Diagnostics and treatment of skin diseases

Skin diseases include a wide spectrum of diseases with different genesis which appear on the skin, starting from contagious diseases (caused by fungi, bacteria, viruses, parasites) to immune system disorders and systemic diseases whose symptoms mainly appear on the skin. The skin diseases we diagnose most frequently are fungal foot infection (tinea pedis), asteatotic eczema and scabies.

Fungal foot infection

Fungal foot infection (tinea pedis) is a skin, hair and nail infection caused by a dermatophyte fungus. Dermatophytes are aerobic fungi that can decompose and obtain nutrients from keratinised material and that parasitize in human keratin tissues (hair, nails). The infection is very common; almost 70% of people are infected at one time in their life.

The condition is typically acquired by your skin coming into contact with a sufficient amount of contagious material and a suitable environment for the growth of fungi. Risk factors are microtraumas, profuse perspiration of feet, skin maceration, closed footwear, warm and humid climate, blood circulation disorders of the feet, immunosuppression.

The symptoms of a fungal foot infection are itching, scaling, unpleasant smell, profuse perspiration of feet, and, when fissures develop, stinging sensation and painfulness. There are three forms of fungal foot infection:

  • Interdigital tinea pedis – occurs most often between the fourth and fifth toes with moist, macerated (wrinkled) and pale skin. Fissures develop between and below toes, there is some scaling.
  • Hyperkeratotic (moccasin type) tinea pedis – slight redness on the soles and whitish flaky scaling in skin folds. Inflammation spreads up from the heel and extends onto the sides of the foot; the dorsal surface of the foot is typically not affected.
  • Vesicular or dyshidrotic tinea pedis – following a long symptom-free period, itchy vesicles that contain cloudy or purulent fluid develop suddenly on the instep or anterior plantar surface of the foot. After their rupture, erosions, scaling and redness follow. The situation may be complicated by a secondary bacterial infection accompanied by purulent vesicles. If the patient scratches these vesicles too strongly, they may develop bloody contents.

To diagnose a fungal infection, we confirm it by using a microscope and by culture, for which material is gathered from skin scales, contents of vesicles etc., from where it is possible to determine the pathogen.

Treatment of fungal infection is either local or systemic. Local treatment (gel, ointment, cream) can be used for the treatment of modestly or moderately developed infection. Systemic treatment (tablets, capsules) is necessary in case of an extensive or a strongly developed disease; patients who suffer from diabetes, blood circulation disorders in extremities or whose immune system is suppressed (due to drugs or diseases) may also require systemic treatment.

Asteatotic eczema

Asteatotic eczema is a form of eczema that commonly occurs in elderly and is characterised by dry and cracked skin that as a result develops slight eczematous signs. This disease may be caused by the reduction of lipids and water reserve in the skin due to age, secondary diseases or malnutrition, extensive use of soaps and other skin cleaning products, repeated microtraumas, low humidity of the environment and dry cold wind, contact with substances that irritate the skin, taking medicines (diuretics, cimetidine, glucocorticosteroids), and a deficit of zinc, linoleic and linolenic acids.

Asteatotic eczema is often found on the shins, arms and hands. Typically, dryness of the skin is combined with itching and, as a result of scratching, redness, crusts and swelling develop.

Treatment recommendations:

  • take short showers, avoid hot water;
  • do not wash the area affected by eczema with soap, avoid very strong skin cleaning products;
  • after washing use strong moistening creams;
  • use moistening creams several times a day;
  • use locally applied creams that contain corticosteroids (mostly prescription drugs).

Scabies

Scabies is a contagious skin infection caused by a parasite, the itch mite. The life cycle of itch mites depends on oxygen; they do not intrude further from the corneal layer of the epidermis (the superficial layer of the skin). Scabies can be contracted through direct skin-to-skin contact which means close physical contact with an infected person (e.g. sexual partner) or prolonged physical contact (e.g. parents and children).

Symptoms typically appear 3–6 weeks after infection: intense itching which becomes severe in the evenings, fine papulous rash (papulae appear in pairs) and crusts. The usual places of the rash to occur are in the area of the finger webs, ventral wrists, breasts, stomach folds of the skin, buttocks, thighs, and genitals. In children and the elderly, the rash may affect the face, palms and soles.

Treatment principles:

  • all family members and any others who have had contact with the infected individual are treated at the same time, regardless if they have symptoms (already) or not;
  • medication is administered on the entire body (except for the head in adults);
  • hands are covered with medication again after washing them with water and soap;
  • clothing and bedding must be changed both when the treatment begins and ends;
  • after treatment, clothing must be washed at least at 60°C, outerwear dry-cleaned (or not used for 3–4 days).