The Superficial Mycoses 63 



M. audouini or M. fulvum) arc all revealed as bright green stubs under 

 the- rays. In the very early stage of infection the color may be noted only 

 in the portion ol the infected hair nearest the scalp. No fluorescence will 

 be revealed in infections due to M. ferrugineum. Hairs infected with A. 

 schoenleinii vary from lighter green to dull gray; when T. violaceum, T. 

 crateriforme or T. sulfureum is the infecting micro-organism the hair is dull 

 gra\ and yet to be differentiated from normal hair. Light brown or gray 

 hair fluoresces somewhat. This might lead to confusion as also might the 

 fluorescence due to petrolatum or to some drugs. 



We believe use of filtered ultraviolet rays to be of the utmost impor- 

 tance in the diagnosis and management of tinea of the scalp. Their use to 

 determine when cure has taken place is indispensable; if the patient is 

 being treated by topical applications, progress may be noted under the 

 rays. Cleveland raised the question whether a child might show fluorescence 

 but be noninfectious when the disease was asymptomatic. He found that 

 such is not the case, being able to reproduce the disease from such cases 

 in animals. He points out the danger to others when children who are 

 clinically cured and yet have infected hairs, as revealed by the fluorescence 

 test, are not treated or whose treatment is lapsed. This method of exam- 

 ination, however, should not entirely supersede the older procedures. It 

 is important to observe fungous elements under the microscope, and it is 

 desirable to culture the causative micro-organism. 



(f) Differential diagnosis.— It is taught at the Cornell University 

 Medical School that patchy loss of hair from a child's scalp denotes ring- 

 worm until repeated laboratory investigation has failed to substantiate 

 the diagnosis. When there is little inflammatory reaction, alopecia areata 

 may be simulated. In alopecia areata, however, there is a sudden complete 

 loss of hair with no scaling on the surface of the patch. Trichotillomania 

 and trichokyptomania have proved puzzling to us in a few instances, but 

 in such cases the child is usually neurotic, the apparent or actual loss of 

 hair is near the front of the scalp, and again there is no scaling. 



Seborrheic dermatitis may be differentiated by the presence of greasy 

 scales and the absence of patchy loss of hair. The superficial form of favus 

 may so closely resemble seborrheic dermatitis that only the lack of response 

 to therapeutic agents may favor the diagnosis of favus. 



When marked inflammation is present, pyoderma is the chief condition 

 to differentiate. Pyodermic lesions on the scalp of a child usually spell 

 pediculosis, and an inspection of the scalp ordinarily reveals nits. Pustular 

 lesions, however, ma}' appear secondarily to a focus of infection such as a dis- 

 charging ear. We have observed an instance of pustular lesions of the scalp^., 

 due to the ingestion of iodized salt. /yS*Z~- 



