DAAD QOOBA, DERMATOPHYTOSIS

 INFORMATION OF قو با، داد DAAD QOOBA, DERMATOPHYTOSIS, RINGWORM, CAUSES, TYPES, CLASSIFICATION, USOOLE ILAJ, AND ILAJ IN UNANI SYSTEM OF MEDICINE

INTRODUCTION

The medical term for ringworm is tinea. (Tinea is the Latin name for a growing worm.) Health care professionals add another word to indicate the part of the body where the fungus is located. Tinea capitis, for instance, refers to scalp ringworm, tinea corporis to fungus of the body, tinea pedis to fungus of the feet, and so on. some of these fungi produce a rash of round scaly spots on the skin, but many do not. On the other hand, many round, red spots or rashes on the skin are not due to a fungal infection. A physical examination of the affected skin, evaluation of skin scrapings under the microscope, and culture tests can help health care professionals make the appropriate . A proper diagnosis is best for successful treatment

HISTORY OF QOOBA

As far as the history of Qooba, and ancient unani physicians the first recorded reference to a dermatophyte infection is attributed to Aulus Cornelius Celsus, the roman encyclopaedist, who in the treatise De Re Medicina written around 30- A.D. described a suppurative infection of the scalp that came to be known as the Kerion of Celsus.

*DIOSCORIDES* in 60 A.D. gave the description of Qooba in children’s and its treatment in De   Materia Indica.

*JALINOOS* (Galen of Pergamon, 129-200 A.D.) considered to be the most distinguished 

Physician of antiquity after Hippocrates, described qooba, its cause and treatment and classified it into acute and chronic in his book Mayameer.

*RABBAN TABRI* (810-895 A.D.) in his book Firdaus ul hikmat, has made a mention of qooba, its causes and treatment based on humeral theory.

 What causes ringworm?

.Although the world is full of yeasts, molds, and fungi, only a few cause skin disease.  These agents are called the dermatophytes (which means "skin fungi"). An infection with these fungi is medically known as dermatophytosis. Skin fungi can only live on the dead layer of keratin protein on top of the skin. They rarely invade deeper into the body and cannot live on mucous membranes, such as those in the mouth or vagina.

Scientific names for the most common of the dermatophyte fungi that cause ringworm include Trichophyton rubrum, (it was first described by Malmsten in1845 )Trichophyton tonsurans  (It was first recognized by David Gruby in 1844.) Trichophyton interdigitale, and Trichophyton mentagrophytes, Microsporum canis, and Epidermophyton floccosum. .

·         Tinea pedis (foot) ·         Tinea unguium (nails) ·         Tinea manum (hand) ·         Tinea cruris (groin) ·         Tinea corporis (body) ·         Tinea capitis (scalp) ·         Tinea faciei (face) ·         Tinea barbae (beard) ·         Tinea imbricate (overlapping pattern) ·         Tinea nigra (black) ·         Tinea versicolor (various color) ·         Tinea incognito (disguised) ·           Tinea pedis (foot) Athlet’s foot (also known as "ringworm of the foot", tinea pedum, and "moccasin foot  is a common and contagious skin disease  that causes itching, scaling, flaking, and sometimes blistering of the affected areas. Its medical name is tinea pedis, a member of the group of diseases or conditions known as tinea, Globally, athlete's foot affects about 15% of the population. Tinea pedis is caused by fungi such as Epidermophyton fioccosum or fungi of the tricophyton genus including T.rubrum. These fungi are typically transmitted in moist communal areas where people go barefoot, such as around swimming pools or in showers, and require a warm moist environment like the inside of a shoe to incubate. Fungal infection of the foot may be acquired (or reacquired) in many ways, such as by walking in an infected locker room, by using an infested bathtub, by sharing a towel used by someone with the disease, by touching the feet with infected fingers (such as after scratching another infected area of the body), or by wearing fungi-contaminated socks or shoes. Infection can often be prevented by keeping the feet dry by limiting the use of footwear that enclose the feet, or by remaining barefoot.  To effectively treat athlete's foot, it is necessary to treat the entire infection, wherever it is on the body, until the fungi are dead and the skin has fully healed. There is a wide array of over the counter and prescription topical medications in the form of liquids, sprays, powders, ointments, and creams for killing fungi that have infected the feet or the body in general. For persistent conditions, oral medications are available by prescription. The fungi can also spread to hair, grow inside hair strands, and feed on the keratin within hair, including the hair on the feet Tinea unguium (nails) Onychomycosis (also known as "dermatophytic onychomycosis," or "tinea unguium"  is a fungal infection  of the nail.  It is the most common disease of the nails and constitutes about half of all nail abnormalities. This condition may affect toenails or fingernails, but toenail infections are particularly common. It occurs in about 10% of the adult population.  However, the spread of the infection is not limited to skin. Toe nails become infected with fungi in the same way as the rest of the foot, typically by being trapped with fungi in the warm, dark, moist inside of a shoe.,   even though toe nails are part of the foot. Fungi are more difficult to kill inside and underneath a nail than on and in the skin. But if the nail infection is not cured, then the fungi can readily spread back to the rest of the foot. Tinea manuum (hand) Tinea manuum (or tinea manus]) is a fungal infection of the hand. It is typically more aggressive than tinea pedis but similar in look. Itching, burning, cracking, and scaling are observable and may be transmitted sexually or otherwise, whether or not symptoms are present. Tinea cruris (groin) Tinea cruris also known as "crotch itch", "crotch rot", "Dhobie itch", "eczema marginatum", "gym itch", "jock itch", "jock rot", "scrot rot" and "ringworm of the groin is a dermatophyte fungal infection of the groin region in any sex, though more often seen in males. In the German sprachraum  this condition is called tinea inguinalis (from Latin inguen = groin) whereas tinea cruris is used for a dermatophytosis of the lower leg (Latin crus). Tinea cruris is similar to, but different from candidal intertrigo which is an infection of the skin by  Candida albicans It is more specifically located between intertriginous  folds of adjacent skin, which can be present in the groin or scrotum, and be indistinguishable from fungal infections caused by tinia. However, candidal infections tend to both appear and disappear with treatment more quickly. It may also affect the scrotum. Tinea corporis (body) Tinea corporis  (also known as "ringworm", tinea circinata, and tinea glabrosa) is a superficial fungal infection  (dermatophytosis) of the arms and legs, especially on glabrous skin; however, it may occur on any part of the body, it present as annular, marginated plaque with thin scale and clear center. Common organisms are Trichophyton mentagrophytesand Microspore canes. Treatment include: Grisofluvine, itraconazole and clotrimazole cream . Tinea capitis (scalp) Tinea capitis (also known as "Herpes tonsures", "Ringworm of the hair,"] "Ringworm of the scalp," "Scalp ringworm", and "Tinea tonsures) is a superficial fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatophytes in the trichophyton   and microsporum genera that invade the hair shaft. The clinical presentation is typically single or multiple patches of hair loss, sometimes with a 'black dot' pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre-pubertal children, more often boys than girls. At least eight species of dermatophytes are associated with tinea capitis. Cases of Trichophyton infection predominate from Central America to the United States and in parts of Western Europe. Infections from Microsporum species are mainly in South America, Southern and Central Europe, Africa and the Middle East. The disease is infectious and can be transmitted by humans, animals, or objects that harbor the fungus. The fungus can also exist in a carrier state on the scalp, without clinical symptomatology. Treatment of tinea capitis requires an oral anti fungal agent; griseofulvin   is the most commonly used drug, but other newer antimycotic drugs, such as trebinafine, itraconazole, and fluconazole have started to gain acceptance, topical treatment include selenium sulfide shampoo. Unani system of medicine Qooba resembles saafa  especially safa e yabisa. It may be be huzaz but according to some huzaz is the qooba of scalp. Tinea faciei (face) Tinea faciei is a fungal infection of the face.It generally appears as a red rash on the face, followed by patches of small, raised bumps. The skin may peel while it is being treated. Tinea faciei is contagious just by touch and can spread easily to all regions of skin. Tinea barbae (beard) Tinea barbæ (also known as "Barber's itch, "Ringworm of the beard," and "Tinea sycosis"1) is a fungal infection of the hair. Tinea barbae is due to a dermatophytic infection around the beard area of men. Generally, the infection occurs as a follicular inflamation, or as a cutaneous granulomatous lesion, i.e. a chronic inflammatory reaction. It is one of the causes of folliculitis. It is most common among agricultural workers, as the transmission is more common from animal-to-human than human-to-human. The most common causes are Trichophyton mentagrophytes and T. verrucosum. Tinea imbricata (overlapping pattern) Tinea imbricate  (also known as "Tokelau") is a superficial fungal infection of the skin limited to southwest Polynesia, Melanesia, Southeast Asia, India, and Central America.  Tinea nigra (black) Tinea nigra  (also known as "superficial phaeohyphomycosis," and "Tinea nigra palmaris et plantaris") is a superficial fungal infection that causes dark brown to black painless patches on the palms of the hands and the soles of the feet. Tinea versicolor (various colors) Tinea versicolor  (also known as dermatomycosis furfuracea, pityriasis versicolor, and tinea flava)] is a condition characterized by a skin eruption on the trunk and proximal extremities, hypopigmentation macule in area of sun induced pigmentation. During the winter the pigment becomes reddish brown. Recent research has shown that the majority of tinea versicolor is caused by the Malassezia globosa fungus, The condition pityriasis versicolor was first identified in 1846. Versicolor comes from the Latin, from versāre to turn + color. Tinea incognito (disguised) Tinea incognito is a fungal infection (mycosis) of the skin caused by the presence of a topical immunosuppressive agent. The usual agent is a topical corticosteroid  (topical steroid). As the skin fungal infection has lost some of the characteristic features due to suppression of inflamation, it may have a poorly defined border, skin atrophy, telangiectasia, and florid growth. Occasionally,  What are the sources of skin fungi? Fungi are microscopic organisms that can live off the dead tissues of your skin, hair,and nails, much like a mushroom can grow on the bark of a tree. others live on animals and only sometimes are found on human skin. Still others live in the soil. It is often difficult or impossible to identify the source of a particular person's skin fungus. The fungi may spread from person to person (anthropophilic), from animal to person (zoophilic), or from the soil to a person (geophilic).

Heat and moisture help fungi grow and thrive, which makes them more commonly found in skin folds such as those in the groin or between the toes. This also accounts for their reputation as being caught from showers, locker rooms, and swimming pools. This reputation is exaggerated, though, since many people with "jock itch" or " athlete’s foot " has not contracted the infection from locker rooms or athletic facilities.

Causes

CAUSES OF QOOBA IN UNANI SYSTEM OF MEDICINE*

.

In unani system of medicine qooba is a superficial fungal infection, of keratinised tissues the infection is commonly designated as Tinea, it is caused by dermatophytes which are a group of taxonomically related fungi belonging to more than 40 closely related species,classified into three genera, viz; Microsporum, trichophyton, and epidermophytonThese tiny organisms normally live on the superficial skin surface, and when the opportunity is right, they can induce a rash or infection

The disease can also be acquired by person-to-person transfer usually via direct skin contact with an infected individual. Animal-to-human transmission is also common. Ringworm commonly occurs on pets (dogs, cats) and the fungus can be acquired while petting or grooming an animal. Ringworm can also be acquired from other animals such as horses, pigs, ferrets and cows. The fungus can also be spread by touching inanimate objects like personal care products, bed linen, combs, athletic gear, or hair brushes contaminated by an affected person.

               Individuals at high risk of acquiring ringworm include those who:

        --     Live in crowded, humid conditions.

        --     Sweat excessively, as sweat can produce a humid wet environment where       the pathogenic fungi can thrive. This is most common in the armpits, groin creases and skin folds of the abdomen.
       --       Participate in close contact sports like soccer ,rugby , or wrestling.

Wear tight, constrictive clothing with poor aeration. They are capable of 

Colonizing keratinized tissue such as stratum corneum of epidermis, nails, and hair. By their metabolic activities, they evoke inflammatory response in the form of erythematous vesiculation, pustulation, microabsces formation, and scaling

Have a weakened immune system(e.g., those infected with HIV or taking Immunosuppressive

Signs and symptoms

It may have a variety of appearances; most easily identifiable are the enlarging raised red rings with a central area of clearing (ringworm). The same appearances of ringworm may also occur on the scalp ,beard area and the groin

Other classic features of tinea corporis include:

·         The edge of the rash appears elevated and is scaly to touch.

·         Sometimes the skin surrounding the rash may be dry and flaky.

·         Almost invariably, there will be hair loss in areas of the infection. .

Diagnosis

Superficial scrapes of skin examined underneath a microscope may reveal the presence of a fungus. This is done by utilizing a diagnostic method called KOH Test, wherein the skin scrapings are placed on a slide and immersed on a dropful of potassium hydroxide solution to dissolve the keratin on the skin scrapings thus leaving fungal elements such as hyphae, septate or yeast cells viewable. If the skin scrapings are negative and a fungus is still suspected, the scrapings are sent for culture. Because the fungus grows slowly, the culture results do take several days to become positive.

Prevention

    Because fungi prefer warm, moist environments, preventing ringworm involves keepin  skin dry and avoiding contact with infectious material. Basic prevention measures include:

·         Washing hands after handling animals, soil, Wearing and plants.

·         Avoiding touching characteristic lesions on other people.

·         loose-fitting clothing.

Practicing  good hygiene when participating in sports that involve physical contact with other people.

Treatment

In unani system of medicine the basic cause of qooba is disarrangement in sauda and dam so the mainstay of treatment is based on the removal of sauda and tasfi e khoon from the body

Most cases are treated by application of topical antifungal creams (marham qooba) to the skin, but in extensive or difficult to treat cases systemic treatment with oral medication may be required. The over-the counter options include tolnaftate

 In unani system itrifal sahtra, Habbe musafi khoon ,Majoon Ushban , Sharbat unaab is used for the treatment of qooba

Among the available prescription drugs , the evidence is best for terbinafine   and naftifine , but other agents may also work.

Topical antifungal are applied to the lesion twice a day for at least 3 weeks. The lesion usually resolves within 2 weeks, but therapy should be continued for another week to ensure the fungus is completely eradicated. If there are several ringworm lesions, the lesions are extensive, complications such as secondary infection exist, or the patient is immunocompromised, oral antifungal medications can be used. Oral medications are taken once a day for 7 days and result in higher clinical cure rates. The antifungal medications most commonly used are itraconazole and terbinafine.

The benefits of the use of topical steroids in addition to an antifungal are unclear. There might be a greater cure rate but no guidelines currently recommend its addition. The effect of Whitfield's ointment is also unclear.

REGIMENTAL THERAPY FOR QOOBA

Ibn e sina has recommended, leeching, bathing, and alteration in dietary habbits 

Ibn e Sina and zakriya Razi advised leeching as the best therapy for qooba. Hammam is also a good option for treatment of qooba 

 Fasd (venesaction) and hijamat bil shurt (wet cupping) has also been found beneficial for qooba

Prognosis

Tinea corporis is moderately contagious and can affect both humans and pets. If a person acquires it, the proper measures must be taken to prevent it from spreading. Young children in particular should be educated about the infection and preventive measures: avoid skin to skin contact with infected persons and animals, wear clothing that allows the skin to breathe, and don't share towels, clothing or combs with others. If pets are kept in the household or premises, they should get the animal checked for tinea, especially if hair loss in patches is noticed or the pet is scratching excessively. The majority of people who have acquired tinea know how uncomfortable the infection can be. However, the fungus can easily be treated and prevented in individuals with a healthy immune system.

Dr. SYED ABDUL RASHEED
BUMS (INDORE)