The Superficial Mycoses 89 



eruption due to T. purpureum. The similarity to tinea imbricata was strik- 

 ine. We have observed several similar cases. 



(8) Granulomatous type (Majocchi), or tinea profunda— This is a rare 

 but classic form of involvement in whio v the smooth skin may be invoked 

 separately or concurrently with the scalp or with the bearded area. There 

 may be nodules and plaques, characterized by their indolent nature. Pus 

 may collect and finally be discharged. Ulcers may develop, and small 

 discrete nodules may appear in adjacent areas of skin also. 



(c) Immune reactions.— The trichophytin reaction is usually negative 

 in cases of uncomplicated tinea of the glabrous skin. This applies even to 

 tinea circinata due to M. lanosum. For this reason the test is not of much 

 practical value. Although we have no experience with reading the test 

 when the condition is granulomatous, it is more than likely from analogy 

 that there is an initiation of sensitivity in such a case. 



(d) Differential diagnosis.— Tinea circinata is simulated by pityriasis 

 rosea when the herald patch is on the face or on an exposed portion of the 

 bodv. The absence of a vesicular border, of clearing in the center or of the 

 subsequent sudden development of secondary lesions is evidence against a 

 diagnosis of tinea circinata. 



The eczematous type is confused chiefly with contact eczema and some- 

 times with infectious eczematoid dermatitis or parasitic eczema. Contact 

 eczema is usually differentiated by the history of exposure to a substance 

 capable of causing the eruption, by the lack of circinate outline and at times 

 by the patch test. In infectious eczematoid dermatitis there is a focus of 

 infection, such as a boil or a discharging ear. The lack of definition of the 

 lesions is a major point against tinea. Parasitic eczema consists of circum- 

 scribed vesicular erythematous patches, spreading apparently by auto- 

 inoculation. We recognize it as an entity but have never demonstrated 

 fungi in material taken from the lesions. For this reason we doubt that the 

 infection is fungous. The lesions, if examined closely, are seen to be studded 

 with vesicopustules, and there is not the tendency to be present more 

 abundantly along the border of the lesions. 



The scaly type may be confused with seborrheic dermatitis, contact 

 eczema or excessive dryness of the skin. The manifestation is so mild that 

 a definite clinical diagnosis is usually impossible. 



In order to prove the diagnosis of any of the types mentioned, one must 

 demonstrate the causative micro-organism by microscopic and preferably 

 by cultural studies. The clinical course may often be helpful, and the re- 

 sponse to medication may be the only definite indication of the correctness 

 of the clinical diagnosis when the mycologic examinations yield negative 

 results. 



