166 An Introduction to Medical Mycology 



concerning predisposing causes or methods of transmission of the infection. 

 Lack of cleanliness may be a factor. The disease is less common in the 

 United States than in Europe. It is seen much less frequently than tinea 

 versicolor. 



(b) Symptoms.— The patients are usually young adults, men more com- 

 monly than women. There is usually localization to the axillae, the groins, 

 the intergluteal cleft or other intertriginous areas, with involvement of one 

 or more regions. The disease begins as small scaly macules which gradually 

 enlarge to form various sized patches. The lesions are well circumscribed, 

 the margins being accentuated by a reddened border. The color varies 

 through yellowish brown, orange and reddish brown, the exact shade de- 

 pending on the amount of pigment in the skin of the subject, the age of 

 the lesion ( the older the darker ) and the amount of solar radiation to which 

 the lesions have been subjected. The surface of the lesions is scaly. Vesicles, 

 papules and follicular lesions are not present. 



(c) Differential diagnosis.— In tinea versicolor, there is less tendency 

 to localization in intertriginous areas and there is no erythematous border. 

 When the inner surfaces of the thighs, the inguinal region or the pubic 

 area is affected, tinea cruris may be simulated. The long duration, the lack 

 of inflammation ( especially of a vesicular border ) and the absence of satel- 

 lite lesions tend to rule out tinea cruris. 



The demonstration of the micro-organism may be difficult when one uses 

 the usual technic in examining scales. The organism may sometimes be 

 noted under the ordinary high power magnification, but use of the oil 

 immersion objective is usually requisite in order that one may be certain of 

 its presence. In all cases, a mycologic diagnosis should be made. 



(d) Prognosis.— Provided all areas are treated, relapse is uncommon. 



(e) Filtered ultraviolet radiation.— When examined under filtered 

 ultraviolet rays, the eruption shows little change from its usual appear- 

 ance except that the color is less distinct. 



(f ) Treatment.— All areas of infection as noted by a thorough inspection 

 must be treated. All the affected members of the family should receive 

 treatment at the same time. The daily application of a 10 per cent solution 

 of sodium hyposulfite usually is sufficient. Daily bathing should be carried 

 out to prevent reinfection. 



9. TINEA IMBRICATA 



This superficial fungous disease is rarely seen except in the tropics or 

 subtropics. It was first recognized and described by Alibert in 1832. 

 (a) Etiology.— The causative fungus has been described by Castellani 



