108 An Introduction to Medical Mycology 



\. Involvement of the hands and feet. The appearance of the eruption 

 on the feet and on the hands appears to be peculiar to T. pnrpurenm. Le- 

 sions of the feet may occur on the soles, the sides, the dorsa, the toes or 

 the nails. The plantar surface is a common site. When the hands are in- 

 \ ol\ ed, the palms, the dorsa, the fingers or the nails may be affected. Itching 

 is frequent. 



The entire sole is frequently involved, but the infection may be localized 

 to a small area around the heel or on the ball of the foot. When the sole 

 is involved, the infection usually extends to the sides of the foot and about 



TABLE 17.— Location- of Infection Caused by T. Purpureum in 240 Patients 



Skin 



Feet 180 



Hands 44 



Trunk, arms and legs 27 



Inguinal region 35 



Trunk ( gyrate ) | 5 



Face 3 



the heel. The infected skin is dull red and slightly thickened or indurated. 

 The scaling, which is constant, is usually fine and thin (branny), in contrast 

 to the large flaky scale found in psoriasis or in some types of dermatophy- 

 tosis. The absence of visible vesiculation in the infected area is a per- 

 sistent feature. Hopkins and his group reported that in many of the patients 

 with T. purpureum infections studied at Fort Benning, 1942-45, the erup- 

 tion was acute, severe and extensively vesicular. This is at variance with 

 our (civilian) experience and may be explained partially by the climate 

 and conditions under which the soldiers were living and the probability 

 that these young men were experiencing their initial attack. There is usu- 

 ally a sharply marginated border along the outside of the foot, between the 

 infected skin and the normal skin on the dorsum. 



Small irregular infiltrated erythematous and scaly patches may be 

 found on the dorsum of the foot and on the toes. The degree of erythema 

 may vary within a single patch. There is no tendency to central clearing. 



The infection of the under surface of the toes and of the interdigital 

 webs is clinically similar to the infection of the sole, sometimes with the 

 addition of a certain amount of maceration. When the entire area about the 

 toe is infected, the skin appears thickened and dry. Painful fissuring may 

 occur about the joints. 



The eruption on the hands is similar to that on the feet. The entire palm 

 may exhibit the characteristic dull red color, with thickening and scaling. 



