TREATMENT 



2047 



or Trichophyton-like fungi are found. SafCcharomycetic intertrigo 

 is rare ; there is no elevated margin, and the fungus is found to be a 

 Saccharomyces (S. samboni). 



Primary eczema of the scrotum, and of the skin of the thighs in 

 contact with it,, is as frequent in the tropics as it is in temperate 

 zones. The eczema is generally of the moist variety; the moist 

 surface, the absence of the festooned elevated margin, distinguish 

 it from tinea cruris. As already stated, however, an eczematous- 

 like dermatitis due to scratching often develops after a time on old 

 dhobie itch lesions. 



Diagnosis of the Toes' Localization. — The complaining of severe 

 itching between the toes, even if there are no objective symptoms 

 whatever, should in the tropics always arouse the suspicion of a 

 possible local fungus infection, especially if the patient suffers at 

 the time, or has been suffering, from tinea cruris, and scrapings 

 should be made and examined microscopically. It is important 

 to make the diagnosis, as by treating the condition the develop- 

 ment of that distressing dermatitis known as mango toe (see p. 2036) 

 may often be prevented. 



Treatment. — Our usual line of treatment is as follows : — 

 Mild Cases. — A resorcin salicylic ointment applied twice daily: 

 Resorcin, 3i. ; salicylic acid, gr. x. ; vaseline, lanoline, aa 3iv. 

 Tincture of iodine also is very efficacious, but induces a certain 

 amount of smarting, and must be applied with care and in only 

 very recent cases with no eczematoid lesions. In some cases we 

 use Vleminckx' solution or lotio calcii sulphurati (slaked lime 4, 

 sublimed sulphur 4, distilled water 35 ; boil together, evaporate, and 

 filter to produce 20 of solution), pure or diluted. A sodium hypo- 

 sulphite solution (sodium hyposulphite 3ii., aq. §i.) may also 

 be used. 



Severe Cases. — We use a chrysarobin ointment (2 to 5 per cent., 

 a good formula being chrysarobin gr. x.-xxv., unguentum zinci §i.). 

 The result is generally fairly successful. The patient should be 

 informed that the medicine stains the linen, often irritates the skin, 

 which may become oedematous and dusky red, and that occasionally 

 unpleasant evidences of absorption may take place, with fever, 

 diffuse erythema, and haematuria. Chrysarobin should never be 

 used when there is some affection of the kidneys. The irritation 

 induced by the chrysarobin ointment may be allayed by calamine 

 lotion, lead lotion, or an ichthyol ointment i per cent. 



Chrysarobin is obtained from araroba, which is known by the name ot 

 * goa-powder ' all over the East. The crude goa-powder, partly dissolved 

 in vinegar, is often used, but frequently induces very severe inflammatory 

 symptoms. 



In obstinate cases we use local applications of turpentine-oil in the 

 morning, and at night a resorcin salicylic ointment; if the parts are much 

 inflamed, at night simply a boric ointment. This treatment gives good 

 results. Turpentine is generally well borne, but patients qften complain of 

 a smarting and burning sensation a quarter of an hour after the application. 

 Exceptionally one meets with patients who cannot stand turpentine. 



