DERMATITIS BULLOSA PLANT ARIS 



of the epidermis become removed, and small, superficial, red, irritable 

 abrasions are seen. These become severer, and deep, extremely pain- 

 ful fissures appear between the toes in almost all the cases. This 

 dermatitis is difficult to cure, but disappears rapidly on the patient 

 going to the hills or to Europe. It may remain quiescent for long 

 periods, and then reappear again. During the periods of quiescence 

 some pruritus may occasionally be felt, and the skin between the 

 toes may easily crack or be slightly scaly. 



Treatment. — This consists in keeping the patient at rest for a few 

 days, dressing the affected parts continuously with diluted carbolic 

 lotion (I per cent.), or resorcin lotion (f to i per cent.), and later 

 applying a zinc oxide paste, hazeline cream, or a bismuth boric 

 ointment (bismuth subnitratis, gr. xxx. ; acidi borici, gr. xv. ; 

 vaseline, lanoline, aa 3iv.). The stockings should be white, and 

 should be changed at least twice daily, and should be boiled before 

 use. If a fungus is found in the lesions, an antimycotic treatment 

 should be carried out when the acute stage is over, or during the 

 quiescent periods, by means of silver nitrate (3 per cent.), or a 

 strong solution of potassium permanganate (gr. xxx. to ^i.), 

 painted on once or twice daily; or tincture of iodine may be used 

 if the lesions are dry and there are no excoriations. 



Dermatitis Bullosa Plantaris. 

 Synonym. — Foot-tetter (Canthe). 



Definition. — Dermatitis bullosa plantaris is a streptococcal 

 dermatitis, often secondary to an infection of the soles of the feet, 

 caused by Epidermophyton cruris Castellani. 



Historical and Geographical Distribution. — This affection was 

 first described by Cantlie in China, but cases are met with in all 

 tropical countries. 



Etiology. — The disease is probably a streptococcus infection, 

 one of us having isolated a very virulent strain of the germ from 

 the blebs of a number of cases. In several of our cases this strepto- 

 coccus infection developed on some superficial lesions due to a 

 localization of Epidermophyton cruris Castellani to the soles. 



Symptomatology. — It commences with blebs on the sole of the 

 foot. The blebs ultimately break, and by-and-by bare scaly flakes 

 of skin form, and extend all over the sole and between the toes. 

 There is intense itching. Occasionally the condition spreads to other 

 parts of the body. It usually dies away in the cold season, but 

 recommences in the hot season. According to Cantlie, patients 

 who have returned to Europe see their affection reappearing regu- 

 larly every summer for ten or twenty years after leaving the tropics. 



Prognosis. — The condition is of difficult cure, and relapses occur. 



Treatment. — In the acute stage the patient must stay at com- 

 plete rest, and antiseptic dressings, such as mercury perchloride 

 (i in 4,000) or carbolic acid (^ per cent.), applied continuously. 

 Later a lead lotion (liq. plumbi, 3ii., aq. destil. ad 5X.), and still 



