Note on the development of trichopytosis cruris / by George Henry Fox.

  • George Henry Fox
Date:
[1882]
Catalogue details

Licence: Public Domain Mark

Credit: Note on the development of trichopytosis cruris / by George Henry Fox. Source: Wellcome Collection.

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    patch, although the abrupt and gradually advancing margin ivhich is characteristic of ringworm of other parts is frequently wanting in tricho¬ phytosis cruris. Frequently the border of the patch shows an eruption of discrete lesions of a papular, vesicular, or even pustular character, as is seen upon the left thigh of the patient, represented in the accompany¬ ing colored plate. The invariable situation of these lesions at the mouths of the hair follicles is indicative of their trichophytic character. At this period a diagnosis of papular eczema is very apt to be made, since many dermatological writers formerly laid stress upon the diagnostic point that ringworm has a marginate border, while eczema shades off at the margin into the healthy skin. In a few days, however, the discrete lesions multiply in number, coalesce, and form not only a sharply circumscribed periphery, but often a broad marginate band of a bright-red hue, and an inch or more in width. During the extension of the patch, it is not uncommon to observe the development of small, annular elevated patches of inflamed skin of the size of a dime or quarter-dollar. These reddish “buttons” may be located upon the smooth or slightly scaly and pigmented skin, constituting the oldest portion of the patch, or they may develop just outside of its margin. One will be seen upon the left thigh in the case illustrated. The development of these circular patches, as well as the marginal band above mentioned, is accompanied by a decided increase in pruritus, which is often very annoying to the patient. Another peculiar feature of trichophytosis cruris which I have repeat¬ edly noticed is the sudden development of a line of lesions usually vesic¬ ular, about three-fourths of an inch or more beyond the margin of the patch; a band of apparently healthy skin being inclosed. This peculiarity, of which little or no mention is made by writers on the subject, is well shown upon the right thigh of the patient portrayed in the plate. . The only explanation I can give of this singular progress of the eruption, so different from what is observed in ordinary ringworm of the body, is purely hypothetical. The deep-seated fungus may undermine the epidermis for a short distance, and then break through to the surface of the skin without raising an epidermic layer, as happens in the cases of tinea imbricata, or ringworm of the crotch and axilla, occurring in certain tropical climates. This explanation seems probable, in view of the fact that the inclosed band of smooth epidermis becomes transformed in a few days into an inflamed marginal band, such as we have seen to result from the multiplication and coalescence of discrete papular lesions. For example, in the case of the patient portrayed in the plate, this marginate band appeared on both thighs within a week from the time the water- color drawing was made, and the general appearance of the eruption was entirely changed.
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