The Superficial Mi /coses 12, 



rected, the results oi treatment maj be disappointing. Everything else being 

 equal, tin* longer the duration and the more numerous the areas <>1 skin 

 actuall) involved, the more difficult it is to eradicate the disease. 



(j) TREATMENT OF SKIN.— Few dernuUologic diseases have reeeived more 

 attention and space in scientific journals than deriuatoph\ tosis. The ma- 

 jority ol the articles are clinical, and most are concerned with therapy or 

 prophylaxis. It is unnecessar) to mention the long list of proprietary drugs 

 extensivel) advertised and sold to the public. In most textbooks as well, 

 a long list of drugs and formulas is given. All this has led to confusion, and, as 

 Osier has pointed out, the very multiplicity of remedies lor a disease means 

 that no one remedy has much value. 



We agree with .Mitchell that in an approach based on scientific logic- 

 one should first make an accurate- diagnosis. Suppose that the disorder is 

 localized to an interdigital web. We have mentioned that from the clinical 

 signs one may not be able to differentiate between T. gypseum and T. 

 purpureum as the causative fungus. A cultural diagnosis will assist one to 

 determine the prognosis and the importance of treatment. Thus if T. pur- 

 pureum is cultured, the interdigital maceration may be hard to eradicate, 

 but treatment is essential if other areas are not to be subsequently infected. 

 With T. gypseum, on the other hand, therapy is usually effective, but one 

 need not be seriously disturbed if the treatment is not carried out faithfully. 



The type of treatment should be indicated by the type of fungus present, 

 cutaneous sensitization or lack of it and the clinical signs. 



Our methods of treatment and their results leave much to be desired. 

 Bechet stated an obvious truth when he declared that "the more experience 

 one gains in the treatment of this obstinate dermatosis, the less faith one 

 has in our present methods of treatment." 



The various forms of therapy will be discussed according to the follow- 

 ing subdivisions: (1) topical applications ( keratolyses, fungicides and 

 soothing agents); (2) physical agents (such as roentgen rays), and (3) 

 biologic methods (injections of trichophytin, implantation of harmless sap- 

 rophytes). Therapy of infections of the glabrous skin is discussed sepa- 

 rately ( see the section on tinea glabrosa, pp. 78 ff. ) . The treatment of der- 

 matophvtosis of the skin is taken up first; that of the nails next. 



(1) Topical applicat ions. —Some form of topical treatment is essential in 

 all types of the disease. If involvement is localized to the interdigital webs 

 of the feet or if it is widely distributed and T. purpureum is the infecting 

 micro-organism, no other form of therapy need be considered. 



The various medicaments to be applied to the surface of the skin include 

 soothing agents, keratol) tics and fungicides. 



A. Soothing agents. These are required when acute inflammation is pres- 



