448 MEDICAL MYCOLOGY 



hyphae, with septa farther apart, forming a sheath outside the hair made up 

 of small spores, 3-4/a in diameter, spore chains and slender nonseptate hyphae 

 which float in the microscopic preparation as fragments 15-20/a long. Thus it 

 will be seen that clinically these species have many resemblances to Micro- 

 sporum. They also have many cultural and morphologic characters in com- 

 mon with Microsporum and are placed in that genus by several workers, from 

 Gruby to Guiart & Grigorakis. They are very rare in cases of tinea tonsurans, 

 although common in kerion. 



The beard is quite susceptible to fungus infection. The moustache is 

 rarely attacked and the nasal hairs never, reversing the order in bacterial in- 

 fections, which are more common in nasal hairs and in the moustache. The 

 dry type of lesion corresponds veiy closely to tinea tonsurans of the scalp of 

 the TricJiophyton type. The commoner type is sycosis which consists of nodu- 

 lar suppurations, intradermic, disseminated, sometimes below the exudative 

 and suppurative lesions of the surface and sometimes not. It may be the pri- 

 mary infection or it may follow an infection of the dry type. Sometimes the 

 nodules are hypodermic and cannot be evacuated by pressure. At other times 

 they are more superficial, and pressure causes evacuation of pus with or with- 

 out the infected hair. Sometimes they form small elevated cones with the 

 pus under a thin layer of epidermis. The latter type disappears quickly, while 

 the deeper types may last for several months. 



The kerion is a round or oval area of contiguous folliculites. The surface 

 of the lesion is slightly elevated, with follicular abcesses soon visible and open, 

 transforming the follicles into purulent pits from which suppuration evacuates 

 the dead hair. A kerion may have a hemispheric form, or may protrude a 

 centimeter or more, forming a soft tumor analogous to botryomycosis but not 

 pedicelled as in that case. Epilation with forceps removes the dead hairs 

 which the inflammatory process has detached from their roots. Finally, a 

 layer of pus is formed under the whole kerion which becomes soft, and may 

 be detached by sphacelation. It leaves a scar the size and shape of the de- 

 tached kerion. In other cases, the multiple kerions coalesce more or less and 

 below them form abscesses of varying size which may even survive the super- 

 ficial lesions. When, after several weeks, they open, they may contain a serous 

 and oily liquid analogous to the synovial fluid. 



Finally, in the very rare cases where the fungus invades the dermis we 

 find a granuloma, first clinically differentiated by Majocchi (1883) ; more re- 

 cently by Oro (1926). After a short herpetic stage of desquamation, alopecia 

 occurs, the skin assumes a slight rose color, and becomes papuloid. The 

 granuloma slowly develops to the size of a nut or bean, the neoplastic stage. 

 Then degeneration sets in, the nodules soften and become reddish violet. The 

 lesions are found in the dermis media and hypodermis and are formed by a 

 granulation tissue, the center consisting of a hair fragment with spores, the 

 middle zone formed by a layer of giant cells, and the outer layer formed by 

 granulation cells mixed with endothelial cells and with mono- and polynuclear 

 leucocytes, in the midst of which some reticulate, supporting fibrillae are 



