When upon the general surface, the disease usually responds rapidly to therapeutical applications; upon the scalp it is always a stubborn affection, and, as a rule, requires several months to a year of energetic treatment to effect a cure. In this latter region the disease will disappear spontaneously as the age of fifteen or sixteen is reached. Tinea sycosis yields in most instances in the course of several weeks or a few months.

Is ringworm of these several parts treated with the same remedies?

As a rule, yes; but the strength must be modified. The scalp will stand strong applications, as will likewise the bearded region; upon non-hairy portions the remedies should be used somewhat weaker. They should be applied twice daily; ointments, if used, being well rubbed in, and lotions thoroughly dabbed on.

How would you treat ringworm of the general surface?

By applications of the milder parasiticides, such as a ten to fifteen per cent. solution of sodium hyposulphite; carbolic acid, five to thirty grains to the ounce of water, or lard; a saturated solution of boric acid; ointments of tar, sulphur and mercury, official strength or weakened with lard; and tincture of iodine, pure or diluted.

When occurring upon the upper and inner part of the thighs (so-called eczema marginatum), the same remedies are to be employed, but usually stronger. Deserving of special mention is a lotion of corrosive sublimate, one to four grains to the ounce; or the same remedy, in the same proportion, may be used in tincture of myrrh or benzoin, and painted on the parts.

How would you treat ringworm of the scalp?

By occasional soap-and-hot-water washing; by extraction of the involved hairs, when practicable; by carbolic acid or boric acid lotions to the whole scalp, so as to limit, as much as possible, the spread of the disease; and by daily (or twice daily) applications to the patches and involved areas of a parasiticide. The following are the most valuable: the oleate of mercury, with lard or lanolin, in varying strength, from ten to twenty per cent.; carbolic acid, with one to three or more parts of glycerine or oil; corrosive sublimate, in solution in alcohol and water, one to four grains to the ounce; sulphur ointment; and citrine ointment, with one or two parts of lard. Chrysarobin is a valuable remedy, but is to be employed with care; it may be prescribed as a rubber plaster, or in a solution of gutta-percha, or as an ointment, ten to fifteen per cent. strength. [beta]-naphthol in ointment form, five to fifteen per cent. strength, is also useful. An excellent application for beginning areas on the scalp is a solution of the red iodide of mercury in iodine tincture, one to three grains to an ounce.

A compound ointment, containing several of the active remedies named, is convenient for dispensary practice, such as:--

[Rx] [beta]-naphthol, ................. [dram]ss-[dram]j Ol. cadini, ......................... [dram]j Ungt. sulphuris, ............ q.s. ad [Oz]j. M.

In that form known as tinea kerion mild applications are demanded at first; later the same treatment as in the ordinary type.

How is ringworm of the bearded region to be treated?

On the same general plan and with the same remedies (excepting chrysarobin) as in ringworm of the scalp. Depilation is to be practised as an essential part of the treatment. Special mention may be made of an ointment of oleate of mercury, sulphur ointment, a lotion of sodium hyposulphite ([dram]j-[Oz]j), and a lotion of corrosive sublimate (gr.

j-iv to [Oz]j). The _x_-ray has been used in ringworm of this region with alleged success, pushing it to the production of a mild erythema and depilation. The above methods are, however, usually successful, and are without risk of damage.

How is the certainty of an apparent cure in ringworm of the scalp or bearded region to be determined?

By the continued absence of roughness and of broken hairs and stumps, and by microscopical examination of the new-growing hairs from time to time for several weeks after discontinuance of treatment.

Cure of ringworm of the general surface is usually self-evident.

Is systemic treatment of aid in the cure of ringworm?

It is doubtful, although in children in a depraved state of health the disease is often noted to be especially stubborn, and in such cod-liver oil and similar remedies may at times prove of benefit.

Tinea Imbricata.

(_Synonym:_ Tokelau Ringworm.)

What is tinea imbricata?

A vegetable parasitic disease of moist tropical countries, characterized by the formation of patches composed of concentrically arranged, imbricated, scaly rings. It may begin at one or several points as a brownish, slightly raised spot, spreading peripherally; the renewed epidermis of the central part of the patch goes again through the same process; the result is a small or large area of concentrically arranged, imbricated, slightly scaly eruption. Several such areas fusing together may cover a large part of the surface, the ring-like arrangement being sometimes more or less completely lost. The malady is chronic. There may be a variable degree of itching. The cause of the disease, which is of a contagious nature, is a vegetable parasite closely similar to the trichophyton. The treatment is by the parasiticides, being essentially the same, in fact, as ringworm.

Tinea Versicolor.

(_Synonyms:_ Pityriasis Versicolor; Chromophytosis.)

What is tinea versicolor?

Tinea versicolor is a vegetable-parasitic disease of the skin, characterized by variously-sized and shaped, slightly scaly, macular patches of a yellowish-fawn color, and occurring for the most part upon the upper portion of the trunk.

Describe the symptoms of tinea versicolor.

The disease begins as one or more yellowish macular points; these, in the course of weeks or months, gradually extend, and, together with other patches that arise, may form a more or less continuous sheet of eruption. There is slight scaliness, always insignificant and furfuraceous in character, and at times, except upon close inspection, scarcely perceptible. The color of the patches is pale or brownish-yellow; in rare instances, in those of delicate skin, there may be more or less hyperaemia, and in consequence the eruption is of a reddish tinge. The number of patches varies; there may be but a few, or, on the other hand, a profusion. Slight itching, especially when the parts are warm, is usually present.

Does the eruption of tinea versicolor show predilection for any special region?

Yes; the upper part of the trunk, especially anteriorly, is the usual seat of the eruption, but in exceptional instances the neck, axillae, the arms, the whole trunk, the genitocrural region and poplitea, and in rare cases even the lower part of the face, may become invaded.

What course does tinea versicolor pursue?

Persistent, but somewhat variable; as a rule, however, slowly progressive and lasting for years.

To what is tinea versicolor due?

To a vegetable fungus--the _microsporon furfur_.

The affection is tolerably common, and occurs in all parts of the world.

With rare exceptions, it is a disease of adults, and while looked upon as contagious, must be so to an extremely slight degree.

[Ill.u.s.tration: Fig. 73.

Microsporon Furfur x 400. (_After Duhring._) Showing mycelium in various stages of development, groups of spores and free spores.]

What is the pathology?

The fungus, consisting of mycelium and spores, the latter showing a marked tendency to aggregate, invades the superficial portion of the epidermis.

Is tinea versicolor readily diagnosticated?

Yes; if the color, peculiar characters and distribution of the eruption are kept in mind.