TRICHOPHYTONEAE 437 



ou the buttocks or the hauds. Very frequently the nails become infected, 

 probably from scratching', and in tui'n may help to spread it to other regions. 

 In this chronic state it seems largely confined to females, most of whom have 

 contracted this disease soon after puberty. Favotrichoyhyton violaceum seems 

 to be the commonest organism isolated from this type, although Ectotrichophy- 

 ton mentagrophytes and Trichophyton tonsurans have also been reported. The 

 horny layer develops hyperkeratosis, the fungus is no longer found in it. (Sub- 

 corneal microabscesses develop along with edema and leucocytes in the intercellu- 

 lar spaces. The wall of the hair follicle is greatly thickened and spores may still 

 be seen, the lumen becomes smaller and the surrounding area infiltrated, 

 reaching- the derma, but no fungus spores are to be seen in the latter region. 

 Frequently allergic phenomena develop, producing secondary lesions which 

 closely resemble the original lesion though the fungus cannot be demonstrated 

 in these lesions. This is often the case in the generalized exanthematous types. 



In the moister regions of the epidermis, such as the principal folds (the 

 axilla, the submammary, the inguinocrural folds, and the interdigital spaces), 

 there are two main types : eczema marginatum of Hebra originally described 

 from the inguinocrural fold and chiefly confined there (often known as dhobie 

 itch, jock-strap itch, red-flap, etc.), and the dysidrosiform and intertriginous 

 mycoses of hands and feet, usually starting in the interdigital spaces but often 

 spreading thence to the palmar and plantar surfaces where the much thicker 

 horny layer of the epidermis gives the lesion a different appearance. 



Eczema marginatum was first differentiated clinically and its fungus 

 nature shown by Devergie in the second edition of his Maladies de la Peau, 

 p. 275, 1857 [quoted by Sabouraud 1910, p. 427]. However, Hebra in 1860 

 gave a much fuller account, which has remained practically unmodified since, 

 except in a few minor details, such as its extension to scrotum and penis, and 

 its occasional occurrence in the submammary fold and in the axilla. While 

 not confined to any age or sex, it is most frequent in active, mostly unmarried, 

 males shortly after puberty, often reaching epidemic proportions in schools, 

 universities, or barracks (Dubreuilh & Foutrein 1895, Foutrein 1895, Sabour- 

 aud 1907, Symes 1909), and occasionally in families (Fox 1878). It is prob- 

 ably spread by towels, clothing, and benches in locker rooms which are often 

 used promiscuously by young adolescents in dormitories and gymnasiums. 

 Perrin (1896) mentions several cases of contagion following sexual contact. 

 Apparently for infection to occur, the epidermis must be moist almost to the 

 point of maceration, but Hallows (1922) reports two cases on the mons jovis 

 of prepubertal boys. Most cases begin on the thigh where it is in contact 

 Avith the scrotum (the left side in three-quarters of the cases). It spreads 

 rapidly, involving the inner side of the thigh and the gluteal and pubic 

 regions, sometimes as high on the hypogastric region as the umbilicus ; rarely 

 also the scrotum and the shaft of the penis, one case being reported in Avhich 

 infection spread to the glans. 



