The Superficial M if coses L21 



At limes patients arc seen who present SOggy, thickened, Iioim \ -combed 



solos, most involved over points ol pressure. The odor is that ol dirty feet. 

 Although this condition is almost invariabl) attributed to fungous infection, 

 the results ol culture are usually negative. It is our opinion that hyper- 

 hidrosis plus bacterial invasion is responsible. 



Dermatitis venenata due to sensitivity to shoe leather, to the dye in 

 stockings, to loot powder and to corn cures and the like should be con- 

 sidered when the inflammatory disorder is first limited to the region ol the 

 contacted substance. Once this dermatitis is established, secondary eczem- 

 atous changes may quickly occur, further confusing the picture. The 

 lack of other evidence of fungous disease, the negative findings on myco- 

 logic examination, the results of patch testing and cine when the offending 

 article is eliminated from the environment of the patient aid in establishing 

 the correct diagnosis. 



When part of a widespread eczematous condition, whether due to con- 

 tact or to some other cause, the involvement of the feet or ankles may mis- 

 lead the unwary physician. He may consider the whole eruption mycotic 

 because the feet are involved. In these cases, if the trichophytin reaction 

 is negative, the diagnosis of tinea may be excluded. 



The disease known as pustular psoriasis frequently presents a confusing 

 picture. The lesions appear in groups of small, thick-walled pustules. The 

 arch and the heel are the commonest locations on the foot, but lesions may 

 develop elsewhere. Frequently the hands are concomitantly involved. The 

 lesions are usually sterile. Barber, Andrews, Hopkins and others have ob- 

 served that in such cases cure has resulted from the removal of foci of 

 infection. The resemblance to tinea pedis may be striking, but lack of 

 interdigital infection, localization, resistance to therapy and lack of myco- 

 logic confirmation should be sufficient to indicate the correct diagnosis. 



With acrodermatitis perstans or dermatitis repens, which are similar, if 

 not identical, disorders, the initial lesion is usually paronychia. From this 

 arises an undermining pustular eruption, which spreads on one digit and 

 may finally involve large sheets of skin. If the condition is untreated, an 

 exudative eczematous process ultimately develops. 



Streptococcic infections have been credited by Mitchell with causing 

 lesions on the feet which resemble those due to fungi. 



Orbicular eczema is superficial, does not show a tendency to central 

 clearing and does not respond to the usual fungicides. Results of all labo- 

 ratory examinations are negative. 



(■3) Chronic types of infection. 



a. Psoriasis. So-called aberrant types of psoriasis are usually due to T. 

 purpnremn. While the diagnosis can be made with certainty only from 



