52 An Introduction to Medical Mycology 



consider kerion to be more than a marked tissue reaction to the infecting 

 micro-organism: at the top of the list, so to speak, with simple scaling 

 at the bottom. Kerion is a painful, elevated, boggy, erythematous, local- 

 ized tumefaction due to one of several species of fungi. We have records 

 of kerion due to M. lanosum, M. audouini, Microsporum fulvum, Tricho- 

 phyton crateriforme, T. gypseum and Trichophyton niveum. In the main, 

 the characteristics of kerion are the same, irrespective of the causal fungus, 

 and in most instances cure of the fungous infection follows the disappear- 

 ance of the kerion. 



In another particular we deviate from the customary teaching. We 

 cannot see any logic in the traditional respect paid to favus when it is 

 considered more than a type of tinea capitis. The clinical findings of favus 

 are frequently characteristic, so the retention of the name is useful. 



Since the clinical findings and the course of the disease vary a great 

 deal, according to the infecting micro-organism, we shall discuss tinea 

 capitis further under the headings of the causative fungi as follows: 



(1) Microsporum audouini.— This fungus is responsible for the classic 

 type of scalp ringworm known as the "gray patch"; it is the common 

 cause of epidemics in orphanages and other institutions. The onset is usually 

 insidious, and the duration of the infection averages over eight months. 

 When the condition is first detected by the parent, guardian or teacher, 

 there are several small areas in which the hair is dull and broken off. The 

 surface of the patch is usually scaly. As a rule little redness is noted, but 

 occasionally a considerable degree of inflammation may be present. We 

 have observed that the infection frequently begins along the part of the 

 hair or where the hair is short. When first examined, the lesions are usually 

 in the occipital and temporal regions. Usually a number of lesions spread 

 peripherally, finally becoming as large as a silver dollar or larger. There 

 is not much tendency for the infection to spread to other parts of the body. 

 In the cases observed in New York during an epidemic ( 1943 to 1947 ) 

 there was a tendency for the infection to localize to the occipital region. 

 The lesions were more frequently inflammatory than in the ordinary spor- 

 adic disease, and associated lesions on the glabrous skin were more com- 

 monly observed than in the sporadic cases. Montgomery and Walzer re- 

 ported a case of infection of the eyelashes in a patient with tinea capitis. 



(2) Microsporia)! lanosum.— There may or may not be a history of contact 

 with a stray or newly acquired kitten or other young animal. Various 

 home and proprietary remedies have usually increased the inflammation. 

 In other members of the family, particularly the mother or other children, 

 lesions ma\ develop on the glabrous skin. The infection tends to show con- 

 siderable inflammatory reaction. The first patch to develop is frequently 



