148 An Introduction to Medical Mycology 



and the condition may appear not unlike a pyogenic infection. There is 

 usually little or no pain except on pressure, but sometimes the parts throb. 

 No pus will be found if the tissues are incised; a thin purulent discharge 

 may appear under the nail fold. In the nail, transverse ridges are noticed. 

 The nail remains hard but gradually becomes thickened and distorted, 

 particularly at the edges. The color may not change or it may become 

 brownish. Usually the shine is unaffected. The proximal portions or the 

 edges of the nail sometimes become eroded. It is at once apparent that 

 the cardinal signs of tinea unguium, namely, crumbling, yellow color and 

 loss of luster together with lack of paronychia, readily distinguish the 

 two conditions. 



b. Intertrigo. Well defined, bright red, exuding patches with scalloped 

 borders give a fairly characteristic picture of monilial intertrigo. Outside 

 the zone of intertrigo, small flaccid vesicopustules may be noted. There is 

 usually a bright red border of skin around the satellite lesions. According 

 to Hopkins, these represent the primary lesions from which intertrigos 

 develop. The common sites of monilial intertrigo are the axillae, the infra- 

 mammary folds, the groins, the umbilicus, the interdigital webs of the 

 feet and the intergluteal fold. The process may extend from a primarily 

 intertriginous location to the flat skin, and large sheets of skin of a suscep- 

 tible person may be affected. It may be pointed out that interdigital in- 

 volvement of the toes may be mistaken for dermatophytosis caused by 

 filamentous fungi. In case M. albicans is the cause, all the webs of the 

 toes are usually involved. A bright red color and soreness with satellite 

 vesicopustules also favor a diagnosis of moniliasis. Lesions of a similar na- 

 ture on the hands and at the angles of the mouth have distinct names. 



c. Erosio interdigitalis blastomycetica. This form of intertrigo affects the 

 interdigital webs of the hands (usually the third or fourth). The lesion 

 has a bright red base with a moist surface and a peeling border. The lesions 

 are tender rather than itching. 



d. Perleche. This type of intertrigo affects the angles of the mouth. The 

 base is bright red, the surface may show a pellicle of skin, and fissures 

 commonly develop. Some cases of perleche are said to be due to infection 

 with streptococci. Avitaminosis may be a predisposing factor. 



e. Asymptomatic gastrointestinal form. The presence of M. albicans in 

 the saliva or in the stools of patients with no symptoms referable to this 

 and with no concomitant involvement of the skin suggests that many 

 persons are carriers. With many forms of moniliasis of the skin, organisms 

 can also be located in the gastrointestinal excreta. In the treatment of 

 perleche, cure is often difficult unless the mouth is treated at the same time. 



f. Intraoral thrush. Thrush is most commonly seen in infants and some- 



