2034 



PYOGENIC DERMAL INFECTIONS 



leucoc3H:es in certain regions, and more especially superficially, is 

 marked. 



In the deeper part of the section isolated pieces of the ordinary 

 connective tissue of the corium can be seen, while finally, in the 

 depth of the section, well-defined connective tissue is seen containing 

 here and there scattered collections of cells of the same nature, as 

 already described for other portions of the tissue. 



The sweat glands are much damaged, and surrounded by cells 

 of the usual type found in these lesions. 



Still deeper one meets with fatty tissue, between the cells of 

 which lies an accumulation of the typical cells of the lesion. 



Symptomatology. — The eruption begins as a small pruriginous 

 papule or papulo-vesicle, which increases in size and ulcerat es, scabs 

 over, and extends at its margins. When fully developed it is 

 surrounded by a raised margin, behind which small papillae may 

 be noted, which in older cases give rise to very distinct papillomatous 

 outgrowths. The surface of the sore is composed of deep fissures 

 and a few ulcerated areas, which exude a serous fluid, which is apt 

 to form crusts. These ulcerated areas and fissures are separated 

 by other areas coated by a thin epidermal covering, which gives rise 

 to a false pealing appearance. The whole condition spreads slowly 

 from the margin. 



Diagnosis. — This is sufficiently effected by the table given on 

 p. 2030. 



Prognosis. — The prognosis is good provided that the patient is 

 otherwise healthy. 



Treatment. — The best treatment is, without doubt, an auto- 

 genous vaccine, but a polyvalent local (i.e., made from local strains) 

 vaccine acts quite well. 



We generally give 10 millions to commence with, then 50, and, 

 if necessary, 100 millions. 



The affected part in chronic cases may be painted with iodine and 

 a dry dressing applied. 



Dermatitis Cupoliformis. 

 Synonym. — Tropical ecthyma (Castellani). 



Definition. — Dermatitis cupoliformis is characterized by com- 

 mencing as dusky red macules, which are follicular or perifollicular, 

 which either disappear or slowly become cupoliform nodules, which 

 after a time break down and ulcerate. 



Historical.— This disease was first described by Castellani in 1914 

 as seen mostly in Europeans in Ceylon. Subsequently he met 

 with the disease in the Balkans. 



Climatology.— So far it is only reported from Ceylon and the 

 Balkans. 



-ffitiology. — It is caused by a streptococcus belonging to the erysi- 

 pelatous group {vide Chapter XXXVI., p. 929), which is named 

 S, tropicalis Castellani, 1914. 



