2070 



TROPICAL DERMATOMYCOSES 



Differential Diagnosis — Ringworm. — Tinea imbricata has an abso- 

 lutely different clinical aspect from any type of body ringworm: 

 inflammatory signs are totally absent, and the scales are very large, 

 flaky, firmly attached by their bases, and arranged in parallel lines or 

 concentric circles. The scales contain an enormous amount of the 

 fungus. 



Ichthyosis. — The medical man newly arrived in the tropics often 

 mistakes the disease — ^when of the diffuse type — for ichthyosis, so 

 much so that it has also received the name of tropical ichthyosis. 

 The microscopical examination of the scales will clear the diagnosis 

 at once. 



Pityriasis rubra. — In tinea imbricata there is not the intense 

 hyperaemia of the skin, and the scales are firmly attached. The 

 microscopical examination will clear the diagnosis in any doubtful 

 case. 



Tinea intersecta. — Tinea intersecta begins in a manner somewhat 

 similar to tinea imbricata, dark-brownish patches being present at 

 first, and the fungus in both eruptions growing between the super- 

 ficial and deep strata of the epidermis. In contrast to tinea imbri- 

 cata, however, the eruption never develops in concentric rings, the 

 scales are not firmly attached, and the cure is easy. 



Prognosis. — The disease has no tendency to spontaneous cure, 

 and the treatment is difficult. The general health is not much 

 affected, but the patient complains of the disfigurement, which is 

 very great, and of the pruritus, which in the hot season may be 

 unbearable. Europeans complain also of pain, especially if the 

 fungus attacks the hands. In very chronic cases signs of ansemia, 

 general weakness, and emaciation may appear. Coolies affected with 

 the malady in an advanced stage are unable to work owing to 

 the extreme pruritus; hence the disease is of great economical 

 importance, as it may greatly decrease the supply of labour on 

 estates, etc. 



Treatment. — Every medical man practising in the tropics well 

 knows how difficult is the treatment of tinea imbricata. It is easy 

 to obtain a temporary improvement, and even a disappearance of 

 the eruption; but as soon as the treatment is discontinued the 

 eruption, as a rule, starts afresh. 



Strong iodine liniment, as recommended by Manson, or resorcin 

 dissolved in tincture of benzoin (resorcin, 3ii. ; tr. benz. co., §i.), as 

 recommended by Castellani, or chrysarobin ointment (5 per cent.) 

 give, on the whole, the best results. 



In the Colombo Clinic of Tropical Medicine one of us made various 

 experiments to test the efficacy of the various medicaments by applying 

 simultaneously difEerent liniments, ointments, etc., to symmetrical parts of 

 the body, and comparing the result. According to his results: — 



Sulphur has practically no effect whatever on the fungus. 



Turpentine generally induces a slight improvement, some scales disappear- 

 ing, and the skin becoming smoother; the improvement, however, is not per- 

 manent, and as soon as the turpentine application is discontinued the typical 

 scales reappear. 



