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Wax mycosis is tinea pedis with large, thick scabs, scarring and alopecia. Currently, the fungal lesions typical of this mycosis on smooth skin and nail plates are rare. Wax mycosis belongs to the typically anthropophilic mycosis.
What is ringworm?
Ringworm is a condition affecting the scalp that occurs before puberty (mainly a childhood disease). It is very rare for wax mycosis to be located on the surface of smooth skin or on the nails – although there are also such cases.
Ringworm is characterized by the presence of large and thick scabs as well as scarring and alopecia. Wax mycosis is now sporadic. It rarely appears in Germany and the USA. It is endemic to the Mediterranean, the Middle East, the Balkans and Greenland, and is one of the earliest known mycoses. It has long spread and spread among the Muslim and Jewish people of the Mediterranean basin, which is largely related to ritual customs.
After World War II, there was an increase in the incidence, nowadays the incidence of ringworm is very rare. In the years 1952-1967, about 6% of patients with mycosis in Poland were diagnosed.
The causes of wax mycosis
Formerly, earwax mycosis was considered a genetic defect. This changed when the disease was discovered to be an infectious disease caused by the fungus Trichophyton schoenleinii. Other less common underlying fungi are: Trichophyton schoenleinii, Trichophyton mentagrophytes var. quinckeanum and Trichophyton galinae.
Infection occurs very easily – by direct route (from an infected person) or indirectly (as a result of using the same combs, brushes or other hairdressing tools).
Ringworm usually develops in regions with poor hygiene.
Ringworm – symptoms
The lesions are located on the scalp, neck and torso.
The basic eruption in the course of mycosis is the wax plaque (cup – scutulum). Efflorescence – a yellow-green disc, made of exudate and mycelium at the mouth of the hair follicle, resembles a crater. The hair pierces the disc, is occupied along its entire length, dull, without shine, coarse, resembling a dog’s hair. As the disease progresses, larger areas of the skin are affected and a tangle may form. Old scabs fall off, leaving the skin atrophied (atrophic scar) hairless. Sometimes there are remnants of long, healthy hair, sometimes curly.
Alopecia often covers the entire head, with a strip of hair bordering on the hairless skin.
The clinical picture is characteristic. The infection usually affects all family members, persists from early childhood to old age, spreads, among others, by by ceremonial headgear. The discs cover the entire head with time, merge at the edges and form foul layers with the smell of murine burrows, fall off after years, leaving atrophic skin permanently hairless. Ringworm is relatively little contagious.
Types and degrees of severity of ringworm
There are three degrees of severity of wax mycosis:
1) the mildest form: the hair loses its shine, it is dull, rough and dry, it does not fall out, there is only mild inflammation;
2) mild form: stronger erythema, typical shields, sulfur-yellow skin scales and crusts; the shield covers several hairs which then fall out;
3) the most severe form: visible alopecia, atrophic scars, peripheral inflammation and scales; scabs, exudate and secondary bacterial infection form with an unpleasant odor.
Cases of wax mycosis with a different clinical course and different morphology are described:
— Dandruff scab (favus pityroides): the scalp has changes like seborrheic dandruff or psoriasis. Dandruff lesions are loose on the surface and more tightly attached to the skin. After the scabs are detached, the epidermis ooze. Within the dandruff lesions, the hair is visually changed and broken at different heights. The diagnosis is made by mycological examination (Fig. G-50). In the case of ailments related to seborrhea, it is worth reaching for the EPTA DS face and hair care kit with seborrheic dermatitis, which includes shampoo and face cream. We also recommend the EPTA DS scalp and body spray available alone or in the EPTA DS comprehensive skin and hair care kit with seborrheic dermatitis
— Strupień liszajcowaty (favus impetiginiformis): the scalp has honey-yellow scabs, sometimes covering large areas of the skin, resembling impetigo. After the scabs are detached, the epidermis ooze. The fires are recessed, round, corresponding to earwax cups. Within the dandruff lesions, the hair is visually changed and broken at different heights. The smell of mouse burrows emanates from the outbreaks. A mycological examination decides about the diagnosis.
— Strupień beztarczkowy (honey comb): atypical glandular form, resembles psoriasis (favus psoriasiformis). Pale, whitish scales that resemble those of psoriasis are formed. Hair is dull and brittle. A mycological examination decides about the diagnosis. If it turns out that the scab has psoriasis, reach for the EPTA PSO 30 Scalp and Body Cream or EPTA PSO Scalp Cleansing Base.
— Follicular scab (favus follicularis): These are neglected cases. Within the fungal scars, there are paravertic conical lumps, the size of a pinhead and the color of wax. The hair is gray, dull, brittle, and affected by mycosis.
Diagnosis of wax mycosis
The brightened KOH / DMSO preparation is of great importance in the diagnosis of ringworm fungus, which enables the presence of the fungus threads to be quickly detected. In addition, cultivation on Sabouraud’s medium is performed, which allows for species identification (this is a conclusive test). In addition, infected hairs exhibit a faint dull green fluorescence in the light of Wood’s lamp.
T. schoenleinii (endotrix) grows in the hair shaft, forming hyphae composed of irregular short and long members. Characteristic gas spaces in the bristles are visible.
Mycosis should be differentiated from other ailments with similar symptoms:
- seborrheic dandruff,
- head lice,
- psoriasis,
- other shearing mycoses.
How to cure ringworm?
General treatment of ringworm is taking preparations such as: azole, terbinafine, in refractory cases griseofulvin (however, due to its numerous side effects, it has been withdrawn from the market). In turn, topical therapy includes cleansing and anti-inflammatory drugs as well as topical antifungal agents.
What’s the prognosis?
Wax mycosis does not heal itself during puberty. If left untreated, it persists throughout life.
As an adjunct in treatment, it is worth using Bioherba’s enzyme peeling for the scalp, which has an antifungal effect.
DIG. G-47. Very numerous scabs on the scalp (Trichophyton schoenleinii).
DIG. G-48. Advanced changes in the course of wax mycosis – scarring foci of permanent alopecia covering a large area of the scalp.
DIG. G-49. Ringworm.