736 MEDICAL MYCOLOGY 



there is a fragile pellicle and sediment. Growth on gelatin creamy, then pow- 

 dery white. Substrate not liquefied. 



Actinomyces keratolyticus Acton & MeGuire, Indian Med. Gaz. 66: 65-70, 

 3 pis., 1931. 



Produces cracked heels among the ryots of India. The disease known to 

 the medical profession as keratolysis plantare sulcatum or keratodermia plan- 

 tare sulcatum is known in Bengali as chaluni (literally, a sieve) from the pitted 

 condition of the thick skin of the feet, or haja from the sodden condition of the 

 skin between the toes which often splits, giving rise to the deep type of mango 

 foe or phata, from the cracked and fissured condition of the heel. In Urdu it is 

 called panki from its association with mud {pank). 



The thick homy skin of the plantar surface is dissolved in grooves. The 

 thick sodden skin between the toes is suggestive of conditions produced by Epi- 

 dermophyton in such positions, see p. 438. The epidermis on the sides of both 

 toes at the interdigital cleft is thickened, white, and sodden in appearance. On 

 separating the toes a deep fissure extends through the corium into the subcutane- 

 ous tissues which is extremely painful and is likely to be infected by Streptococci. 

 At other times, the infection produced an intertrigo between the web of the 

 fingers or toes and extends to the thick palmar or plantar surface as a gyrate 

 area of keratolysis. The cracked or split heel during the monsoon is usually 

 due to Actinomyces keratolytica, while during cold weather it is produced by 

 other agents. 



Ulcus interdigitale (Castellani 1907. Breinl 1915, Martinez & Lopez 1918) 

 seems to be produced by the same organism. Pruritus between the toes is fol- 

 lowed by deep fissure which gradually develops into a large oval ulcer. The 

 margins consist of heaped up, sodden epithelium, and the base is a dull dark 

 red color. There is little or no discharge, and these ulcers are very painful. 

 The ulcers may also appear on the sole near the tread of the great toe and 

 heel. Sometimes these lesions extend very deeply into the interdigital cleft 

 and may even necessitate amputation of the toe by secondary sepsis. Breinl 

 (1915) described an extreme form (ulcus interdigitale destruens). The lesion 

 starts as a small fissure which gradually forms a painful ulcer and then spreads 

 quite rapidly upward toward the toe and down to the sole. The ulcer is deep and 

 has irregular edges, and the granulation tissue is covered by an irregular dirty 

 gray scab. The floor of the ulcer is reddish and uneven and discharges much 

 thick velloAv pus. The ulceration may spread upward betAveen the toes and 

 gradually lead to complete loss of the affected toe. When healing occurs with- 

 out amputation, the adjoining surfaces of the toes may grow together. The 

 ulcers are very chronic and may cause considerable deformity. 



The disease is usually contracted by walking about barefooted on damp 

 soil, contaminated by horse or cow manure. The ryots and maid servants who 

 are continually walking on damp soil are prone to the disease of the feet, 

 while the malis (gardeners) more frequently develop paronychia with greatly 

 thickened skin margins, or onychomycosis with the base of the nails becoming 



