еды ежедневно в течение 5-6 недель или itraconazole: for children over 12 years of age - 5 mg per 1 kg of body weight 1 time per day orally after meals every day for 4-6 weeks. Preventive measures for microsporia include sanitary and hygienic measures, incl. compliance with personal hygiene measures and disinfection measures (preventive and focal disinfection). Focal (current and final) disinfection is carried out in places where the patient is identified and treated: at home, in children's and medical organizations. Preventive sanitary-hygienic and disinfection measures are carried out in hairdressing salons, baths, saunas, sanitary checkpoints, swimming pools, sports complexes, hotels, hostels, laundries, etc. 1. For a patient with microsporia identified for the first time, a notification is submitted within 3 days to the department of registration and registration of infectious diseases of the Federal Budgetary Institution of Health "Center for Hygiene and Epidemiology" and its branches, to the territorial dermatovenerological dispensaries. Each new disease should be considered as newly diagnosed . 2. When registering a disease in medical organizations, organized groups and other institutions, information about the sick person is entered into the infectious diseases register. 3. The journal is kept in all medical organizations, medical offices of schools, preschool institutions and other organized groups. Serves for personal registration of patients with infectious diseases and registration of information exchange between medical organizations and state sanitary and epidemiological surveillance organizations. 4. The patient is isolated. When a disease is detected in children's institutions, a patient with microsporia is immediately isolated and routine disinfection is carried out before transfer to the hospital or home. Until a child with microsporia recovers, he is not allowed to enter a preschool educational institution or school; an adult patient is not allowed to work in children's and communal institutions. The patient is prohibited from visiting the bathhouse or swimming pool. For maximum isolation, the patient is allocated a separate room or part of it, personal items (linen, towel, washcloth, comb, etc.). In the first 3 days after identifying a patient in preschool educational institutions, schools, higher and secondary specialized educational institutions and other organized groups, medical personnel of these institutions conduct an examination of contact persons. An examination of contact persons in the family is carried out by a dermatovenerologist. The inspection is carried out before final disinfection. Further medical observation with mandatory examination of the skin and scalp using a fluorescent lamp is carried out 1-2 times a week for 21 days with a note in the documentation (an observation sheet is kept). 5. Current disinfection in outbreaks is organized by the medical organization that has identified the disease. Routine disinfection before hospitalization and recovery is carried out either by the patient himself or by the person caring for him. Responsibility for performing routine disinfection in organized teams and medical organizations rests with his medical staff. Current disinfection is considered timely organized if the population begins to perform it no later than 3 hours from the moment the patient is identified. 6. Final disinfection is carried out in foci of microsporia after the patient leaves the foci for hospitalization or after recovery of a patient who was treated at home, regardless of the length of hospitalization or recovery. In some cases, final disinfection is carried out twice (for example, in the case of isolation and treatment of a sick child in the isolation ward of a boarding school : after isolation - in the premises where the patient was and after recovery - in the isolation ward). If a child attending a preschool or school falls ill, final disinfection is carried out at the preschool (or school) and at home. In secondary schools, final disinfection is carried out according to epidemiological indications. The final disinfection in the outbreaks is carried out by a disinfection station. Bedding, outerwear, shoes, hats, carpets, soft toys, books, etc. are subject to chamber disinfection. An application for final disinfection in households and isolated cases in organized groups is submitted by a medical worker of a medical organization with a dermatovenerological profile. When 3 or more cases of microsporia are registered in organized groups, as well as for epidemiological indications, the exit of a medical worker from a medical organization with a dermatovenerological profile and an epidemiologist from state sanitary and epidemiological surveillance institutions is organized. As directed by the epidemiologist, final disinfection is prescribed and the scope of disinfection is determined. The medical worker who has identified the disease is working to identify the source of infection (contact with sick animals). Animals (cats, dogs) are sent to a veterinary hospital for examination and treatment, followed by the submission of a certificate from the place of treatment and observation of the patient with microsporia. If a stray animal is suspected, information is transmitted to the appropriate animal control services.