The Superficial Mycoses 67 



acid, chrysarobin, croton oil, oil of turpentine and the like as unnecessarily 

 hazardous. The loosened hair is best removed by frequent shampoos. The 

 use of a mild soap applied with a brush has been found effective. If the 

 shampoo is carried out too vigorously or too frequently, the infected hair 



may be kept rubbed off close to the scalp instead of being epilated. The 

 result is that the infection does not respond as rapidly as expected. The 

 remedy is to lengthen the interval between shampoos and to use less 

 vigor in applying the hand brush. 



(i) Treatment of resistant infections.— When the infecting micro- 

 organism is M. audouini, A. schoenleini or one of the endothrix Trichophyta 

 (chiefly T. violaceum), unless there is a vigorous response to the test with 

 trichophytin, some type of depilating treatment is usually required. Livin- 

 good and Pillsbury have shown that even M. audouini infections will often 

 become spontaneously cured if left long enough. In practice it is not con- 

 sidered wise to defer active treatment. There are three methods which may 

 be used: (1) manual epilation with salves and adhesive plaster, (2) roent- 

 gen epilation and (3) epilation by the thallium salts. If the infection is 

 due to M. audouini and the patient is near the age of puberty, expectant 

 treatment rather than depilating measures may be undertaken. We have 

 attempted to cure the resistant infections by means of vaccinotherapy 

 (trichophytin), substitution of another fungus capable of producing an 

 inflammatory response in the scalp, short wave ultraviolet radiation and 

 other modalities and methods without any consistent effects. The poor 

 results which we obtained from the therapeutic use of trichophytin were 

 similar to those reported by other observers who studied their cases from 

 the etiologic point of view. Cures attributed to trichophytin for the most 

 part concern infections due to M. lanosum, M. fulvum or T. gypseum, and 

 since these have a tendency to spontaneous cure, the role of trichophytin 

 is debatable. We have not been able to substantiate the claims made by a 

 commercial concern for an imported trichophytin which has been exten- 

 sively advertised as a certain cure for ringworm of the scalp. The cases 

 of patients reported cured with estrogens by Poth and Kaliski were prob- 

 ably due to M. lanosum. In a study by Lewis, Hopper and Reiss of the 

 effect on fungi of estrogenic and androgenic substances, an in vitro effect 

 was apparent, but clinical results were poor when such agents were applied 

 locally to areas of infection. 



(I) Manual epilation and local applications— When there is only a small 

 patch (as revealed by examination under filtered ultraviolet rays), epila- 

 tion of the infected hairs with forceps may be attempted. The process is 

 repeated at intervals of three or four days. During the interval between 

 treatments, adhesive plaster, larger in diameter than the infected patch. 



