CHAPTER 



The Superficial Mycoses 



IN THE majority of cases of fungous infection the eruption is confined to 

 some part of the skin. There are two large groups of the mycoses: (1) 

 ringworm, or tinea, in which the site of invasion and propagation of the fun- 

 gus is keratin (stratum corneum, hair, nails) and in which, while dissemi- 

 nation by the blood stream may occur, the involvement of visceral organs 

 is unknown, and (2) moniliasis, in which the yeastlike micro-organism is 

 found in intertriginous areas but is also a common silent inhabitant of 

 the gastrointestinal tract. Included also are tinea versicolor, erythrasma, 

 myringomycosis, tinea imbricata and several other tropical mycoses and 

 other fungous diseases which do not produce granulomas. Some workers 

 subdivide the superficial mycoses into parasitic and saprophytic types, 

 according to the degree of cellular reaction in the adjacent tissues. We do 

 not share their point of view, since some of the more virulent (difficult to 

 cure) infections caused by organisms such as T. purpureum or A. schoen- 

 leini show little reaction in the tissues, invoke little or no immunologic 

 response and yet, therapeutically, are the opprobrium of dermatologists. 

 To call these organisms saprophytes might be correct in the sense that 

 they do not provoke reaction in the host, but this would be misleading from 

 the aspect of response to treatment. 



As a group, the superficial mycoses show a wide diversity of types and 

 characteristics, and no generalization may be offered regarding their re- 

 sponse to treatment. They constitute the bulk of fungous infections which 

 plague the general population. The incidence of species varies in different 

 parts of the world. We shall consider the various phases of the subject, 

 including the clinical features and the treatment, under the respective 

 titles. It is of interest, but so far of not much practical importance, that 

 multiple fungous infections involving different species of dermatophytes 

 are not uncommon. Muskatblit and we also have recorded a number of 

 instances in which one infection antedates another, in which the different 



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