TRICHOMYCOSIS AXILLARIS FLAVA 



2105 



Diagnosis. — This is based on the presence of yellow, black, or 

 red, rather soft, nodules on the hairs of the axillary regions, which, 

 on microscopical and cultural examination, show presence of 

 Nocardia tenuis (Cohnistreptothrix tenuis) alone, or with Micrococcus 

 (Nigrococcus) nigrescens or Micrococcus [Rhodococcus) castellanii. 



Differential Diagnosis. — The condition must be differentiated 

 from the other nodular parasitic conditions of the hair, viz. : — 



1. Trichosporosis tropica, or piedra. 



2. Unna's trichosporosis, or piedra nostras. 



3. Behrend's trichosporosis, or ' nodular trichomycosis.' 



4. Beigel's trichosporosis, or tinea nodosa. 



5. Du Bois's trichosporosis. 



1. Trichosporosis tropica, or piedra, generally affects the hair 

 of the head. The nodules are extremely hard, hence the name 

 'piedra.' The fungus found belongs to the genus Trichosporfim 

 (Trichosporum giganteum Behrend, 1890). 



2. Unna's trichosporosis, or piedra nostras, has been described 

 by Unna in the hair of the moustache and beard. It is due to 

 Trichosporon ovale (Unna, 1896). 



3. Behrend's trichosporosis, or ' nodular trichomycosis,' described 

 by Behrend, affecting the hair of the beard. It is due to Tricho- 

 sporum ovoides (Behrend, 1890). 



4. 'Beigel's trichosporosis,' or 'tinea nodosa,' discovered in 

 London by Cheadle and Morris, and later in Breslau, Nancy, etc. 

 It attacks the hairs of the head, and is due to Trichosporum heigeli 

 (Rabenhorst, 1867). 



5. Du Bois's trichosporosis of the hairs of the pubic region due 

 to Trichosporum glycophiles (Du Bois, 1910). 



Trichomycosis axillaris flava, rubra, and nigra has nothing to do 

 with piedra or with any other form of trichosporosis, as no Tricho- 

 sporum is found, the fungus being a Nocardia or more correctly a 

 Cohnistreptothrix, with very thin, baciUary-like mycelium. The 

 types of the condition we have seen in Europe are very similar or 

 identical with those we have seen in the tropics, except that in 

 temperate zones we have never observed the black variety. The 

 nodules were not very hard and the hairs not brittle, though 

 European observers describe the European type as being charac- 

 terized by the presence of hard nodules and the hairs becoming 

 brittle. 



Course and Prognosis.- — The course is chronic, but the condition 

 may subside or disappear on the patient going to a cold climate. 

 The affection, if of very little pathological importance, has a certain 

 practical interest, being much objected to by patients, especially 

 by ladies. 



Treatment. — ^The treatment originally used by Castellani is often 

 efficacious. It consists in dabbing the hair two or three times daily 

 with a solution of formalin in spirit (3i.-^vi.) and applying at night 

 a sulphur ointment (2 to 5 per cent.). Shaving, Tr. lodi, and a 

 salicylic alcoholic lotion, have been recommended. 



