Treatment.- The treatment of favus of the general surface is exceedingly simple. All that is necessary is to pick off the crusts and make a few applications of tincture of iodine, or other efficient parasiticide, to the affected patches.
When, however, the affection is located on the scalp, it is very difficult to cure. The primary indication is to destroy the parasite. As this fungus flourishes in the lowest depths of the hair follicles, ordinary applications made to the surface are not sufficient. It is necessary to attack the parasite in its stronghold, and this can only be done by first extracting the hairs. These should be removed by properly constructed epilation forceps. After epilation a solution of corrosive sublimate, two grains to the ounce, should be rubbed in. This should be repeated daily until a considerable degree of irritation is produced. The artificial irritation should be sufficient to produce exfoliation of the epithelial lining of the follicle. If the affected surface is at all extensive, it is hardly practicable to epilate and mercurialize the whole of it at a single sitting: it should be done in sections. This treatment should be continued with as much regularity and thoroughness as circumstances will permit. In a few weeks the disease will appear to be cured; but in general this appearance is delusive, and treatment should not be relaxed simply because the disease is no longer visible on the surface. In all cases the patients should be kept under observation for several months after active treatment has been suspended.
Of internal remedies the following may be mentioned:
Agaricus.-Favus with biting itching in the scalp; crusts sometimes spread to other parts of the body; sensation as if ice- old needles were piercing the skin.
Arsenicum alb.- The scalp is found perfectly dry and rough, covered with dry scales and scabs, extending sometimes even over the forehead, face, and ears.
Arsenicum iod.-Scalp dry and rough, and covered with dry scales and scabs; extend to forehead, face and ears; intense itching and burning.
Bromine.-Malignant scald head, oozing profusely; discharge dirty looking, offensive smelling; when the skin is dry, extreme tenderness of the scalp; crawling beneath the skin of the occiput.
Calcarea carb.- Scabs are thick and cover a quantity of thick, pus; the scabs are large, even one-half of the entire scalp being covered with a single scab; eruption spreading to the face; burning itching; glandular swellings on the neck.
Clematis.- Eruption on occiput, extending down the neck, moist, sore, with crawling and stinging itching; often drying up in scales; itching worse when getting warm in bed, and but temporary relief by scratching.
Cornus circinata.- Dry or moist eruption; scrofulosis, with dry spasmodic cough, or tedious chronic cough, with mucous expectoration.
Dulcamara.- In scrofulous children when the crusts are thick and the hair falls out; bleeding after scratching; glandular swellings in the neighborhood of the eruption.
Graphites.- Exudation of clear, glutinous fluid forming moist scabs; secretion from scratching; falling out of hair; skin dry and inclined to crack; tendency to ulceration.
Jacea.- Thick incrustations, pouring out a large quantity of thick yellow fluid, which agglutinates the hair.
Kali carb.- Exudation of moisture after scratching; sensitiveness to cold; frequent urination, especially at night; dryness and falling out of the hair, in old over-treated cases.
Lappa major.- Scalp covered with a grayish-white crust, and most of the hair disappeared; eruption spreading over head, face, and neck; moist foul-smelling eruption on the head of children; swelling and suppuration of the axillary glands; boils all over the body.
Lycopodium.- Eruption beginning on the back of the head; when there are several spots, and when the crusts are fetid, thick and bleed easily. Hunger, but a small quantity of food fills him up.
Mezereum.- Head covered with a thick leathery crust, under which pus collects and mats the hair; dry eruption on the head, with intolerable itching, as if the head were in an ant’s nest. White, scaly, peeling off eruption on the scalp, extending over forehead and temples.
Oleander.- Biting itching on the scalp, as if from vermin; worse back part of head and behind ears; better when first scratching it, followed by burning and soreness; worse evenings when undressing; humid, scaly, biting, itching eruption, especially on the back part of head.
Phosphorus.- May be used when the follicles appear to have been destroyed, and the scalp left smooth and shining.
Psorinum.- Moist, suppurating, fetid eruption, or dry eruption; hair dry, lustreless, tangles easily; averse to having head uncovered; wears a fur cap even in hottest weather.
Staphisagria.- Yellow, moist, offensive, scales; falling out of the hair; humid, itching, fetid eruption on occiput, sides of the head, and behind ears; scratching changes the place of itching, but increases the oozing.
Sulphur.- May be necessary to help along the action of the indicated drug.
Ustilago.- When there is moisture, with matting and falling of the hair.
Vinca minor.- Offensive, moist eruption, with brownish crust; abundance of lice on the head; hair matted together; the hair falls out in singly spots and white hairs grow there.
Viola tricolor.- Thick crusts; hair becomes matted; urine smells like cat’s urine. Swelling of the cervical glands; intolerable itching at night.
Trichophytosis.
Trichophytosis is an affection of the skin, due to the development of a minute fungus known by the name of the Trichophyton tonsurans. The disease itself bears the common name of ” ringworm.” There are four principal varieties of the affection, which present appearances differing somewhat from each other, due to differences of location. These are Trichophytosis capitis, barbae, corporis, and genito-femoralis.
Trichophytosis Capitis.
This variety is almost wholly confined to childhood and youth-very rarely, if ever, appearing in adult life. The symptom that usually first attracts attentions is a small, scaly patch on the scalp, perhaps half an inch in diameter, from which the hair appears to have fallen. On closer examination, however, it is found that, instead of the hairs having fallen, they are broken off a line or two from the surface. If an attempt be made to extract a few of these short stumps with forceps, it will be found that many of them do not come out by the roots, but break off in the follicle, leaving the lower extremity of the root in situ. This fragility of the hairs is a marked feature of the disease, and brings it into contrast with favus, in which affection the hair-shafts are not notably weakened.
If one of the extracted hair-stumps be examined under the microscope, it will be found infiltrated throughout its entire extent with the minute spores of the Trichophyton. This fungus, when it takes lodgment on the scalp, gains access to the hair- follicles, into which it descends until it reaches the bottom. Here it increases and invades the root, and travels up the shaft toward the surface. It produces dissociation of the fibres, and thereby weakens the hair. after the surface is reached, there is no outside pressure to counteract the pressure from within the shaft, and the latter gives way and breaks off. The original patch extends centrifugally, and new ones from, so that after a few weeks or months there may be a pretty complete involvement of a considerable portion of the scalp.
In scrofulous subjects, or those prone to suppurative action, the irritation of the fungus may cause the formation of little collections of pus on the substance of the scalp, which, opening on the surface, give a honey-combed appearance to the lesion, to which the older writers assigned the name of kerion.
When left to nature, the affection persists indefinitely, apparently as long as the hairs and hair-follicles afford sufficient pabulum for the fungus. The ultimate termination is baldness. The circular patches on the scalp may spread beyond the line of the hair and down upon the adjacent uncovered skin; and in the form of trichophytosis corporis may appear on other parts of the body.
Trichophytosis Barbae.
This variety is confined to adult males, and appears on the bearded portions of the face and neck. At its first appearance we usually find a small, red, and very slightly raised spot. In a few days this develops into a distinct ring, with elevated margin, gradually increasing in size, and new spots and rings appearing. Accompanying these lesions we may have pustules, tubercles, and sometimes considerable infiltration of the integument-in fact, something not unlike the kerion of children. If shaving be practiced, the irritation is increased. The hairs sometimes break and sometimes fall out, and, if examined microscopically, will be found infiltrated with the fungus.
Trichophytosis Corporis.
This is the ordinary ringworm of the body, and is too familiar to need any special description. Appearing at first as a small red spot, it soon assumes the annular form, bounded by a slightly reddened and raised periphery. The centre of the patch is apparently healthy, or, at most, slightly reddened. When two neighboring rings extend until they meet, the elevated margins which are in contact melt away, and we may have a figure eight, or some similar form.
