Inguinal folds. Diagnosis of mycosis of large folds

The inguinal region (ilio-inguinal) is bounded above by a line connecting the anterior-superior iliac spines, below by the inguinal fold, and inside by the outer edge of the rectus abdominis muscle (Fig.).

Borders groin area(ABV), inguinal triangle (IGT) and inguinal space (E).

In the groin area there is the inguinal canal - a slit-like gap between the muscles of the anterior abdominal wall, containing in men and in women the round ligament of the uterus.

The skin of the groin area is thin, mobile and forms an inguinal fold at the border with the thigh area; in the subcutaneous layer of the groin region there are the superficial hypogastric artery and vein. The aponeurosis of the external oblique muscle of the abdomen, spreading between the anterosuperior iliac spine and the pubic tubercle, forms the inguinal ligament. Behind the aponeurosis of the external oblique abdominal muscle are the internal oblique and transverse abdominal muscles. The deep layers of the anterior abdominal wall are formed by the transverse abdomen, located medially from the muscle of the same name, preperitoneal tissue and parietal peritoneum. The inferior epigastric artery and vein pass through the preperitoneal tissue. Lymphatic vessels skin groin area are sent to the superficial inguinal lymph nodes, and from the deep layers - to the deep inguinal and iliac lymph nodes. Innervation of the inguinal region is carried out by the iliohypogastric, ilioinguinal and branch of the genital-femoral nerve.

In the groin area, inguinal hernias (see), lymphadenitis that occurs when inflammatory diseases lower limb, pelvic organs. Sometimes there are cold leaks descending from lumbar region with tuberculous lesions, as well as metastases to the inguinal lymph nodes with cancer of the external genital organs.

The inguinal region (regio inguinalis) is part of the anterolateral abdominal wall, the lateral section of the hypogastrium (hypogastrium). Boundaries of the region: below - the inguinal ligament (lig. inguinalis), the medial-lateral edge of the rectus abdominis muscle (m. rectus abdominis), above - a segment of the line connecting the anterior superior iliac spines (Fig. 1).

In the inguinal region there is an inguinal canal, occupying only its inferomedial section; therefore, it is advisable to call this entire area the ilioinguinal (regio ilioinguinalis), highlighting a section in it called the inguinal triangle. The latter is limited from below by the inguinal ligament, the medial-lateral edge of the rectus abdominis muscle, from above - by a horizontal line drawn from the border between the lateral and middle third inguinal ligament to the lateral edge of the rectus abdominis muscle.

The structural features of the groin area in men are determined by the process of descent of the testicle and the changes that the groin area undergoes in embryonic period development. A defect remains in the muscles of the abdominal wall due to the fact that part of the muscle and tendon fibers went to form the muscle that lifts the testicle (m. cremaster) and its fascia. This defect is called topographic anatomy inguinal space, which was first described in detail by S. N. Yashchinsky. Boundaries of the inguinal space: above - the lower edges of the internal oblique (m. obliquus abdominis int.) and transverse abdominal muscles (m. transversus abdominis), below - the inguinal ligament, the medial-lateral edge of the rectus muscle.

The skin of the groin area is relatively thin and mobile, at the border with the thigh it is fused with the aponeurosis of the external oblique muscle, resulting in the formation of an inguinal fold. Hair cover in men occupies a larger area than in women. The skin of the scalp contains many sweat and sebaceous glands.

Subcutaneous tissue has the appearance of large fat lobules collected in layers. The superficial fascia (fascia superficialis) consists of two sheets, of which the superficial one passes to the thigh, and the deep one, which is stronger than the superficial one, is attached to the inguinal ligament. Superficial arteries represented by branches femoral artery(a. femoralis): superficial epigastric, superficial, circumflex ilium, and external pudendal (aa. epigastrica superficialis, circumflexa ilium superficialis and pudenda ext.). They are accompanied by veins of the same name that flow into femoral vein or big saphenous vein(v. saphena magna), and in the umbilical area the superficial epigastric vein (v. epigastrica superficialis) anastomoses with vv. thoracoepigas-tricae and thus a connection is made between the axillary and femoral vein systems. Cutaneous nerves - branches of the subcostal, iliohypogastric and ilioinguinal nerves (m. subcostalis, iliohypogastricus, ilioinguinalis) (tsvetn. Fig. 1).

Rice. 1. On the right - m. obliquus int. abdominis with nerves located on it, on the left - m. traasversus abdominis with vessels and nerves located on it: 1 - m. rectus abdominis; 2, 4, 22 and 23 - nn. intercostales XI and XII; 3 - m. transversus abdominis; 5 and 24 - m. obliquus ext. abdominis; 6 and 21 - m. obliquus int. abdominis; 7 and 20 - a. iliohypogastricus; 8 and 19 - n. ilioinguinalis; 9 - a. circumflexa ilium profunda; 10 - fascia transversalis et fascia spermatica int.; 11 - ductus deferens; 12 - lig. interfoveolare; 13 - falx inguinalis; 14 - m. pyramidalis; 15 - crus mediale (crossed); 16 - lig. reflexum; 17 - m. cremaster; 18 - ramus genitalis n. genitofemoral.

Rice. 1. Boundaries of the groin area, inguinal triangle and inguinal space: ABC - groin area; DEC - inguinal triangle; F - inguinal space.

The draining lymphatic vessels of the skin are directed to the superficial inguinal lymph nodes.

The fascia proper, which looks like a thin plate, is attached to the inguinal ligament. These fascial sheets prevent inguinal hernias from descending to the thigh. The external oblique abdominal muscle (m. obliquus abdominis ext.), which has a direction from top to bottom and from outside to inside, does not contain muscle fibers within the groin area. Below the line connecting the anterior superior iliac spine to the navel (linea spinoumbilicalis), there is an aponeurosis of this muscle, which has a characteristic pearlescent sheen. The longitudinal fibers of the aponeurosis overlap with the transverse ones, in the formation of which, in addition to the aponeurosis, elements of the Thomson plate and the fascia proper of the abdomen participate. Between the fibers of the aponeurosis there are longitudinal gaps, the number and extent of which vary extremely, as does the severity of the transverse fibers. Yu. A. Yartsev describes the differences in the structure of the aponeurosis of the external oblique muscle (Fig. 2 and color Fig. 2), which determine its unequal strength.

Rice. 2. On the right - the aponeurosis of the external oblique muscle of the abdomen and the nerves passing through it, on the left - superficial vessels and nerves: 1 - rami cutanei lat. abdominales nn. intercostales XI and XII; 2 - ramus cutaneus lat. n. iliohypogastrici; 3 - a. et v. circumflexae ilium superficiales; 4 - a. et v. epigastricae superficiales, n. iliohypogastricus; 5 - funiculus spermaticus, a. et v. pudendae ext.; 6 - crus mediale (pulled upward); 7 - lig. reflexum; 8 - ductus deferens and surrounding vessels; 9 - ramus genitalis n. genitofemoralis; 10 - n. ilioinguinalis; 11 - lig. inguinal; 12 - m. obliquus ext. abdominis and its aponeurosis.

Rice. 2. Differences in the structure of the aponeurosis of the external oblique abdominal muscle (according to Yartsev).

A strong aponeurosis, which is characterized by well-defined transverse fibers and the absence of cracks, can withstand a load of up to 9 kg and is found in 1/4 of the observations.

Weak aponeurosis with significant amount cracks and a small number of transverse fibers can withstand loads of up to 3.3 kg and are found in 1/3 of cases. These data are important for assessing in various ways plastic surgery for inguinal hernia repair.

From a practical point of view, the most important formation of the aponeurosis of the external oblique muscle is the inguinal ligament (lig. inguinale), otherwise called Poupartian, or fallopian; it is stretched between the anterior superior iliac spine and the pubic tubercle. Some authors consider it as a complex complex of tendon-fascial elements.

Due to the aponeurosis of the external oblique muscle, the lacunar (lig. lacunare) and wrapped (lig. reflexum) ligaments are also formed. With its lower edge, the lacunar ligament continues into the pectineal ligament (lig. pectineale).

Deeper than the aponeurosis of the external oblique muscle is the internal oblique muscle, the course of the fibers of which is opposite to the direction of the external oblique: they go from bottom to top and from outside to inside. Between both oblique muscles, that is, in the first intermuscular layer, the iliohypogastric and ilioinguinal nerves pass. From the internal oblique muscle, as well as from the anterior wall of the rectus abdominis sheath and in approximately 25% of cases from the transverse abdominal muscle, muscle fibers arise that form the levator testis muscle.

Deeper than the internal oblique muscle is the transverse abdominal muscle (m. transversus abdominis), and between them, that is, in the second intermuscular layer, there are vessels and nerves: the subcostal with the vessels of the same name, thin lumbar arteries and veins, branches of the iliohypogastric and ilioinguinal nerves (the main trunks of these nerves penetrate the first intermuscular layer), the deep artery circumflexing the ilium (a. circumflexa ilium profunda).

The deepest layers of the inguinal region are formed by the transverse fascia (fascia transversalis), preperitoneal tissue (tela subserosa peritonei parietalis) and parietal peritoneum. The transverse fascia connects to the inguinal ligament, and along the midline it is attached to the upper edge of the symphysis.

Preperitoneal tissue separates the peritoneum from the transversalis fascia.

This layer contains the inferior epigastric artery (a. epigastrica inf.) and the deep circumflex ilium artery (a. circumflexa ilium prof.) - branches of the external iliac artery. At the level of the navel a. epigastrica inf. anastomoses with terminal branches superior epigastric artery (a. epigastrica sup.) - from the internal thoracic artery- a. thoracica int. The artery of the levator testis muscle (a. cremasterica) departs from the initial section of the inferior epigastric artery. The efferent lymphatic vessels of the muscles and aponeuroses of the groin region run along the inferior epigastric and deep circumflex iliac arteries and are directed mainly to the external iliac lymph nodes located on the external iliac artery. Between lymphatic vessels All layers of the inguinal region have anastomoses.

The parietal peritoneum (peritoneum parietale) forms a series of folds and pits in the groin area (see Abdominal wall). It does not reach the inguinal ligament by about 1 cm.

Located within the groin area, immediately above the inner half of the Poupart ligament, the inguinal canal (canalis inguinalis) is a gap between the muscles of the anterior abdominal wall. It is formed in men as a result of the movement of the testicle in uterine life and contains the spermatic cord (funiculus spermaticus); In women, this gap contains the round ligament of the uterus. The direction of the channel is oblique: from top to bottom, from outside to inside and from back to front. The length of the canal in men is 4-5 cm; in women it is several millimeters longer, but compared to men’s it is narrower.

There are four walls of the inguinal canal (anterior, posterior, superior and inferior) and two openings, or rings (superficial and deep). The anterior wall is the aponeurosis of the external oblique abdominal muscle, the posterior wall is the transverse fascia, the upper wall is the lower edges of the internal oblique and transverse abdominal muscles, the lower wall is the groove formed by the fibers of the inguinal ligament curved backwards and upwards. According to P. A. Kupriyanov, N. I. Kukudzhanov and others, the indicated structure of the anterior and upper walls of the inguinal canal is observed in people suffering from inguinal hernia, in healthy people, the anterior wall is formed not only by the aponeurosis of the external oblique muscle, but also by the fibers of the internal oblique muscle, and the upper wall is formed by the lower edge of only the transverse abdominal muscle (Fig. 3).

Rice. 3. Scheme of the structure of the inguinal canal healthy men(left) and in patients suffering from an inguinal hernia (right) on a sagittal section (according to Kupriyanov): 1 - transverse abdominal muscle; 2 - transverse fascia; 3 - inguinal ligament; 4 - spermatic cord; 5 - internal oblique abdominal muscle; 6 - aponeurosis of the external oblique abdominal muscle.

If you open the inguinal canal and displace the spermatic cord, the above-mentioned inguinal space will be revealed, the bottom of which is formed by the transverse fascia, which at the same time constitutes the posterior wall of the inguinal canal. This wall on the medial side is strengthened by the inguinal falx, or the conjoined tendon (falx inguinalis, s. tendo conjunctivus) of the internal oblique and transverse abdominal muscles, closely connected to the outer edge of the rectus muscle by discrepancies - inguinal, lacunar, pectineal. WITH outside the bottom of the inguinal space is strengthened by the interfossa ligament (lig. interfoveolare), located between the internal and external inguinal fossae.

In people suffering from an inguinal hernia, the relationship between the muscles that form the walls of the inguinal canal changes. The lower edge of the internal oblique muscle extends upward and, together with the transverse muscle, forms the upper wall of the canal. The anterior wall is formed only by the aponeurosis of the external oblique abdominal muscle. With a significant height of the inguinal gap (over 3 cm), conditions for hernia formation are created. If the internal oblique muscle (the most opposing of all elements of the anterior abdominal wall) intra-abdominal pressure) is located above the spermatic cord, then back wall the inguinal canal with a relaxed aponeurosis of the external oblique muscle cannot withstand intra-abdominal pressure for a long time (P. A. Kupriyanov).

The outlet of the inguinal canal is the superficial inguinal ring (anulus inguinalis superficialis), formerly called the external, or subcutaneous. It is a gap in the fibers of the aponeurosis of the external oblique abdominal muscle, forming two legs, of which the upper (or medial - crus mediale) is attached to the upper edge of the symphysis, and the lower (or lateral - crus laterale) is attached to the pubic tubercle. Sometimes a third, deep (posterior) leg is also observed - lig. reflexum. Both legs at the top of the gap they form are crossed by fibers running transversely and in an arcuate manner (interpeduncular fibers - fibrae intercrurales) and turning the gap into a ring. Ring sizes for men: base width - 1-1.2 cm, distance from base to top (height) - 2.5 cm; it usually misses the tip in healthy men index finger. In women, the size of the superficial inguinal ring is approximately 2 times smaller than in men. At the level of the superficial inguinal ring, the medial inguinal fossa is projected.

The entrance opening of the inguinal canal is the deep (internal) inguinal ring (anulus inguinalis profundus). It represents a funnel-shaped protrusion of the transverse fascia, which is formed during the embryonic development of the elements of the spermatic cord. Due to the transverse fascia, a common membrane of the spermatic cord and testicle is formed.

The deep inguinal ring has approximately the same diameter in men and women (1-1.5 cm), and most of it is filled with a fatty lump. The deep ring lies 1-1.5 cm above the middle of the Poupart ligament and approximately 5 cm above and outward from the superficial ring. At the level of the deep inguinal ring, the lateral inguinal fossa is projected. The inferomedial section of the deep ring is strengthened by the interfossa ligament and fibers of the iliopubic cord; the superolateral section is devoid of formations that strengthen it.

On top of the spermatic cord and its membranes there is a muscle that lifts the testicle with fascia, and more superficially than the latter - fascia spermatica ext., formed mainly by the Thomson plate and the fascia of the abdomen. TO spermatic cord(in women, the round ligament of the uterus) within the inguinal canal is adjoined above by the ilioinguinal nerve, and below by the branch of the inguinofemoral nerve (ramus genitalis n. genitofemoralis).

Pathology. The most common pathological processes are congenital and acquired hernias (see) and inflammation lymph nodes(see Lymphadenitis).

The fungus can appear on the skin in the area of ​​large folds, mainly in the groin, as well as on the buttocks and thighs. The development of the disease occurs in a constantly humid environment, increased sweating, high temperature environment, disorders of carbohydrate-fat metabolism in the body. The most common variant of infection with this mycosis is infection through objects used by a person with this disease, such as a washcloth or bath towel.

Inguinal mycosis of the skin is not a “banal” problem, and people are often ashamed to talk about it. Without proper treatment, fungus can cause problems for years.

In the uncomplicated form of this disease, confirmed by the conclusion of a medical specialist, externally prescribed antifungal ointments, sold in pharmacies without a doctor's prescription. Such drugs include NIZORAL ® cream, containing the active antimycotic ketoconazole 2%, which is indicated for the treatment of mycosis of the inguinal folds ( athlete's foot inguinal). NIZORAL ® cream is recommended to be applied once a day to the affected skin and the area immediately adjacent to it. The usual duration of treatment for athlete's foot is 2-4 weeks.

In addition, during treatment you must adhere to the following rules:

● apply the cream once a day not only to the affected area, but also to the healthy skin around it;
● during treatment it is necessary to change underwear, clothes and bed linen daily;
● if several different areas are affected by the fungus, they must be treated simultaneously to exclude the possibility of transferring the infection.

Treatment should be continued for a sufficient period of time, at least for several days after all symptoms of the disease have disappeared. The diagnosis should be reconsidered if there is no clinical improvement after 4 weeks of treatment. Should be observed general measures hygiene to control sources of infection and reinfection (re-infection).

In addition, during treatment of groin mycosis, it is recommended to follow a number of rules:

1. If you are overweight, try to normalize your weight.
2. Use cotton underwear. Synthetic fabrics do not provide sufficient air access to the skin. Due to the increase in temperature and difficult evaporation of sweat, conditions are created for the occurrence of a fungal infection
3. Avoid casual sex.
4. Consult a medical specialist about treatment tactics. Unjustified, uncontrolled use of a number of medications (for example, antibiotics) can lead to conditions against which mycoses develop various localizations. And remember that timely consultation with a medical specialist, early diagnosis and adequate treatment of fungal diseases, as well as their prevention - important aspect maintaining good health.

Mycosis of the inguinal folds - This fungal infection skin of the groin and other large natural folds of the skin. Most often, the disease is caused by red trichophyton or inguinal eridermophyton, less often by other types of fungi.

Mycosis of the inguinal folds occurs three times more often in men than in women. The disease is chronic. Mycoses of large, including inguinal folds, are widespread in countries with a humid and warm climate.

Reasons for the development of the disease

Wearing tight clothes- This is one of the reasons for the development of the disease.

This type mycosis usually begins acutely, and if untreated it can develop into chronic form. Mycosis manifests itself as red or reddish-brown spots. The spots have clear boundaries, the skin on them slightly peels.

The spots tend to grow peripherally and merge; they gradually spread beyond the boundaries of the folds, forming figures resembling garlands. Along the edges of the inflamed areas, protruding above the surface is clearly visible. healthy skin a roller consisting of bubbles. Patients with athlete's foot complain of pain, itching and burning, which intensify during movement. This type of mycosis is prone to recurrence; most often, exacerbations occur in the summer, when a person sweats more.

Mycosis of the inguinal folds, caused by fungi of the genus T. rubrum, acquires chronic course. This disease is also called rubrophytosis.

With this type of mycosis inflammatory process rarely limited only to the skin of the inguinal folds, spreading to the skin of the buttocks and abdomen. The symptoms of rubrophytia are generally similar to the clinical picture of mycosis caused by fungi of the genus E. floccosum. The only difference is that the inflamed areas are limited not by vesicles, but by single nodules that have a bluish color. In addition, this type of mycosis is characterized by severe itching. But be careful, because...

Diagnostic methods

Diagnosis of mycoses is carried out on the basis laboratory research. It is necessary to carry out tests to detect the fungus, as well as determine its type.

As a rule, two types of research are prescribed:

1. Microscopic.
2. Cultural.

The first step in diagnosis is precisely microscopic examination, which allows you to detect the fungus and confirm the initial diagnosis.

Important! The success of a microscopic examination largely depends on how correctly the material was collected.
For diagnostics accurate diagnosis conduct a microscopic examination.

Skin flakes sent for examination are scraped from the peripheral zone of the lesion. This is where the fungi are found large quantities.

Cultural diagnostics are carried out to determine the type of fungus that provoked the development of mycosis. This type of research consists of obtaining a fungal culture on artificial nutrient media. Next, a microscopic examination is carried out to determine the type of fungus, as well as its sensitivity to different types medicines.

For mycosis of the inguinal folds it is necessary differential diagnosis with diseases such as:

• Candidal or steptococcal diaper rash.

Treatment using official medicine methods

For mycoses of the inguinal folds, it is usually used local therapy. IN acute stage mycosis is prescribed:

1. Wet-dry dressings and lotions using solutions of chlorhexidine bigluconate (0.05%), boric acid(2%), resorcinol (2%). And combined agents, which include antimycotic agents and glucocorticosteroids. This method of treatment is used for 1-3 days.
2. Next, therapy begins with gels and creams antifungal action. As a rule, drugs such as Clotrimazole, Econazole, Ciclopirox (the active ingredient is ciclopirox), etc. are prescribed.
3. Systemic antifungal therapy for mycoses of the inguinal folds is rarely used.

Important! To achieve success in the treatment of mycoses of the inguinal folds, correction is necessary endocrine disorders(if they were identified during the examination). Patients with overweight body should be given recommendations for weight normalization.

Traditional medicine treatment

Along with medications, methods can be used to treat mycoses of the groove folds traditional medicine.

1. For oral administration for inguinal mycoses, it is worth preparing an infusion of the following types of herbs: violet flowers (5g), St. John's wort herb (20g), lingonberry leaf and chamomile flowers (15g each), eucalyptus leaf and yarrow herb (10g each). Prepare the infusion in a thermos; per liter of boiling water you need to take 4 tablespoons of a mixture of herbs. Leave for 12 hours, drink half a glass three times a day.
2. For lotions for mycosis of the inguinal folds, it is recommended to prepare an infusion from the mixture oak bark, string, yarrow and flaxseed, all plant materials are taken in equal parts. For a liter of boiling water you need to take 50 grams of the mixture. Leave in a thermos for 24 hours. Use the strained infusion for lotions. After completing the procedure, zinc ointment should be applied to the skin affected by mycosis.

Prognosis and prevention

Important! The earlier treatment for mycosis of the inguinal folds is started, the greater the chance that the disease will not take a chronic course. Therefore, when painful symptoms You should immediately contact a dermatologist.

Prevention of the development and recurrence of mycoses of the inguinal folds consists of the following measures:

1. Provoking factors should be excluded - rubbing of the skin in the groin area, excessive sweating caused by wearing synthetic clothing.
2. If detected, promptly treat.
3. To prevent relapses, it is necessary to regularly treat the skin in the area of ​​​​former lesions with a 2% solution salicylic alcohol or 2% iodine solution.

Fungal skin diseases (dermatomycosis or dermatophytosis) are one of the most common diseases for which people consult a dermatologist. About 40% of them are related to fungal infections of the groin and axillary area- dermatophytosis of large folds.

Types of dermatophytosis (fungus in the groin area)

All cases of dermatophytosis of large folds are caused by the presence of one of the pathogenic fungi of the genus Epidermophyton (, Trichophyton or Microsporum. Most often during diagnosis, the pathogen of the genus Trichophyton is isolated - T.rubrum, which also causes fungal diseases scalp.

To identify the fungus that is causing the patient's symptoms, laboratory tests are performed, which include microscopic analysis of a sample taken from the affected area.

To determine the types of fungus in the groin under special lighting, skin cells infected with the fungus produce a luminescence effect, which allows the disease to be diagnosed.

When diagnosing fungus of large folds, it is necessary to differentiate mycosis from other pathologies that manifest themselves similar symptoms(, psoriasis, eczema, etc.), and also carry out bacteriological examination a skin sample to check for the presence of pathogenic bacteria (especially if characteristic symptoms are present).

Symptoms

The fungus of large folds has quite characteristic initial manifestations: areas of the affected skin are located in armpits, groin area, on inner surface hips and shoulders, and in the folds below them.

It should be understood that the term “fungus of large folds” has a relative meaning - the disease can develop in any area of ​​the body that is characterized by prolonged skin-to-skin contact. So, if a person’s professional employment involves a prolonged position of the arms bent at the elbows, then dermatophytosis can develop on the inner surface of the elbow.

Mycosis in the groin in men is a chronic pathological process of a fungal nature associated with damage to the skin of the inguinal folds. The main reason the occurrence of the disease is damage to the skin various types pathogenic fungi, and sometimes combinations of several species. However, there are also a number etiological factors exogenous and endogenous nature, which can cause an increase in the likelihood of developing mycosis of the groin area.

Exogenous factors contributing to the onset of the disease include:

1. Long wearing underwear from synthetic materials;
2. Prolonged wearing of tight, thick clothing;
3. Overheating, intense sweating and moisture in the skin in the groin area;
4. Obesity, presence of cellulite;
5. High temperature and humidity;
6. Neglect of personal hygiene rules.

Endogenous factors contributing to the onset of the disease include:

• Decreased natural immunity;
• Chronic diseases endocrine system (diabetes, thyroiditis);
• Systemic and autoimmune diseases;
• The presence of foci of fungal infection in the foot area;
• The presence of neoplasms (including malignant ones): verrucous carcinoma, lipoma, basal cell carcinoma;
• Violations metabolic processes in organism.

Inguinal mycosis of the folds is caused by the following types mushrooms:

1. Epidermophyton floccosum is the most highly contagious species of pathogen, causing athlete's foot inguinal. Infection with this type of fungus occurs by contact– through household items, as well as personal hygiene items (shared towels, public toilets, seats in baths and saunas, shared linen). Infection of the groin area with your hands is also possible after contact with an infected object or a focus of fungus (foot, interdigital space);
2. Trichophyton rubrum causes the appearance of rubrophytosis, which has a predominantly chronic course with an acute onset of the disease. With rubrophytosis, the process involves the inguinal-femoral, axillary folds, as well as the area between the buttocks. This disease affects not only the folds, but can spread throughout the body, involving the hairline of the body in the process.

Clinic

Clinical manifestations of scrotal mycosis will depend on the type of pathogen. In case of inguinal epidermophytosis, the causative agent of which is Epidermophyton floccosum, the following clinical features will be observed:

• Acute onset of the disease followed by chronicity of the process in the absence of therapy;
• The onset of the disease is characterized by the appearance of spots of pink, red or brown-red color with signs of inflammation (swelling, hyperemia, peeling) and a clear demarcation from other unaffected tissues. The spots can merge and form a single focus (peripheral growth occurs);
• As the disease progresses, the central focal zone resolves, and the marginal area becomes covered with vesicles different sizes, pustules, erosive elements, scales or crusts that form a kind of roller;
• There may be separate lesions located separately from the main spot;
• , pain, which intensify even more during movement and physical activity;
• The appearance of peeling and cracks.

If inguinal mycosis is caused by Trichophyton rubrum, then the symptoms will differ from athlete's foot inguinal by frequent recurrence (especially in the summer), the presence of lesions in the area of ​​​​the feet and hands, widespread spread of the process to the skin of the abdomen and buttocks, the area of ​​​​inflammation is delimited by nodular formations of purple-cyanotic color

Diagnostics

Diagnosis of scrotal mycoses is based on an external examination, collection of anamnestic data and laboratory test results. When collecting anamnesis, it is necessary to find out from the patient about the presence of any systemic, endocrine and chronic pathologies, nature of food, frequency of visits to public baths and saunas, ask about the place and working conditions.

During an external examination, it is necessary to evaluate the nature and location of the spots, the number and type of elements of the rash, and the presence of peeling. You also need to pay attention to the patient’s physique and the presence of signs of body obesity.

Laboratory tests include:

1. General blood analysis;
2. General urine analysis;
3. Microscopic examination of scrapings (the method allows to detect the presence of fungi; scrapings from the peripheral area of ​​the infected lesion are taken for examination);
4. Cultural cultures allow you to find out the specific type of fungus that caused the mycotic lesion. The essence of the method is to grow fungi on artificial nutrient media, followed by microscopy, which will identify the specific species and genus of the fungus. Also, during cultural inoculation, the degree of sensitivity of the microorganism to various types medications.

Treatment and prevention

Treatment inguinal mycosis depends on the pathogen and type of pathology. For inguinal athlete's foot, the following medications are used;

• Hydrocortisone ointment (1%), zinc ointment for local rubbing onto affected areas of the skin;
• Creams: “Miconazole”, “Econazole”, “Clotrimazole”, “Oxiconazole”, “Terbinafine”, “Ketoconazole”, “Ciclopirox”, “Micatin”. The drugs should be applied after hygiene procedures(the affected area must be thoroughly washed and then wiped dry with a napkin or towel), the cream is applied 2-3 centimeters around the affected area;
• Also effective is the application of lotions, dressings, applications, which include “Chlorhexidine bigluconate 0.05%”, “Boric acid 2%”, “Resorcinol 2%”.

When diagnosing a patient with inguinal trichophytosis, local treatment using antifungicidal ointments: Lamisil, Micatin, Mycelex, Clotrimazole. Treatment with alcohol is also effective. iodine solution and salicylic-sulfur ointment. Tablet forms of drugs are used if the pathological process involves the scalp, nails and deep layers of the skin (Griseofulvin, Nizoral).

It is advisable to treat mycoses of the inguinal folds in men before the appearance of negative symptoms. negative results laboratory research. On average, the course of therapy ranges from two weeks to one month.

Preventive measures include careful adherence to hygiene rules, wearing underwear made from natural fabrics and changing it daily, which should not be allowed profuse sweating, the use of talcs or powders is recommended.