The Superficial Mycoses 175 



(v) Symptoms.— There may be a superficial resemblance to tuberculosis 

 verrucosa cutis or to blastomycosis. The lesions usually develop on the 

 [eg; the condition may begin as a verrucous nodule or an ulcer. The nodule 



ii kin be reddish, purplish or brownish. After many months or years, ver- 

 rucous masses may result from coalescence of two or more lesions and 

 their subsequent growth. Pruritus may or may not be present. In Lane's 

 ease there were two lesions, one an ulcer and the other a nodule, both on 

 a buttock. Later, large cauliflower-like masses may be noted, with sec- 

 ondary invasion of saprophytic micro-organisms, and a foul discharge may 

 be present. No instance of metastasis to an internal organ has been re- 

 corded; rarely, subcutaneous or intramuscular lesions occur at sites remote 

 from the original focus of disease. Edema of the foot and ankle is frequent. 

 Adenopathy is infrequent. In the case of chromoblastomycosis reported by 

 ( larrion as due to H. compactum, the lesions were on the left arm and of 

 28 years' duration. There were no ulcers or large warty or cauliflower-like 

 lesions. The eruption spread by extension rather than by satellite lesions, 

 as is usual. The rash was dry, dull red or violaceous and scaly and was 

 well demarcated. Scarring was present in healed areas. The disease resem- 

 bled psoriasis, lupus erythematosus and tuberculosis. 



(d) Histology.— According to Weidman, the tissue reaction consists of 

 granulomatous changes similar to those resulting from the presence of a 

 foreign body; there are also interspersed small foci showing a tuberculoid 

 reaction and still other areas in which there is some miliary abscess forma- 

 tion. 



(e) Differential diagnosis.— Blastomycosis and tuberculosis verrucosa 

 cutis may be confused with chromoblastomycosis. In blastomycosis the flat 

 border studded with pustules and the budding of the organism in pus are 

 two prominent differences, but with tuberculosis verrucosa cutis, only the 

 results of mycologic study and the results of inoculation of guinea-pigs may 

 serve as distinguishing features. 



(f) Prognosis.— While there is no tendency to spontaneous recovery, 

 the prospect for cure is good. There is no need to fear internal involve- 

 ment. 



(g) Treatment.— The administration of potassium iodide by mouth or 

 sodium iodide by intravenous injection has proved curative in a number 

 of instances. While we have had no experience in treating the disorder, 

 roentgen therapy appears to be indicated, since it is effective in disorders 

 of somewhat similar pathologic characteristics. Conant et ah treated one 

 patient with copper sulfate administered by means of iontophoresis and 

 obtained a good result after five months. If the condition is localized, elec- 

 trodesiceation and curettage should be successful. 



