160 An Introduction to Medical Mycology 



The sites of predilection are the chest, the abdomen and the back, but 

 the condition may attack any part of the skin, including the scalp and the 

 palms and soles. Baer noted an instance of involvement of the face and 

 scalp. We have observed a number of instances of infection on the back of 

 the neck, and the extensor surface of the arm above the elbow appears to be 

 a common site. At times the eruption favors intertriginons locations, such 

 as the axillae, the inframammary folds or the inguinal regions; adiposity 

 may predispose to the involvement of these regions. The disease sometimes 

 involves large sheets of skin, and the manifestations may be extreme. Mild 

 itching may be present. There is little if any tendency to spontaneous cure. 



When lesions of tinea versicolor are examined under filtered ultraviolet 

 rays, fluorescence is noted; this varies from golden yellow to dark brown 

 (depending on the amount of pigment in the lesions). This fluorescent 

 characteristic has proved of interest and value not only in establishing a 

 diagnosis but in determining the extent of the eruption. Changes of the 

 color of the skin may be invisible in ordinary light but will be readily de- 

 tected when a thorough cutaneous inspection under filtered ultraviolet 

 radiation is undertaken. 



(2) Psetido-achromia.— During the summer or autumn, a patient with 

 tinea versicolor not uncommonly exhibits light-colored (apparently de- 

 pigmented) areas on the surfaces of skin exposed to sunlight. These areas 

 usually appear suddenly after sunburn followed by peeling, although a 

 history of a visible reaction is not always obtained. The patches occupy 

 the sites of lesions of tinea versicolor; thev are irregular and of various 

 sizes and appear chiefly on the trunk. Their color is not the dead white 

 of vitiligo, although because of their contrast to the surrounding skin, espe- 

 cially in persons of dark complexion, they may be mistaken for that 

 disease. Areas of skin on the covered parts of the body are usually found 

 to match in color the achromic-appearing spots. There is no increase of 

 pigment at the periphery of a lesion. A scarcely perceptible scaling may be 

 noted. Sometimes the condition appears year after year, becoming less no- 

 ticeable during the winter and reappearing during the summer. 



The light areas do not, as a rule, become tanned after further exposure 

 to ultraviolet radiation; on the contrary, they become more and more 

 noticeable, owing to the increase of pigment in the surrounding normal skin. 



Examination for fungi combined with observation of the patient under 

 filtered ultraviolet rays reveals that organisms are frequently present in 

 these light patches. Some writers have expressed the opinion that there is 

 definite achromia. Our inquiry into the nature of the lightening of the 

 skin favored the theory of mechanical screening of the sun's rays, suggest- 

 ing that the skin was light by contrast to the surrounding, normally pig- 



