This form of Trichophytosis rarely gives rise to much inconvenience by itself, except in tropical countries, when this fungus is found to flourish with a vigor not met with in cooler regions.
Trichophytosis Genito-Femoralis.
This is not a very uncommon variety of ring worm, and is almost wholly confined to adult males. The usual location is at the upper and inner aspect of the thigh and contiguous parts. It generally involves a portion of the scrotum as well as the thigh.
The diagnosis of t. capitis is usually easy, as the broken- off hair-stumps are characteristic. T. barbae, when seen early, and before marked inflammatory action has changed the aspect of the part, ought to be recognized without difficulty, but later in the course of the disease it might be mistaken for eczema barbae, or so-called non-parasitic sycosis. Ringworm of the body is recognizable under almost any condition that can be imagined, and Trichophytosis genito-femoralis equally so, unless obscured by a co-existing eczema. Under all circumstances, however, the microscope may be relied on to settle the diagnosis.
Etiology.- Trichophytosis is due to a vegetable parasite, and is propagated from one to another by contact. Ringworm of the head is usually contracted by the careless habit among children of wearing each other’s headgear, and in public institutions by the common use of brushes and combs, towels, etc. In nursing infants the trouble is sometimes conveyed to the breasts of their mothers.
Ringworm of the beard is perhaps more frequently contracted at barber shops than elsewhere, from the use of contaminated utensils, and may be passed in turn to the lips or cheeks of young women.
Trichophytosis is met with in the rat, cat, dog, cow, horse, and perhaps in other animals, and may be conveyed by them to man. Cavalrymen, who are accustomed to practice their exercise on bare-back horse, sometimes contract the genito-femoral variety.
Treatment.- The cure of t. capitis is by no means easy. Methods of treatment innumerable have been and are being proposed; but none are simpler or more effective than the treatment originally proposed by Bazin forty years ago. This consists in thorough epilation, combined with applications of a solution of bichloride. If the parasite is destroyed, the affection ceases; hence the first object is to secure destruction of the Trichophyton. The spores, however, are deeply buried in the hair-follicle, and are not easily reached by lethal applications while the hairs are still in situ. The first thing to be done, then, is to remove them as thoroughly as possible with the aid of a properly constructed epilation forceps.
Attack the affected spot or spots with forceps, extracting every hair-stump possible. Many will break off; but do not leave a single one visible above the surface. Then thoroughly wash with a bichloride lotion, of the strength of one to three grains to the ounce. Apply this daily, unless it produces too much reaction, in which case dilute it, or omit for a few days. At the end of a week, again, with forceps in hand, repeat the epilation, as many of the broken hairs will have appeared above the surface. Extract as many of them as possible, and continue this treatment as long as necessary, which may perhaps be six weeks or six months, according to the extent of the disease, or the intelligence and care with which the treatment is carried out, remembering that patience and bichloride will succeed in the end.
The following makes a good application:
Rx. Carbolic acid, Chloral, Tincture Iodine, aa z3jjj.
M. Sig.: apply once a day with a brush. Three or four times for ringworm.
Ringworm of the beard demands and will respond to the same treatment.
Ringworm of the non-hairy parts is a very readily curable affection. Sulphur ointment, any form of mercurial ointment, tincture of iodine, or chrysarobin dissolved in traumaticin. A few applications of either of these will promptly remove the trouble.
Ringworm of the crotch may be treated in a similar manner, without epilation-an excellent application being a solution of six or seven grains of chrysarobin in an ounce of traumaticin.
Internal remedies :
Sepia and Tellurium are adapted to the ringworm variety, as occurring on either body or scalp.
See remedies under ” Favus.”
Chromophytosis.
Chromophytosis is a parasitic affection characterized by the appearance of yellowish-brown spots on the skin.
The discolored spots are in the beginning small and irregularly scattered over the invaded surface. They are very slightly, if at all, elevated, and are covered with minute, barely perceptible scales. The affections is usually confined to the trunk and upper extremities, almost never appearing on the lower limbs. Its favorite seat is the chest and back; but it may spread to the neck and down upon the abdomen, and upon the arm between the shoulder and elbow. The macules may be very numerous, and many of them not larger than a pea; or they may coalesce by mutual extension, and form patches of considerable size.
The progress of the affection is slow; and it is not uncommon to meet with cases in which the lesions have existed for several years. It is sometimes met with in the strong and hearty, but most commonly in those who are enfeebled by chronic disease, and is especially frequent in those who are suffering from phthisis or syphilis. It was, in fact, at one time classed as a symptom of phthisis. This was, of course, before the true nature of the disease had been ascertained. It is usually more noticeable in winter than in summer, a fact explainable by the lighter clothing and more frequent ablutions in warm than in cold weather. Itching is sometimes present, but is rarely severe enough to seriously incommode the patient.
Etiology.- Chromophytosis is cause by the development of a minute fungus, called the microsporon andonini among the superficial epidermic cells. Being of a parasitic nature, it is presumably contagious.
Treatment.- This affection is easily cured, provided proper treatment is instituted and persisted in. The one prominent indication is to destroy the superficial epithelial cells, and bring about their exfoliation, bringing with them the parasite. The list of agents that will accomplish this is a long one; but those found most generally useful are lotions of bichloride, tincture of iodine, sulphur ointment, and chrysarobin. If seven or eight grains of the latter be added to an ounce of traumaticin, and painted upon the spots for several days in succession, the epidermis will soon desquamate. For the treatment to be effectual, it is necessary that every spot, no matter how minute, should receive the selected application. This is rarely done the first time, and the case should be inspected weekly by the physician, and the applications made by him so far as practicable. It must not be forgotten that the under clothes need disinfection or destruction; otherwise the affection is very liable to recur.
Onychomycosis.
This term is used to designate disease of the nails due to the attack upon them of vegetable parasites. The name of the fungus is the achorion.
Speaking generally, the effect of the attack of the fungus upon the nail is to thicken it, to render it brittle, to break it up into layers, and to make it opaque, or it may be yellowish. The seat of the fungus growth is shown in some cases in the early stage by yellowish specks imbedded in the nail, and the fungus oftentimes attacks in the first place the side or the part near the root of the nail, giving rise to a certain amount, it may be, of inflammation and discomfort.
This condition of nail has been produced in those who have attended to children’s heads affected with ringworm, in one or more nails, and as an independent state of disease or preceded by tinea circinata of the fingers or back of the hand, which has spread to the nail, and in that way infected it.
The diagnosis is made by paying attention to the co- existence of parasitic disease, and by the microscopical examination. It must not be forgotten that the nails are rendered opaque, thick, and brittle in connection with psoriasis, pityriasis rubra, lichen ruber, and the like; but in parasitic pityriasis cases the evidence of the connection between the nail and the general disease and the origination of the former from the latter is usually clear.
The treatment is, the majority of cases, very satisfactory, but in order that a successful result may be attained speedily it is necessary that the parasiticide should be made to reach the deeper parts of the nail, and that the nail structure should be kept soaked in the parasiticide lotion. Scrape off some of the loose laminae of the nails, then apply every second or third day some strong acetic acid to the seat of the change, the whole nail area if necessary, taking care not to make the matrix too tender; and then keep the nail or nails soaked in a solution of hyposulphite of soda (z3ss to z3vj of water). Perseverance with the lotion will certainly cure the disease.
