The Superficial Mycoses 135 



the sites of interdigital fungous infection was followed l>\ clinical improve- 

 ment. In studies along the same direction we were further influenced by 

 the rapid overgrowth of many culture tubes by some of the common molds. 

 Since 1941 we have had under observation in the laboratory a bacterial 

 filtrate with a potent fungistatic capacity. This filtrate of Bacillus (subtilis) 

 XG has shown promise of clinical value in the treatment of the superficial 

 mycoses. From the reports of Tolmach and Lowenthal and of Hopkins and 

 his co-workers, clavacin and some other antibiotics are also promising 

 fungicides, although by no means superior to many of the standard rem- 

 edies. 



It is of interest that Belisario some years ago found lemon juice to be 

 an effective fungicide. The work of Peck indicates that ascorbic acid has 

 definite fungicidal and fungistatic properties. 



(k) Treatment of nails.— In the main, the indications for treatment 

 and the principles underlying it are the same for the nails as for the skin. 

 Because there are minor differences and additional therapeutic procedures, 

 the treatment of the nails is considered separately. 



If a fingernail is the site of an infection due to T. purpureum, it is prob- 

 able that the feet and the toenails are also infected. 



Infection due to T. gypseum may usually be cured by a combination 

 treatment consisting of scraping the nail and applying fungicides. Roentgen 

 therapy is sometimes useful. Evulsion of one or two fingernails may be 

 carried out provided there is no other evidence of infection. 



If the infection is due to T. purpureum, one is faced with a difficult ther- 

 apeutic problem. The condition has probably been present for several 

 months or even years, and infection of at least several nails is likely. There 

 is probably also concomitant infection of the feet or of other regions. Com- 

 plete evulsion of nails is not usually recommended here, as recurrence will 

 almost invariably follow. Reliance must be placed on topical measures, 

 after the nail has been scraped or as much nail substance as possible has 

 been removed. If a sharp scalpel is available and the procedure is carried 

 out with care, a surprising amount of nail can be removed without pain. 

 Although there are important disadvantages to the office use of a burr 

 powered by a small motor, its use has been gratifying in selected cases 

 when patients purchased their own equipment and used it regularly to 

 remove the infected nail material. One need not fear that the patient will 

 destroy normal structures since pain will indicate when to stop. Newspapers 

 should be spread over the floor to collect the material and a surgical mask 

 should be worn. The topical application may be changed from time to time, 

 and various medicaments may be used. 



(I) Complete surgical evulsion.— Evulsion of a fingernail is not difficult, 



