128 An Introduction to Medical Mycology 



ent, whether on the hands, the feet or other parts. One should forget for 

 the time being that the primary disease is mycotic. The safest application 

 is a continuous wet dressing or soak, with use of Burow's solution (solution 

 of aluminum acetate, 1:15); solution of boric acid (3 to 4 per cent) or 

 solution of silver nitrate (0.125 to 0.25 per cent), particularly if there is an 

 exuding surface, which indicates eczematization. Even when there are 

 numerous unbroken vesicular lesions, wet dressings or soaks are best. Large 

 pustules and blebs may be incised and all loose tissue clipped away. The 

 same solutions or a solution of potassium permanganate (1:3,000) or of 

 tannic acid (2 per cent) will be useful. If no secondary eczematization is 

 present and if it is inconvenient or impossible to use wet dressings, the 

 application of paints, lotions and powders may be considered. A 1 per cent 

 aqueous solution of gentian violet (methylrosanilin) is soothing and, as Sut- 

 ton pointed out, is not known to be a sensitizer. Damage to clothing may be 

 controlled by careful handling. As substitutes, a 2 per cent solution of 

 mercurochrome or an aqueous 1 per cent solution of brilliant green (mala- 

 chite green) may be employed. The calamine shake lotion commonly used 

 in the treatment of eczema and other cutaneous disorders may be used on 

 the hands or body when an acute inflammatory disease is present. Purified 

 talc to which 10 per cent each of zinc oxide and boric acid have been added 

 is often gratefully accepted by swollen and acutely inflamed feet. When 

 the acute vesicular character of the rash has passed, zinc oxide (20 per 

 cent) in petrolatum may be followed by the sparse application of a tar (3 

 per cent juniper tar or 5 per cent solution of coal tar) in zinc oxide paste 

 ( 10 to 20 per cent ) or incorporated in boric acid ointment. If no irritation 

 results, the use of stimulating remedies is in order. 



b. Keratolytics. These are useful in peeling off the stratum corneum, 

 which contains many fungi. By doing away with extraneous material they 

 also prepare the way for the fungicides to act more effectively. The two 

 drugs most commonly employed are salicylic acid and resorcinol. Most 

 skins tolerate salicylic acid better. The strength of either drug depends on 

 the site in which it is to be used and the character of the infection. Treat- 

 ment between the toes is usually begun with a strength of 6 per cent. 

 The same strength may be used on the soles. On the dorsa of the feet 

 and on the hands a 2 per cent solution of salicylic acid should not be ex- 

 ceeded at first. If this is well tolerated, stronger concentrations may be 

 used to promote more vigorous exfoliation. Satenstein stated that he used 

 an alcoholic solution ol salicylic acid in a strength of from 20 to 30 per cent. 



These drugs arc commonly employed with fungicides, although they 

 may be used singly. The vehicle also may vary. According to some observers, 

 drugs are more active in alcoholic or aqueous solutions than in grease. In 



