Groin folds. Diagnosis of mycosis of large folds

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

Borders inguinal region(ABV), inguinal triangle (GDV) and inguinal gap (E).

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

The skin of the inguinal region is thin, mobile, and forms an inguinal fold on the border with the thigh region; in the subcutaneous layer of the inguinal region are the superficial hypogastric artery and vein. The aponeurosis of the external oblique muscle of the abdomen, spreading between the anterior superior 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, the preperitoneal tissue and the parietal peritoneum. The inferior epigastric artery and vein pass through the preperitoneal tissue. Lymphatic vessels skin the inguinal region are sent to the superficial inguinal lymph nodes, and from the deep layers - to the deep inguinal and iliac lymph nodes. The innervation of the inguinal region is carried out by the ilio-hypogastric, ilio-inguinal and branch of the pudendal nerve.

In the inguinal region, inguinal hernias are not uncommon (see), lymphadenitis that occurs when inflammatory diseases lower limb, pelvic organs. Sometimes there are cold leaks coming down from lumbar with tuberculous lesions, as well as metastases in the inguinal lymph nodes with cancer of the external genital organs.

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

In the inguinal region there is an inguinal canal, which occupies only its lower medial section; therefore, it is advisable to call this entire area the ilioinguinalis (regio ilioinguinalis), highlighting in it a department called the inguinal triangle. The latter is limited from below by the inguinal ligament, by 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 border of the rectus abdominis.

The structural features of the inguinal region in men are due to the process of lowering the testicle and the changes that the inguinal region 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 referred to as topographic anatomy inguinal gap, which was first described in detail by S. N. Yashchinsky. The boundaries of the inguinal gap: at the top - the lower edges of the internal oblique (m. obliquus abdominis int.) and the transverse abdominal muscles (t. transversus abdominis), below - the inguinal ligament, the medial-lateral edge of the rectus muscle.

The skin of the inguinal region is relatively thin and mobile, at the border with the thigh it is fused with the aponeurosis of the external oblique muscle, as a result of which the inguinal fold is formed. The hairline 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, more durable than the superficial one, is attached to the inguinal ligament. Superficial arteries represented by branches femoral artery(a. femoralis): superficial epigastric, superficial, envelope of the ilium, and external shameful (aa. epigastrica superficialis, circumflexa ilium superficialis and pudenda ext.). They are accompanied by veins of the same name, flowing into femoral vein or in big saphenous vein(v. saphena magna), and in the umbilical region, the superficial epigastric vein (v. epigastrica superficialis) anastomoses with vv. thoracoepigas-tricae and thus a connection is made between the systems of the axillary and femoral veins. Cutaneous nerves - branches of the hypochondrium, iliac-hypogastric and iliac-inguinal nerves (m. Subcostalis, iliohypogastricus, ilioinguinalis) (printing. Fig. 1).

Rice. 1. 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. transverse 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. Borders of the inguinal region, inguinal triangle and inguinal gap: ABC - inguinal region; DEC - inguinal triangle; F - inguinal gap.

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

Own fascia, which looks like a thin plate, is attached to the inguinal ligament. These fascial sheets prevent the lowering of inguinal hernias on the thigh. The external oblique muscle of the abdomen (m. obliquus abdominis ext.), having a direction from top to bottom and from outside to inside, does not contain muscle fibers within the inguinal region. Below the line connecting the anterior superior iliac spine with the navel (linea spinoumbilicalis), is the aponeurosis of this muscle, which has a characteristic mother-of-pearl luster. 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 proper fascia of the abdomen participate. Between the fibers of the aponeurosis there are longitudinal fissures, the number and length of which varies greatly, as well as 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 up); 7-lig. reflexum; 8 - ductus deferens and surrounding vessels; 9 - ramus genitalis n. genitofemoralis; 10-n. ilioinguinalis; 11-lig. inguinale; 12 - m. obliquus ext. abdominis and its aponeurosis.

Rice. 2. Differences in the structure of the aponeurosis of the external oblique muscle of the abdomen (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 observations.

Weak aponeurosis with significant number cracks and a small number of transverse fibers withstand a load of up to 3.3 kg and occurs in 1/3 of cases. These data are important for the evaluation 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 pupart, 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, lacunar (lig. lacunare) and twisted (lig. reflexum) ligaments are also formed. With its lower edge, the lacunar ligament continues into the comb ligament (lig. pectineale).

Deeper than the aponeurosis of the external oblique muscle is the internal oblique, 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 ilio-hypogastric and ilio-inguinal nerves pass. From the internal oblique muscle, as well as from the anterior wall of the vagina of the rectus abdominis muscle and in about 25% of cases, muscle fibers depart from the transverse abdominal muscle, forming the muscle that lifts the testicle.

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: hypochondrium with the same vessels, thin lumbar arteries and veins, branches of the ilio-hypogastric and ilio-inguinal nerves (the main trunks of these nerves penetrate the first intermuscular layer), the deep artery that envelops 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 is connected to the inguinal ligament, and in the midline is attached to the upper edge of the symphysis.

Preperitoneal tissue separates the peritoneum from the transverse fascia.

In this layer, the lower epigastric artery (a. epigastrica inf.) and the deep artery that envelops the ilium (a. circumflexa ilium prof.) pass - branches of the outer 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. From the initial section of the inferior epigastric artery, the artery of the muscle that lifts the testicle (a. cremasterica) departs. The efferent lymphatic vessels of the muscles and aponeuroses of the inguinal 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 number of folds and pits in the inguinal region (see. Abdominal wall). It does not reach the inguinal ligament by about 1 cm.

Located within the inguinal region, immediately above the inner half of the pupart 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 utero and contains the spermatic cord (funiculus spermaticus); in women, the round ligament of the uterus is located in this gap. 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 narrower than in men.

There are four walls of the inguinal canal (anterior, posterior, upper and lower) and two holes, or rings (superficial and deep). The anterior wall is the aponeurosis of the external oblique abdominal muscle, the posterior one is the transverse fascia, the upper one is the lower edges of the internal oblique and transverse abdominal muscles, the lower one is a gutter formed by the fibers of the inguinal ligament bent 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, 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 in healthy men(left) and in patients suffering from inguinal hernia (right) on the sagittal section (according to Kupriyanov): 1 - transverse abdominal muscle; 2 - transverse fascia; 3 - inguinal ligament; 4 - spermatic cord; 5 - internal oblique muscle of the abdomen; 6 - aponeurosis of the external oblique muscle of the abdomen.

If you open the inguinal canal and displace the spermatic cord, then the above-mentioned inguinal gap will be revealed, the bottom of which forms the transverse fascia, which at the same time constitutes the posterior wall of the inguinal canal. This wall is strengthened from the medial side by the inguinal sickle, or the connected tendon (falx inguinalis, s. tendo conjunctivus) of the internal oblique and transverse abdominal muscles, closely connected with the outer edge of the rectus muscle by discrepancies - inguinal, lacunar, scallop. WITH outer side the bottom of the inguinal gap is strengthened by the interfoveal ligament (lig. interfoveolare), located between the inner and outer inguinal fossae.

In people suffering from an inguinal hernia, the ratio 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 muscle of the abdomen. With a significant height of the inguinal gap (over 3 cm), conditions for hernia formation are created. If the internal oblique muscle (the most counteracting 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 muscle of the abdomen, 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) - to the pubic tubercle. Sometimes there is also a third, deep (back), leg - lig. reflexum. Both legs at the top of the gap they form are crossed by fibers that run transversely and arcuately (interpeduncular fibers - fibrae intercrurales) and turn 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 to 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 sheath of the spermatic cord and testis 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 pupartite ligament and about 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 reinforced by the interfossular ligament and fibers of the iliac-pubic cord, the upper lateral 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 is fascia spermatica ext., Formed mainly by the Thomson plate and the abdominal fascia itself. TO spermatic cord(in women, to the round ligament of the uterus) within the inguinal canal adjoins the iliac-inguinal nerve from above, from below - the branch of the inguinal-femoral nerve (ramus genitalis n. genitofemoralis).

Pathology. The most frequent 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 inguinal, as well as on the buttocks and thighs. The development of the disease occurs in a constantly humid environment, increased sweating, high temperature environment, violation 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, a bath towel.

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

In the uncomplicated form of this disease, confirmed by the conclusion of a specialist doctor, externally prescribed antifungal ointments sold in pharmacies without a doctor's prescription. These drugs include NIZORAL ® cream containing the active antimycotic ketoconazole 2%, which is indicated for the treatment of mycosis of the inguinal folds ( inguinal epidermophytosis). 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 epidermophytosis groin is 2-4 weeks.

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

● apply the cream once a day not only on the affected area, but also on 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 should be treated simultaneously in order to exclude the possibility of infection transfer.

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

In addition, during the 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 formed for the occurrence of a fungal infection.
3. Avoid casual sex.
4. Consult with a specialist doctor about treatment tactics. Unjustified, uncontrolled use of a number of drugs (for example, antibiotics) can lead to conditions against which mycoses develop. different localization. And remember that timely consultation with a specialist doctor, 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 inguinal and other large natural skin folds. Most often, the disease is caused by red trichophyton or inguinal erydermophyton, less often by other types of fungi.

Mycosis of the inguinal folds in men occurs three times more often 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 begins, as a rule, acutely, and if left untreated, it can turn into chronic form. Mycosis is manifested by the appearance of spots of red or reddish-brown color. The spots have clear boundaries, the skin on them is slightly flaky.

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 made up of bubbles. Patients with inguinal epidermophytosis complain of soreness, itching and burning, which increase 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, from the very beginning of the disease acquires chronic course. This disease is also called rubrophytosis.

With this type of mycosis inflammatory process rarely limited to the skin of the inguinal folds, spreading to the skin of the buttocks and abdomen. The symptoms of rubrophytosis 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 bubbles, 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 of laboratory research. It is necessary to conduct tests to detect the fungus, as well as to determine its type.

As a rule, two types of research are assigned:

1. Microscopic.
2. Cultural.

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

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

Skin flakes sent for examination are scraped from the peripheral zone of the lesion. This is where fungi are located. in large numbers.

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

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

• Candidal or streptococcal diaper rash.

Treatment by methods of official medicine

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

1. Wet-drying dressings and lotions using solutions of chlorhexidine bigluconate (0.05%), boric acid(2%), resorcinol (2%). And combined funds, 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, Cyclopirox (- active ingredient ciclopirox), etc. are prescribed.
3. Systemic antifungal therapy for fungal infections 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 survey). Patients with overweight body should be given advice on the normalization of weight.

Traditional medicine treatment

Along with drugs for the treatment of mycoses of the groove folds, methods can be used traditional medicine.

1. For ingestion with inguinal mycoses, it is worth preparing an infusion of the following types of herbs: violet flowers (5g), St. The infusion is prepared in a thermos, per liter of boiling water you need to take 4 tablespoons of a mixture of herbs. Infuse for 12 hours, drink at half a glass three times a day.
2. For lotions with mycosis of the inguinal folds, it is recommended to prepare an infusion from a mixture oak bark, succession, yarrow and flaxseed, all vegetable raw materials are taken in equal parts. For a liter of boiling water, you need to take 50 grams of the mixture. Insist in a thermos for a day. Strained infusion is used for lotions. After the procedure is completed, zinc ointment should be applied to the skin affected by mycosis.

Forecast and prevention

Important! The earlier the treatment of mycosis of the inguinal folds is started, the more likely it is that the disease will not take a chronic course. Therefore, when it occurs painful symptoms you should immediately consult a dermatologist.

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

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

Fungal diseases of the skin (dermatomycosis or dermatophytosis) are one of the most common diseases that are addressed to a dermatologist. About 40% of them are related to fungal infections of the inguinal and armpit- dermatophytosis of large folds.

Types of dermatophytosis (fungus in the groin)

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, the pathogen of the genus Trichophyton, T.rubrum, is isolated during diagnosis, which also causes fungal diseases scalp.

To identify the fungus that caused the symptoms in the patient, laboratory tests are carried out, including microscopic analysis of a sample taken from the affected area.

To determine the types of fungus in the groin under special lighting, the skin cells infected with the fungus produce a luminescence effect, which makes it possible to diagnose the disease.

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

Symptoms

The fungus of large folds has quite characteristic initial manifestations: areas of the affected skin are located in armpits, inguinal region, on inner surface hips and shoulders, and in the folds underneath.

It should be understood that the term "large fold fungus" has a relative meaning - the disease can develop in any area of ​​​​the body, which is characterized by prolonged skin-to-skin contact. So, if the professional employment of a person provides for a long position of the arms bent at the elbows, then dermatophytosis can develop on the inner ulnar surface.

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. main reason the onset of the disease is a lesion of 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 inguinal region.

Exogenous factors contributing to the onset of the disease include:

1. Prolonged wearing underwear from synthetic materials;
2. Prolonged wearing of tight tight clothing;
3. Overheating, intense sweating and moisture of the skin in the groin area;
4. Obesity, the 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 feet;
• The presence of neoplasms (including malignant): verrucous carcinoma, lipoma, basalioma;
• Violations metabolic processes in organism.

Inguinal mycosis of the folds cause the following types mushrooms:

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

Clinic

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

• Acute onset of the disease with subsequent chronicity of the process in the absence of therapy;
• The onset of the disease is characterized by the appearance of pink, red or brown-red spots with signs of inflammation (swelling, hyperemia, peeling) and a clear demarcation from other unaffected tissues. 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 bubbles. different size, pustules, erosive elements, scales or crusts that form a kind of roller;
• There may be separate foci that are separate from the main spot;
• , pain, which increase even more during movement and physical exertion;
• The appearance of peeling, cracks.

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

Diagnostics

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

During an external examination, it is necessary to assess the nature and localization of spots, the number and type of rash elements, 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 studies include:

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

Treatment and prevention

Treatment inguinal mycosis depends on the causative agent and the type of pathology. With inguinal epidermophytosis, the following drugs are used;

• Hydrocortisone ointment (1%), zinc ointment for local rubbing on the affected areas of the skin;
• Creams: Miconazole, Econazole, Clotrimazole, Oxyconazole, Terbinafine, Ketoconazole, Cyclopirox, Mikatin. Drugs should be applied after hygiene procedures(the affected area must be thoroughly washed, then wiped dry with a napkin or towel), the cream is applied 2-3 centimeters around the affected area;
• It is also effective to apply lotions, dressings, applications, which include Chlorhexidine bigluconate 0.05%, Boric acid 2%, Resorcinol 2%.

When diagnosing inguinal trichophytosis in a patient, local treatment with the use of antifungal ointments: "Lamisil", "Mikatin", "Micelex", "Clotrimazole". Alcohol treatment is also effective iodine solution and salicylic-sulfur ointment. Tableted forms of drugs are used if the scalp, nails and deep layers of the skin are involved in the pathological process (Griseofulvin, Nizoral).

Treatment of fungal infections of the inguinal folds in men should be carried out before the appearance of negative negative results laboratory research. On average, the course of therapy ranges from two weeks to one month.

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