90 An Introduction to Medical Mycology 



Little difficulty will be experienced in the diagnosis of favus when typi- 

 cal scutula are present. The solid plaque type must be differentiated from 

 psoriasis and from neurodermatitis circumscripta. The irregular distribu- 

 tion and the lack of bleeding points, together with other evidence of the 

 infection on the feet and lack of involvement of the scalp, will serve to 

 rule out psoriasis. Neurodermatitis circumscripta is more pruritic; there 

 may not be a history of another allergic disease, and there is usually evi- 

 dence of other forms of infection on the feet. 



The bizarre and configurate type may be simulated by erythema annulare 

 centrifugum (Darier), but the scales on the surface of the lesions, the 

 intense itching, the absence of edematous plaques and the lack of tempo- 

 rary remissions are against the latter diagnosis. 



Majocchi's granuloma may be mistaken for pyoderma, bromoderma or 

 iododerma, one of the deep mycoses, such as sporotrichosis, or tubercu- 

 losis. The mycologic study may be the onlv definite method of determining 

 the true nature of the condition. 



(e) Prognosis.— This varies with the infecting micro-organism. Ordinary 

 tinea circinata usually responds to treatment within a week or two. The 

 presence of infected lanugo hairs will retard recovery. The eczematous 

 type requires a longer time for cure, but the final result is usually satisfac- 

 tory. In the manifestations of A. schoenleini the prognosis is good provided 

 treatment is continued for a long period. The infections due to T. pur- 

 pureum are similarly resistant and should always invite inspection of other 

 likely sites of the infection. 



(f) Treatment.— Applications twice daily of an ointment containing 

 3 per cent salicylic acid and 5 per cent ammoniated mercury usually cause 

 a lesion of tinea circinata to disappear within a week or two. Tincture of 

 iodine (1 per cent) may be painted on the affected skin once daily, but not 

 when ammoniated mercury is being used. Anthralin ointment (0.25 per 

 cent) is useful but is irritating to a sensitive skin. For the eczematoid form, 

 soothing treatment such as application of calamine lotion or, if exudation 

 is pronounced, of dressings wet with a solution of boric acid or with dilute 

 Burow's solution is the correct initial procedure. Roentgen therapy is useful 

 in cases witli exudative processes. 



Infected lanugo hairs should be manually epilated. It is known that the) 

 often break off and for this reason repetition of hand epilating may be 

 necessary. 



In the manifestations due to A. schoenleini or T. purpureum, fungicides 

 similar to those mentioned for ordinary tinea circinata may be used, but 

 concentrations should be stronger. Compound ointment of benzoic acid is 

 another useful preparation. The main point is to continue treatment, even 



