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PYOGENIC DERMAL INFECTIONS 



In purulent folliculitis oj the legs there are no ulcers, only pustules 

 pierced by hairs being present. 



Prognosis. — The condition runs a very long course and is difficult 

 to cure, unless treated by an autogenous vaccine. 



Treatment. — An autogenous vaccine is the correct treatment, and 

 generally produces a cure in two to three ^'weeks. Local treatment 

 by antiseptic lotions is also recommended. 



The Secondary Streptococcal Dermatites. 



Only two forms of this affection concern us, and both are second- 

 ary to infections with Epidermophyton cruris Castellani. They are 

 dermatitis interdigitahs and dermatitis bullosa plantaris. 



They may be differing phases of the same affection, but they can 

 be differentiated as follows: — 



A. Situate primarily between the toes. Bullae absent — 



Dermatitis inter digitalis. 



B. Situate primarily on the soles. Bullae present — Dermatitis 



bullosa plantaris. 



Dermatitis Interdigitalis. 



Synonyms. — Dermatitis rimosa of the toes. Mango toe (Ceylon), 

 Frieira (Brazil). 



Definition. — Dermatitis interdigitalis is a streptococcal dermatitis 

 secondary to an infection of the parts between the toes caused by 

 Epidermophyton cruris Castellani. 



Historical. — This affection, which is popularly known in Ceylon 

 as ' Mango toe,' was first brought into prominence by Sabouraud's 

 observation that the primary cause was an infection by Epidermo- 

 phyton cruris Castellani. In 1910 Castellani found that very often 

 there was a secondary streptococcal infection. 



A somewhat similar affection was described long ago by Martin Costa 

 in Brazil, who stated that the condition was very common among natives, 

 who called it ' frieira.' He believed it to be caused by the heavy perspira- 

 tion, and accumulation of dust and dirt between the toes. 



Geographical Distribution. — It is extremely common in Southern 

 India, Burma, Ceylon, and many other tropical countries, being 

 the cause of great discomfort to European residents, especially 

 during the hot season. 



etiology. — The condition seems to be a pyogenic infection, 

 starting generally on slight lesions produced by a localization of 

 Epidermophyton cruris Castellani to the toes. This localization 

 of the fungus was first observed by Sabouraud. The fungus per se 

 in this situation gives rise to very shght symptoms very often only 

 some scaliness and pruritus. 



Symptomatology. — The patient first complains of great itching 

 between the toes, without there being present any papular or 

 vesicular lesion. On scratching to relieve this itching, portions 



