A system of practical medicine. By American authors. Vol. 4

by Unknown

Rx.	Iodinii,	drachm ij;
	Olei picis,	ounce j. M.

This is painted on the patch, and permitted to remain on until the crust comes off, then is reapplied: a few applications are sometimes sufficient. In tinea kerion the hairs are extracted and a mild parasiticide applied: sulphurous acid, a weak solution of corrosive sublimate, carbolic acid, ten to twenty grains to the ounce of water, or a weak ointment of the oleate of mercury or of white precipitate, may be employed.

If the disease proves obstinate, resisting the above treatment, it may be necessary to adopt stronger applications with a view of producing an acute inflammation in the part. To be efficacious the inflammatory action should be marked. For this purpose croton oil is used. It should never be employed when the disease is extensive; or if used in such cases a small area only, not exceeding that of a quarter dollar, should be treated at one time. Although valuable, the remedy is severe, and must be used cautiously. It may be applied pure or weakened with two or three parts of olive oil. An application requires but a small quantity, as it is apt to involve the skin beyond the area of application. In some cases a single application is sufficient; in others several or more are necessary before the requisite amount of follicular inflammation and suppuration results. The applications should be made by the physician, as it is not a safe remedy to entrust to attendants. After the application the part should be poulticed, and subsequently epilation practised and mild parasiticides employed. Instead of using croton oil, the patches may be painted with glacial acetic acid or cantharidal collodion once a week, and mild parasiticides, as sulphurous acid, carbolic-acid lotion, or sulphur ointment, applied in the interval. From time to time in the treatment of the disease, usually at intervals of from three to four weeks, applications should be discontinued a few days, and a microscopic examination of the scales and hairs made: if fungus is found, treatment is to be resumed.

TINEA SYCOSIS.—Tinea sycosis, or parasitic sycosis, is a disease confined to the hairy portions of the face and neck in the adult male, involving the hair and hair-follicles, with inflammation of the skin and subcutaneous connective tissue, and the formation of tubercles and pustules. It is popularly known under the name of barber's itch. It usually begins as one or more small, red, scaly spots, similar, in fact, to ringworm on the non-hairy portions of the surface. The redness and scaliness increase, and swelling and induration are noticed. In a short time the hairs are involved, become dry, brittle, inclined to break, and begin to fall out, the same changes occurring as noted in ringworm of the scalp. The fungus passes to the hair-follicles; perifollicular inflammation is set up, and results in the formation of deep-seated tubercles, varying in size from a pea to that of a cherry, giving the part a distinct nodular appearance. These coalesce and give rise to lumpy patches. The surface is of a deep reddish or purplish color; pustulation is noted about the openings of the hair-follicles. More or less crusting may take place; if removed, the hairs may come away with it. The amount of suppuration depends upon the grade of inflammation. Sometimes the hair-follicles are destroyed and permanent alopecia results.

The disease may involve a small area, appearing as a sharply-circumscribed, prominently-raised, deep-seated, nodular, coin-sized patch, with or without a purulent discharge from the emptied hair-follicles or with crusting; or the whole bearded region of the neck and chin may be invaded. It is not common on the upper lip or the upper bearded portion of the cheeks. Burning and itching are usually present, but are variable as to degree. The disease tends to chronicity. It is not uncommon at the same time to see patches of ringworm on other portions of the body. It is markedly contagious, although individuals differ as to susceptibility. It is often contracted at the hands of a barber. The fungus (trichophyton) which gives rise to the disease invades the same parts as when seated upon the scalp—the epidermis and the hair and hair-follicles; the latter are usually found permeated with spores, the mycelium being scanty.

The affection is not common, its frequency varying in different countries. It is to be distinguished from simple (non-parasitic) sycosis, pustular eczema, and the vegetating syphiloderm. In simple sycosis the process is comparatively superficial and confined to the hair-follicles; the hairs are not involved, and in the beginning, at least, are seated firmly in the follicles. In tinea sycosis the skin and subcutaneous connective tissue are extensively involved, resulting in the formation of nodular masses—a condition that is characteristic; the hairs are affected, are loose, and often fall out. In doubtful cases the microscope will determine. From pustular eczema it may be differentiated by its history and course: its clinical features are entirely dissimilar. Eczema is never attended with the nodular and tubercular formation peculiar to this disease, nor are the hairs affected. The absence of ulceration will distinguish the disease from the vegetating syphiloderm. Tinea sycosis when occurring as a circumscribed patch may sometimes resemble carbuncle.

In the treatment epilation with the use of parasiticides is employed; as a rule, the disease yields readily to treatment. Crusts, if present, are to be removed by means of oily applications and washings with castile soap (or if necessary sapo viridis) and warm water. The parts should be clipped or shaved, preferably the latter. Although this operation is painful at first, later it may be accomplished without much discomfort; shaving every second or third day is frequent enough. In the interval epilation is to be practised. The milder parasiticides, as sulphite or hyposulphite of sodium, a drachm to the ounce of water or ointment; sulphurous acid, full strength or diluted; citrine ointment, two or three drachms to the ounce of vaseline or lard; and a weak sulphur ointment,—are all useful. A 10 to 30 per cent. ointment of oleate of mercury is a valuable remedy; the same may be said of a solution of corrosive sublimate, two to four grains to the ounce of water or alcohol. In addition, the other parasiticides mentioned in the treatment of ringworm of the body or scalp may be referred to. The applications should be made twice daily; together with epilation they should be continued until microscopical examinations of the hairs give negative results.

Tinea Versicolor.

Tinea versicolor is a vegetable parasitic disease due to the microsporon furfur, characterized by variously-sized, irregularly-shaped, dry, slightly furfuraceous, yellowish, macular patches, occurring for the most part upon the trunk and in adults. The affection may be slight, consisting of several small patches on the upper part of the chest, or so extensive as to involve the greater part of the trunk, neck, axillæ, flexures of the elbows, groins, and in very rare instances the face. It never occurs on the scalp, hands, or feet. As commonly met with, it is a disease of the trunk, especially the anterior portion of the thorax. It begins as small yellowish or brownish, fawn-colored, furfuraceous spots scattered over the region affected. These gradually increase in size, new spots may appear, and considerable surface may be invaded. In size they vary from a pea to large irregular patches, and are scarcely, if at all, elevated. The larger patches are irregular, and usually formed by coalescence of several smaller spots. Rarely patches may clear up in the centre and assume an annular form.