The Superficial Mycoses 1 L3 



Friction and frequent washing in all probability make the scaling less ap- 

 parent than that on the soles. The erythema may be slight and the condition 

 thus be considered a callus. Isolated irregular patches may he present about 

 the dorsum of the hand and on the fingers, as is the case with the feet. 

 Frequent!) the skin of an entire finger is involved. Redness of the skin 

 with or without sealing may he 1 noted oxer the joints ol the hands. Fissuring 

 in affected patches about the joints is a fairly constant feature. The absence 

 of vesiculation, except in rare instances, and the presence of severe itching 

 are again notable. On several occasions, when the palm was involved, we 

 observed a marked decrease 1 in the amount of sweat. 



b. Involvement of the nails. Nails infected with any pathogenic fungus 

 except M. albicans are usually opaque, lusterless, friable and yellowish. 

 Varying degrees of dystrophy, as evidenced by irregularities of the nail 

 plate, separation of the nail and subungual hyperkeratosis, are frequently 

 present. 



Nails infected with T. purpureum sometimes have certain features pecu- 

 liar to this organism and not always shared by nails infected by other 

 fungi. Unlike ungual infections caused by T. gypseum, the condition due 

 to T. purpureum does not often concomitantly involve the interdigital 

 webs of the toes. Furthermore, a superficial location of the infection on 

 the surface of the nail is frequent with T. gypseum but practically un- 

 known with T. purpureum. The duration of the infection is shorter and 

 the progress of the infection is faster with T. gypseum. 



The onset and progress of the ungual infection due to T. purpureum is 

 slow 7 and insidious. When the condition is first observed, one or more 

 nails may be involved. Frequently the patient who has applied for treat- 

 ment of infected fingernails may unknowingly have involvement of the toe- 

 nails and even of the feet. There is little reaction in the subungual and 

 paronychial tissues. We have not observed paronychia in our eases. (Com- 

 pare infections due to T. gypseum or to M. albicans.) 



The infection usually begins under the free border or along the lateral 

 margins of the nail plate. We have observed a single ease in which the 

 infection started in the proximal portion of the nail. Yellow or white ver- 

 tical streaks may appear in the nail, seeming to result from separation of 

 the nail plate from its bed. These streaks gradually widen; the nail sepa- 

 rates more and more and debris accumulates. There may be gradual in- 

 volvement of the distal end of the nail, without the usual formation ot 

 streaks. Meanwhile the nail itself becomes thinned, owing to gradual in- 

 vasion of the fungus. The nail becomes brittle, and the 1 distal portion may 

 be broken or worn of], leaving only the proximal part. Sometimes the entire 

 nail plate is lost, leaving the nail bed covered with scales and debris. 



