CHAPTER XI 



Fungous Diseases and 

 Compensable Dermatoses 



AN ACCURATE (cultural) diagnosis of fungous disease or adequate 

 JTx. proof that such a disease is not present may be of special importance 

 to patients who apply for help under one of the state laws on workmen's 

 compensation. If a mycotic disease is contracted while at work, the worker 

 is entitled to compensation. The hands are the usual site of the rash. There 

 is no good evidence that contact dermatitis predisposes to the invasion of 

 fungi. Fungi certainly would not select inflammatory tissue such as an 

 eczematous patch from choice. The dermatophytes prefer noninflammatory 

 tissue. However, we have frequently observed that an acute tinea may be 

 followed by increased susceptibility to sensitizing and irritating agents, ex- 

 pressed as an eczematous eruption, often supervening on and becoming 

 more serious than the original fungous disease. 



1. PRIMARY DERMATOPHYTOSIS OF THE HANDS 



Sometimes the patient's work may be directly responsible. For instance, 

 the occurrence in a bank teller suggests an occupational origin, since han- 

 dling of paper money may be the source. A fellow worker who has the dis- 

 ease may be the important focus. The diagnosis of primary dermatophytosis 

 of the hands should not be based solely on clinical grounds but should be 

 verified by microscopic and cultural studies. Each case presents an individ- 

 ual problem, and it is important at least to attempt to trace the origin of 

 the proved infection. In this way additional proof is gained of the occupa- 

 tional or nonoccupational origin of the infection, and prevention of further 

 spread may be obtained. In many instances, taking an accurate history 

 will reveal other cases. While the diagnosis of primary fungous infection of 

 tin hands is probably too frequent, the disease should not be overlooked. 



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