Part 86

Upon the general surface it usually responds readily to treatment, excepting favus of the nails, which is always obstinate.

#How is favus of the scalp treated?#

Treatment is entirely local and consists in keeping the parts free from crusts, in epilation and applications of a parasiticide.

The crusts are removed by oily applications and soap-and-water washings. The hair on and around the diseased parts is to be kept closely cut, and, when practicable, depilation, or extraction of the affected hairs, is advised; this latter is, in most cases, essential to a cure. Remedial applications--the so-called parasiticides--are, as a rule, to be made twice daily. If an ointment is used, it is to be thoroughly rubbed in; if a lotion, it is to be dabbed on for several minutes and allowed to soak in.

#Name the most important parasiticides.#

Corrosive sublimate, one to four grains to an ounce of alcohol and water; carbolic acid, one part to three or more parts of glycerine; a ten per cent. oleate of mercury; ointments of ammoniated mercury, sulphur and tar; and sulphurous acid, pure or diluted. The following is valuable:--

Sulphur, præcip., .................... ij Saponis viridis, Ol. cadini, ....... [=a][=a] ......... j Adipis, .............................. ss. M.

Chrysarobin is a valuable remedy, but must be used with caution; it may be employed as an ointment, five to ten per cent. strength, as a rubber plaster, or as a paint, a drachm to an ounce of gutta-percha solution. Formalin, weakened or full strength, has been extolled. Some observers have experimentally tried the effect of x-ray exposure with alleged good results, pushing the treatment to the point of producing depilation; if used great caution should be exercised.

#How is favus upon the general surface to be treated?#

In the same general manner as favus of the scalp, but the remedies employed should be somewhat weaker. In favus of the nail frequent and close paring of the affected part and the application, twice daily, of one of the milder parasiticides, will eventually lead to a good result.

#Is constitutional treatment of any value in favus?#

It is questionable, but in debilitated subjects tonics, especially cod-liver oil, may be prescribed with the hope of aiding the external applications.

#Tinea Trichophytina.# (Synonym: Ringworm.)

#What is tinea trichophytina?#

Tinea trichophytina, or ringworm, is a contagious, vegetable-parasitic disease due to the invasion of the cutaneous structures by the vegetable parasite, the trichophyton, or the microsporon Audouinii.

#Do the clinical characters of ringworm vary according to the part affected?#

Yes, often considerably; thus upon the scalp, upon the general surface, and upon the bearded region, the disease usually presents totally different appearances.

#Describe the symptoms of ringworm as it occurs upon non-hairy portions of the body.#

Ringworm of the general surface (tinea trichophytina corporis, tinea circinata) appears as one or more small, slightly-elevated, sharply-limited, somewhat scaly, hyperæmic spots, with, rarely, minute papules, vesico-papules, or vesicles, especially at the circumference. The patch spreads in a uniform manner peripherally, is slightly scaly, and tends to clear in the centre, assuming a ring-like appearance. When coming under observation, the patches are usually from one-half to one inch in diameter, the central portion pale or pale red, and the outer portion more or less elevated, hyperæmic and somewhat scaly. As commonly noted one, several or more patches are present. After reaching a certain size they may remain stationary, or in exceptional cases may tend to spontaneous disappearance. At times when close together, several may merge and form a large, irregular, gyrate patch.

Itching, usually slight, may or may not be present.

Exceptionally ringworm appears as a markedly inflammatory pustular circumscribed patch, formerly thought to be a distinct affection and described under the name of conglomerate pustular folliculitis. It consists of a flat carbuncular or kerion-like inflammation, somewhat elevated, and usually a dime to silver dollar in area. The most common seats are the back of the hands and the buttocks. The surface is cribriform, and a purulent secretion may be pressed out from follicular openings.

#Describe the symptoms of ringworm when occurring about the thighs and scrotum.#

In adults, more especially males, the inner portion of the upper part of the thighs and scrotum (tinea trichophytina cruris, so-called eczema marginatum) may be attacked, and here the affection, favored by heat and moisture, develops rapidly and may soon lose its ordinary clinical appearances, the inflammatory symptoms becoming especially prominent. The whole of this region may become involved, presenting all the symptoms of a true eczema; the border, however, is sharply defined, and usually one or more outlying patches of the ordinary clinical type of the disease may be seen.

#Describe the symptoms of ringworm when involving the nails.#

In ringworm of the nails (tinea trichophytina unguium) these structures become soft or brittle, yellowish, opaque and thickened the changes taking place mainly about the free borders. Ringworm on other parts usually coexists.

#Describe the symptoms of ringworm as it occurs upon the scalp.#

Ringworm of the scalp (tinea trichophytina capitis, tinea tonsurans) begins usually in the same manner as that upon the general surface, but, as a rule, much more insidiously. Sooner or later, however, the hair and follicles are invaded by the fungus, and in consequence the hair falls out or becomes brittle and breaks off. The follicles, except in long-standing cases, are slightly elevated and prominent, and the patch may have a puffed or goose-flesh appearance. In addition, there is slight scaliness.

#Describe the appearances of a typical patch of ringworm of the scalp.#