66 An Introduction to Medical Mycology 



taneous cure of M. audouini infections (and also the immunity of adult 

 scalps) is due to the secretion, at puberty and later, of sebum which con- 

 tains, in higher concentration than before, low-boiling saturated fatty acids 

 with selective fungistatic and fungicidal effect on this fungus. We believe 

 that an entirely different mechanism of cure (hypersensitivity; inflamma- 

 tion; epilation of hair) is responsible for the cure of M. lanosum infections 

 and for those due to other fungi capable of sensitizing the skin. Favus 

 and the manifestations of the endothrix organisms persist for an indefinite 

 period unless treated. We have seen instances of infection with A. schoen- 

 leini which lasted over 20 years. It seems that eventually even here the 

 fire burns out, but cinders (in the form of atrophy) may be noted. The 

 most resistant conditions which we have treated were caused by T. vio- 

 laceum (an endothrix). 



In our experience, 90 per cent of patients with M. audouini infections 

 may be cured in nine weeks if roentgen epilation is undertaken. 



(h) Treatment of nonresistant infections.— In several publications 

 we have called attention to the tendency to spontaneous cure and to the 

 success of local measures alone when tinea capitis is caused by M. lanosum. 

 The series of patients reported cured by Poth and Kaliski following ther- 

 apy with estrogens were not controlled by filtered ultraviolet ray studies, 

 nor were cultures done. The estrogens were rubbed on the scalp in most 

 cases, probably assisting cure by rubbing out the infected hairs. Unless 

 there are special reasons, one may not wish to subject a child with this 

 type of ringworm to epilation of the entire scalp by means of thallium ace- 

 tate or roentgen rays or to the administration of estrogens. This also applies 

 to infections due to an ectothrix Trichophyton, to markedly inflammatory 

 conditions (at least until the process is less severe) and to states of vigorous 

 reaction to trichophytin, irrespective of the cultural diagnosis. In all such 

 cases the treatment should be conservative. We use one of several topical 

 applications, such as an ointment containing 5 per cent ammoniated mer- 

 cury or one containing 1 per cent thymol, 0.5 per cent oil of cinnamon 

 and 0.5 per cent iodine crystals. Salves containing any antiseptic in a not 

 too concentrated form would probably be of equal benefit. 



We have previously pointed out that cure of these infections invariably 

 occurs because the infected hair comes out and not because of any direct 

 fungicidal action of an applied medicament. Because of this the salve 

 should be mildly stimulating, to assist in loosening the hair but not strong 

 enough to cause 1 too much inflammation, and fungicidal, to prevent the 

 spread of the infection. Besides the drugs just mentioned, sulfur in an oint- 

 ment base (5 to 10 per cent) and iodine crystals (10 per cent) in wool 

 fat will be found equally effective. We advise against the use of salicylic 



