Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/297

TROPICAL TRICHOPHYTOSIS. T. barbae, etc. These later affections are outside the scope of this paper, as their clinical features are identical with what one finds in temperate zones, though it is quite probable that the fungi are different species.

As you well know, the term "Dhobie itch" is applied very loosely in the Tropics by the lay public to practically any form of pruritic eruption. The term, however, is specially used to denote a form of severe pruriginous affection which mostly affects the inner surface of the thighs, occasionally the axillae, and, in stout women, the regions under the breasts. It is in this stricter meaning that the term is used by medical men practising in the Tropics.

The clinical feature of the affection corresponds to Hebra's "eczema marginatum." In a well-marked case, the perineum, scrotum, and the inner surface of the thighs present large festooned patches with an abrupt elevated margin. The whole of the patches are bright red, or in a later period the margin only is red, while the rest of the patch is fawnish, or even normal in colour. The pruritis is unbearable. Owing to the scratching, secondary pyogenic infection, or an eczematous-like dermatitis, may develop. The complaint, if not properly treated, is extremely chronic; the condition gets better during the cold season, but recommences during the hot months. Patients who suffer very severely from dhobie itch may get almost well in a few days without any treatment on going to the hills; in coming back to the plains the pruritis and all the other symptoms reappear. The affection has been known to last for many years. It is to be noted that after a time the eruption may spread to other parts of the body—the abdomen, the trunk, legs, etc.—and may develop in rings or