TBICHOPHYTONEAE 439 



After a while the couteuts of the vesicles dry, the covering cracks and peels 

 oft', leaving a rose colored area surrounded by a border of loosened horny 

 layer. Near the first vesicles, new ones form, dry, and peel, leaving a gradu- 

 ally widening irregular area of pink, surrounded by the loose horny layer. 

 On the hands the lesions are likely to be less confluent, resembling the clinical 

 picture described by the older authors as dysidrosis (see clinical discussion 

 of Strickler, Ozellers and Zaletel, 1932, Schmidt, 1933), or it may be very 

 difficult to differentiate from some dermatitis of cfiemical origin without a 

 knowledge of occupation and other facts of case history. The duration may 

 be very long, the lesions tending to heal when the weather is cool and the feet 

 less moist, and recurring in warm weather Avhen the feet perspire freely. 

 (See statistics of Sharp and Taylor 1928.) It is often puzzling to decide 

 whether some of these recurrences may not be due rather to reinfection from 

 socks which have not been sterilized in the process of laundering, bath slip- 

 pers, or other articles of clothing. Woolen or silk socks, especially, may be 

 sources of reinfection, as they are rarely, if ever, sterilized in the ordinary 

 course of events. 



Eczema marginatum seems predominantly to attack the adolescent and 

 those of the succeeding decade, in America being spread especially in shower 

 baths connected with gymnasiums, swimming pools, etc. An examination of 

 3,100 freshmen of one of our large universities showed 53.3% of the men and 

 15.3% of the women were infected when entering the university and a reex- 

 amination at the end of the year showed that 78.6% of the men and 17.3% 

 of the women were infected; also that 9.3% of the men had become infected 

 with tinea cruris (Legge, Bonar & Templeton 1929), the increase being largely 

 due to unsanitary conditions about the gymnasium and perhaps fraternity 

 houses. Levin & Silvers (1931) suggest that sweat is important in transmis- 

 sion. These figures are typical of most of our universities, where the athletic 

 directors and university physicians are ignorant and apathetic. On the other 

 hand, some of our high school physicians are very active in the matter and 

 have shown a remarkable control of the disease following the introduction 

 of comparatively simple prophylactic measures. By supplying troughs or de- 

 pressions in the floor between the shower and locker rooms which are filled 

 with a disinfecting solution, such as 10-15% sodium thiosulphate (Gould 1931) 

 or 1% sodium hypochlorite (Osborne & Hitchcock 1931), the percentage of 

 infection in the Albany Junior High School was reduced from 50% to prac- 

 tically no infection in a few months and in the Buffalo high schools, from a 

 large percentage at the beginning of the school year to complete disappear- 

 ance before the end of the year. Lomholt (1933) reports about 60% infection 

 in a group of Danish students living in a single dormitory. 



Much less frequently a scaly hyperkeratotic form occurs on the feet. This 

 may be only a less active form of the dysidrotic type or may be caused by a 

 species of THchophyton rather than Epidermophyton, which is the usual organ- 

 ism attacking hands and feet. A diffused thickening of the horny layer on 

 the inner border and ball of the great toe or even of the whole plantar surface 



