TINEA IMBRICATA [TOKELAU) 



207 I 



Calomel and other ointments of mercurial preparations do not induce any 

 improvement in the eruption. 



Thymol and Naphthol ointments may cause a slight improvement. 



Carbolic Acid and Epicarin ointments have no effect whatever. 



Cyllin ointment (20 to 50 per cent.) may induce a temporary im- 

 provement. 



Formalin is very effective for localized patches. The usual 40 per cent, 

 solution is applied with care, treating each time a small portion of the erup- 

 tion. Formalin often causes severe pain and a certain degree of inflammation, 

 which is best relieved by applications of iced water. Soon after the applica- 

 tion of formalin the patches become dark brownish, which colour lasts for a 

 few days, when they clear. Care must be taken not to apply the formalin 

 to too large portions of the skin, and not to repeat the application too often; 

 otherwise a peculiar form of apigmentation, similar to leucodermic patches, 

 may appear later on, to which disfigurement coloured patients strongly 

 object. 



Chrysarohin. — The repeated application of chrysarobin ointment (30 grains 

 to I ounce of vaseline) may induce a strikingly rapid improvement in cases 

 which are not of long standing. The eruption, however, recommences a 

 few days or weeks after its apparent disappearance. Chrysarobin is a very 

 toxic medicament; the patient must be watched and the urine regularl}^ 

 examined. In one of our cases symptoms of absorption appeared after a 

 single application. 



Salicylic A cid and Methyl Salicylate have very little, if any, action on the 

 fungus. 



Tinctura lodi and Linimentum lodi. — Tinctura iodi, freely applied, in- 

 duces a very marked improvement, which, however, is not permanent. 

 Strong iodine liniment, as recommended by Manson, is most effective; it 

 cannot be used freely, however, on patients with a delicate skin, such as 

 women and children. 



Resorcin and Tincture of Benzoin. — Resorcin, alone or mixed with salicylic 

 acid in alcoholic solution and in ointments, has very little efficacy. If, 

 however, resorcin be dissolved in tinctura benzoini composita (60 to 120 grains 

 of resorcin to i ounce of the tincture of benzoin), very good results are 

 obtained ; it is now the routine treatment for tinea imbricata in the Colombo 

 Clinic. It is to be noted that tincture of benzoin without resorcin has very 

 little action on the eruption. The resorcin, dissolved in tincture of benzoin, 

 should be applied freely once or twice daily on the affected regions. If the 

 whole body be affected, one day one half is painted, and the other days 

 the other half, alternately. The treatment must be continued for several 

 weeks. Once or twice a week the patient is given a very hot bath, and 

 scrubbed all over with sand-soap. Symptoms of absorption are rare; it is 

 always prudent, however, to proceed at first with care, as it is well known 

 that individuals may be met with, though rarely, showing idiosyncrasy for 

 resorcin. 



Prophylaxis. — Some authorities recommend isolation; this is good 

 wherever possible, but in regions where the disease is or has become 

 endemic usually the great number of people suffering from the affec- 

 tion render the measure hardly practicable. In those tropical 

 countries, however, where the disease has not yet appeared, the 

 medical officers would do well to be on the look-out for it, and if a 

 case is reported the patient should certainly be kept isolated and 

 thoroughly treated before being allowed to mix with the general 

 population, and all infected clothing should be boiled or burnt. 

 We have seen an epidemic of tinea imbricata in a hospital in which 

 a patient suffering from the disease was admitted and allowed to 

 mix with the other patients. There is a general native belief that 



