**2.2 Clinical picture of dermatomycosis**

Fungi are present both in the natural environment and in the immediate surroundings of man. The host organism reaction to the infection with these pathogens is different and it depends greatly on what kind of dermatophyte causes it.

The main factor favourable to the development of fungal infection is a disorder of right microclimate of the skin, which is often caused by occlusion (poorly sheered clothes, shoes made of synthetic fabric) and microinjuries. Some diseases like diabetes and circulation disorders are of great importance in the development of mycoses (Macura & Pawlik, 1998).

Clinical pictures of superficial mycoses are diverse, types of fungi infections are:

 *Tinea capitis* – infection of the scalp. When it is caused by antropophilic and zoophilic species ringworm of the scalp reveals the presence of foci of alopecia and scaling. The changes develop on erythematous base, but the severity of the inflammation is very

appendixes without causing the disease (asymptomatic carrier) (Adamski & Batura-

Infection may occur also through some objects on which infectious material can be found (stratum corneum or hair with spores of fungi). The source of trunk, groin or extremities infections may be clothes, underwear or towels and sponges. Scalp diseases may happen through using the same brushes or combs. Shoes, socks, accessories for feet care or cosmetic

Nails diseases are often connected with cosmetic manicure, infection may be a result of

Also some public places could be potential source of antropophilic dermatomycoses – for example swimming-pools, toilets, showers, hotels, schools and similar (Bolinski et al., 2003,

Recently some cases of *tinea corporis gladiatorum* were described in literature. This type of dermatomycosis is common among wrestlers and judo competitors. The source of infection

Similarly with zoophilic species – transmission of pathogen may happen through direct contact with an infected animal or animal being carrier of fungus. Zoophilic dermatophytes can be also transmited from human to human. The source of infection in children and adults are mostly domestic animals – cats, dogs, hamsters, guinea pigs, rabbits or even some birds. Farmers also often suffer from dermatomycoses transmitted from breeding cattle (pigs,

Infection with geophilic dermatophytes usually happens as a result of contact with soil and it is common among people, who cultivate the soil (gardeners, farmers). The disease more often affect males than females. Working without protective gloves and unsuitable hygiene is conductive for transmission of pathogen. In literature were also described cases of transmission of geophilic dermatophytes through some animals (for example monkeys, mouses, leopards, rats, tigers) and insects (flies). Infection through direct contact with ill

Fungi are present both in the natural environment and in the immediate surroundings of man. The host organism reaction to the infection with these pathogens is different and it

The main factor favourable to the development of fungal infection is a disorder of right microclimate of the skin, which is often caused by occlusion (poorly sheered clothes, shoes made of synthetic fabric) and microinjuries. Some diseases like diabetes and circulation disorders are of great importance in the development of mycoses (Macura & Pawlik, 1998).

 *Tinea capitis* – infection of the scalp. When it is caused by antropophilic and zoophilic species ringworm of the scalp reveals the presence of foci of alopecia and scaling. The changes develop on erythematous base, but the severity of the inflammation is very

Clinical pictures of superficial mycoses are diverse, types of fungi infections are:

pedicure are often the source of infections of feet and toenails.

unsuitable disinfection of nails care accessories in cosmetic salons.

are athletes and wrestling mats (Hryncewicz-Gwozdz et al., 2011).

cows, sheep, horses, goats) (Adamski Z & Batura-Gabryel H., 2007).

peoples occurs rather rarely (Kalinowska et al., 2009b)

depends greatly on what kind of dermatophyte causes it.

**2.2 Clinical picture of dermatomycosis** 

Gabryel, 2007).

Szepietowski & Baran, 2005).

diverse and in some individuals may it be a slight erythema. In extreme cases, the changes are soft with the presence of pustules and inflammatory tumors with pus or yellow crusts. This condition is called deep mycosis (kerion) and is the result of an inflammatory response to the presence of the fungus. Apart from very severe forms of deep fungal infection of the scalp, hair loss is usually transient. Even in the worst cases, regrowth occurs at a surprisingly high proportion. Exception is infection with antropophilic *Trichophyton schoenleinii*, which leads to scarring and permanent alopecia foci formation. Lesions very often are accompanied with itching.


Epidemiology of Dermatomycoses in Poland over the Past Decades 37

Topical antifungal therapy is often the only procedure in the superficial mycoses of skin, it is decisive for the effectiveness of therapy. In cases of extensive and chronic superficial fungal infections of the scalp and nails, topical treatment is usually an essential element of

In a situation where there is a poor penetration of topical drug to the foci of fungal

After complete cure of fungal infection, the physician should inform the patient about the the principles of prevention. This is especially important for onychomycosis, because these infections are often recurrent and chronic. For this purpose, patient should frequently disinfect shoes, wear cotton socks and avoid places with high humidity such as saunas,

Within the past decades changes in percentage of fungal infections and spectrum of dermatophytes were observed – in given geographical regions appear new species, replacing the existing ones. Migration of population, industrialization, economic and cultural development, ageing of society, increased percentage of diseases like diabetes, circulation disorders, antibiotic therapy or taking of immunosuppressive medicines - these are the factors that are conductive to this phenomenon. There is a close relation between mycological biota isolated from skin and its appendages and changing spectrum of

Studies on epidemiology of dermatomycoses in different parts of the world show how large changes can occur in the fungal biota in just a few decades. This phenomenon concerns also Poland and it is affected by changing environmental factors, including the formation of ever larger urban agglomerations, permanently changing profiles of the economy, and also clearly present in the last 15 - 20 years the changes in climatic conditions (Kobierzycka et al., 2005; Macura & Pawlik, 1998; Szepietowski & Baran, 2005). Of great importance is also easy to move to distant climatic - geographical regions – both tourist travel and mass migration

combined therapy, shortening its duration and improves the treatment results. The main indications for oral antifungal agents include the following infections :

To effectively treat fungal infections following conditions should be also applied:

Removal of the factors predisposing to the development of fungal infection.

**3. Epidemiology of dermatomycoses in Poland over the past decades** 

The correct mycological diagnosis before starting treatment.

Control after treatment (clinical and mycological).

Knowledge of the principles of conducting antifungal treatment.

steam baths or swimming pools (Adamski & Batura-Gabryel, 2007).

dematophyte fungi in environment (Wronski & Nowicki, 2005).

**3.1 Geographical distribution of dermatophytes in Poland** 

Fungal infections of nails and scalp

Persistent focus of fungal infection

Appropriate selection of drug.

Good cooperation with the patient.

infection

 Fungal infections involving large areas of skin Fungal infections in patients with immune disorders

feet. It is revealed by the appearance of a typical erythematous lesions associated with exfoliation and itching, which spread on the upper surface of the thighs and crotch.

 *Tinea unguium*, *Onychomycosis* – dermatophyte infection of the nail plates. Mostly caused by antropophilic and very rarely by geophilic species. Changes within nail plates begin on free edge of nail and can cause excessive callus and fragility, appearance of grooves and fractures on surface of nail, the most often nail plates are turning yellow. Infected, untreated nails undergo gradually diminishing. Toenails are more often infected than fingernails. Fungal infection of toenails is often a result of athlete`s foot.
