Skin Diseases (1)

Diseases of the skin are usually unsightly, and are frequently the result of, or occasionally the cause of, ill health of other parts of the body. While they are often uncomfortable, few of them are a menace. to life; but many of them may be quite persistent.

Their visibility aids in their early recognition and in judging the effectiveness of treatment. But since they result from the widely differing hereditary tendencies, habits, environmental conditions, and diets of mankind, and are affected by both mental and physical powers and limitations, a great variety of skin abnormalities are exhibited by skin diseases.

Some of these may be so unusual or malignant that only a competent physician or specialist is qualified to recognize their true nature or to treat them. In cases where any doubt exists regarding the nature of a persistent skin eruption, attempts at self-diagnosis or self-treatment are not wise. In such a condition, giving the wrong treatment, or delay in giving the right treatment, may be serious.

There are numerous skin disorders, however, which an intelligent person with little guidance can recognize and treat, at least temporarily, when he is out of reach of a skin specialist or is unable to afford professional medical care. In discussing the various skin diseases included in this chapter, we have tried to give the reader a reliable basis for judging what can safely be done without prior consultation with a physician, and what circumstances indicate such consultation necessary or at least wise.

Perhaps the most important warning that should be heeded by all, but especially by those who try to treat skin diseases without professional supervision, is this: Do not over treat. While a skin disease is being treated, any increase in the signs of irritation or inflammation should be taken as evidence of probable over treatment, or as an allergic reaction to the applied medication.
New remedies for skin diseases are being discovered or devised all the time. Furthermore, no two patients and no two physicians are exactly alike; and what a physician uses or recommends will depend to a considerable degree on his past experience in dealing with patients.

It often happens that a remedy or treatment program that works well in one physician's practice does not work so well in the practice of another. Do not be surprised, therefore, if a physician prescribes remedies or treatments differing from those recommended in this book.
Among the great number of "patent" or "proprietary" remedies on the market, there are many for skin diseases. As a general rule, we have not named or recommended such remedies even though they may be effective, because in most cases there are several similar remedies, and it is not our purpose to favor one manufacturer over another.

The only exceptions to this rule are a few products which have become well-known and widely used under their trade names, and are quite generally prescribed by physicians under these names.

Most of the new effective remedies discovered in recent years cannot be purchased without a physician's prescription, and many cannot be safely used without a physician's supervision. We consider it unwise to recommend in this book a remedy that the reader cannot buy on his own, or that would be unsafe for him to use if he could buy it. We have limited our recommendations to remedies that have stood the test of time, to those that can usually be obtained without a physician's prescription, and to those that are not likely to be harmful if used as directed.

Some drugstores refuse to fill any prescription unless written and signed by a physician, no matter how simple or harmless the remedy may be; so you may find some druggist unwilling to fill some prescription which we have judged safe to include in our discussions and advice.

In some cases their unwillingness may be the result of the increasing stringency of laws and regulations regarding the dispensing of drugs. We find no fault with this stringency. We agree that much harm has been done by the use of powerful drugs when they were not needed, and that unintelligent drugging is all too common.


Allergy
Some people are abnormally sensitive to certain substances which may be present in the air they breathe, in the food they eat, or in something they get on their skin or may brush against. These same substances may be harmless to other members of the family and to other people in general. This sensitivity may be present from birth, in which case it is said to be atopic; but it is more often built up as a result of repeated contacts with the offending substance or substances. The sensitivity itself is called allergy; and, if comparatively prompt and violent, the reaction of the body when brought into contact with a substance to which it is sensitive is called anaphylaxis.

Allergy might properly be discussed in relation to any or all of several different body systems. It is mentioned in this volume as a causative factor in the discussions of many diseases that have no relation to the skin. We discuss it in a general way in this chapter, however, because so many of its most common manifestations are in the skin. See also the chapter on "Allergy" which appears later in this same volume.

Almost every body tissue may show allergic reactions, and the reactions may take many different forms. Reactions associated with skin diseases will be discussed later in this chapter in their due order. Sometimes the reactions come on immediately after contact with the offending substance, but sometimes they come after a delay of one or more days. Delayed reactions are 'comparatively common when the digestive tract is concerned, and hence they may cause much perplexity. The person concerned may eat some of the offending food and not notice any trouble till considerably later. The tendency then will be to blame some food eaten shortly before the distress became manifest, and the true offender will not be detected.

A variety of diseases, at least in a large proportion of the people suffering from them, may be caused by allergy. Hay fever and asthma, acute vomiting or purging especially in children-eczema, hives, and several other skin affections are prominent examples. Occasionally a single individual may at times suffer from more than one of these conditions.

Among the offending substances frequently affecting these abnormally sensitive individuals are these common ones: various pollens from plants; hair or dandruff; emanations from cats, dogs, or horses; various kinds of fur or feathers; such foods as milk, eggs, fish, shellfish, pork, fowl, wheat, oranges, and strawberries; and, in children, some of the cereals and butter.


What to Do
1. Try to find out the identity of the offending food or other substance and avoid it. This may call for the aid of a physician, and one of the methods he may use in his detective work is a series of skin tests.
2. When an attack occurs, possibly because of some food, stop the use of all food and take a tablespoonful of Epsom salts in a glass of water.
3. Itching may be troublesome. The various skin diseases in which allergy plays a part are discussed later in this chapter in their proper order, together with suitable treatment. Further suggestions as to the relief of itching are given there under the subject of "Pruritus."
4. If the attack is severe and a physician is available, consult him. He may be able to give some injection that will give prompt relief and to prescribe other remedies to fit the individual case.

Atrophies
KRAUROSIS VULVAE.
This is a malady peculiar to middle-aged or elderly women, characterized by atrophy, shriveling, and constriction of the skin and mucous membrane of the external genital region. While rarely present in a fully developed form, it is a chronic and stubborn disorder, with surface changes, including hardening, drying, and graying of the skin, and sometimes of the underlying tissues, resulting in a narrowing of the vaginal opening. Itching may be intense, but tends to lessen in time. One reason why suitable treatment is important is that, if untreated or improperly treated, there is a possibility that a cancerous condition may develop.

What to Do
1. Apply wet dressings of Burow's solution, diluted with from 16 to 32 times as much water as stock solution. Such dressings or packs often allay inflammation and relieve itching.
2. Take a diet rich in vitamins, especially vitamin A, which has considerable preventive value, and which may be curative in early cases.
3. If possible, consult a dermatologist, because there are some effective treatments, such as hormone therapy and cortisone creams, which cannot be self-administered; and surgery may even be needed.

SENILE ATROPHY (ATROPHIA SENILIS).
Senile atrophy is a skin condition accompanying advancing age, appearing as patches of tightened, dry and inelastic, or thin and shiny skin, abnormally discolored, especially in spots, and frequently giving rise to more or less itching. It is not a disease with a specific cause, but only a manifestation of one of the body changes due to a reduction in hormones, which to some degree affect all elderly people.

It seldom becomes noticeable before the fiftieth year, and is most pronounced in slender individuals. This type of atrophy, aggravated by exposure to sun- light through the years and resulting from a decrease in the amount of fat normally padding the deep layer of the skin, is characterized by spots or areas of skin that are usually yellowish or brownish in color, appearing most noticeably on the backs of the hands, the legs, the neck, or the face. Itching is most troublesome in cold or very dry weather.

What to Do
1. Remember that the character of this ailment is such that a restoration of the former normal skin condition is impossible.
2. Partial relief from discomfort (which is not always present) is possible through the following procedures: (A.) Keep the skin softened by using some simple ointment, such as cocoa butter or rose-water ointment. Apply as often as needed, but especially after each bath. (B.) Use a mild soap, preferably one that is superfatted.
Bacterial and Rickettsial Diseases

ACNE (ACNE VULGARIS).
Acne is characterized by pimples or eruptions of varying severity on the face and often the upper back and/or chest papules, pustules, nodules, or small abscesses, which may be superficial or deep-seated. It is not actually caused by a bacterial infection, but is frequently complicated by one.

An acne pimple develops first as a small, red papule, and pus usually appears at its center within a few days unless it is unusually deep-seated. Superficial pustules tend to open and drain of themselves if left alone, leaving no lasting trace; but it is possible for deep-seated abscesses to leave permanent scars, whether they open and drain or not.

Prominent among possible causes are a hereditary tendency, sex hormone imbalance at puberty, and impaired fat metabolism. Germs are frequently present in the pus from acne pimples, especially Staphylococcus albus, acne bacillus, and other pus germs of mild virulence. Germs alone, without other factors, will not cause the disease; and in any case they should be considered only as secondary invaders.

A typical acne pimple is simply an obstructed and inflamed oil gland, and the pimples are most numerous where the oil glands are most abundant. Naturally, an oily skin is more likely to be affected than a dry skin.

Since the pimples often accompany adolescence and appear from about the twelfth to the fifteenth year, they are logically associated with the increased glandular activity, especially of the sex glands, that comes during and following puberty. Eunuchs seem to be immune to acne because they lack male sex hormones. The pimples usually stop forming in the early twenties in males and by age twenty-five in females, whether the ailment is treated or not.

Some mild itching and soreness may be present with acne, but serious symptoms are uncommon. Acne causes the formation of scars in the skin. The disease comes at a time of life when young people naturally want to look their best. Actually, then, those who have acne suffer more from psychological stress than from poor general health.

The possible effect of diet in causing acne has not been positively determined. Some think it is an important factor. To be on the safe side, it is wise for a person with acne to take counsel from his doctor regarding diet.


What to Do
1. Use a conservative diet, avoiding excesses of fat (especially the "saturated fats" of animal origin), rich foods, chocolate, and pastries.
2. Avoid tea, coffee, cocoa, cola drinks, and all alcoholic beverages.
3. Take no medicines by mouth unless prescribed by a physician. Bromides and iodides are especially to be avoided.
4. Get eight and a half to nine hours of sleep each night.
5. Keep the bowels open, preferably by means of an abundance of fresh fruit and vegetables in the diet.
6. Take gentle exercise daily, but avoid violent exertion which causes you to perspire freely.
7. No cream, oil, ointment, or grease of any kind should be allowed to come in contact with the face or other affected skin areas. Keep your hands away from your face, and do not lean your chin on your hands.
8. Shampoo your scalp twice a week with a simple soft soap (non-medicated).
9. Wash your face with tepid water and mild soap twice a day. After the evening washing, use lotio alba (white lotion) or the following prescription on the affected skin, including that of the upper chest and back:
.
Sulfur ppt ............................................3|6
Zinc sulfate .........................................3|6
Sodium borate.....................................6|0
Zinc oxide ............................................6|0
Acetone ..............................................30|0
Camphor water .................................45|0
Rose water .........................................45|0

Apply the lotion with the tips of the fingers, and let it dry on the skin.
10. Never squeeze the pimples at any time.
11. Suitable antibiotics may be helpful, but should be taken only as directed by a physician.
12. When acne is persistent, a skin specialist should be consulted. He may recommend the use of an abrasive soap. He may arrange for treatments by sunlight or by ultraviolet lamp and prescribe hormones for a woman patient. fie may resort to X-ray treatments or minor surgical procedures.

BLACKHEADS (COMEDONES). Blackheads are small, tallow like plugs formed in the skin pores by the accumulation of oil and dead skin scales. The blackness of the exposed ends results more from oxidation of the oil than from dirt. Although it has never been proved that germs play a part in the formation of blackheads, blackheads may be infected. An acne pimple differs little from an inflamed blackhead, and the two conditions are often found together.

In most cases blackheads begin to appear about the time of puberty; and they often keep coming until about the age of twenty-five, after which they gradually diminish. In most cases blackheads cause no itching or pain; but, like acne, they give rise to a distressing sense of inferiority because of an unsightly appearance.

What to Do
1. Follow the first eight directions given under Acne
2. Wash your face with tepid water and mild soap at least three times a day. Do not use hot water.
3. Occasionally, gently squeeze out the visible blackheads with a metal blackhead remover not with your fingers. After doing so, briefly wash the area with tepid water and abrasive soap, and wipe dry. Then with the fingertips dab on the lotion prescribed for acne under (9) above, letting it dry on the skin. (Blackhead removers are sold in most drugstores. )
4. If blackheads are numerous or large, skin-peeling treatments may be advisable, but such treatments call for the services of a physician, preferably a dermatologist.
5. Exposure to sunlight or quartz-light treatments often improve the condition.

BOILS (CARBUNCLES, FURUNCLES).
Boils are hard, red, painful, and rather deep-seated swellings, usually beginning as pimples or nodules about hair roots. They increase rapidly in size and develop "cores" in their centers. Furuncle is another name for a boil. Carbuncles are unusually severe forms of boils, ordinarily characterized by more than one core or head, and accompanied by considerable systemic disturbance and general illness and debility.

Boils and carbuncles are caused by the same kind of germ a more or less virulent strain of Staphylococcus aureus as a rule. To start a boil or carbuncle, the germs must gain entrance to an oil or sweat gland or to a hair follicle. It has often been noticed, however, that a general low level of resistance, a low metabolic rate, rubbing in of dirt by clothing, or the presence of diabetes mellitus paves the way for the development of boils or carbuncles facts which emphasize the need for a physician to study cases characterized by a "run of boils."

The core of a boil consists of a collection of innumerable bacteria surrounded by and interspersed with white blood cells. It tends to soften and form a thick liquid pus around it, which normally eventually escapes through a break in the skin. The pus, containing living germs, may spread the infection and cause other boils if it comes in contact with unprotected skin.

Warmth and moisture hasten the formation and breakdown of the core, and help to keep the skin soft so that the pus may more easily break through. If the skin is kept wet continually, however, it may become soft enough to encourage the spread of germs through it. Dressings wet with strong solutions of salt or other suitable chemicals tend to stimulate the drainage of the pus out of the tissues and into the dressings. Boils are most painful if located on a skin area with but little soft tissue between the skin and the underlying bone. They continue to be painful until free drainage of pus is established. Following adequate drainage, a boil subsides quickly.

The danger of squeezing or picking at boils needs to be emphasized. The collection of germs in the forming core may be broken up and spread into surrounding tissues, thus making the boil larger than it would otherwise be. The germs may even spread into the bloodstream, causing septicemia or "blood poisoning," which may prove fatal. The most dangerous spot in all the body for a boil to be located is the area marked out by the bridge of the nose, the corners of the mouth, and the outer corners of the eyes. This includes the inside of the nostrils. Many cases of fatal septicemia or meningitis have resulted from improper interference with boils or pimples in this area.

What to Do
1. Immediately upon the appearance of a pimple which appears severe enough to develop into a boil if it is not deep-seated and has a small yellow spot in the center dip the point of a needle into tincture of iodine or carbolic acid and open the pimple by thrusting the needle sideways through the yellow spot and lifting the needle. Do not press or squeeze. Wipe off the small amount of pus with a bit of sterile gauze or absorbent cotton. Apply 2 percent tincture of iodine to and around the opened pimple at once. This may abort the boil.

2. If the pimple is deep-seated, or if it does not have a definite yellow center, do not attempt to open it, but paint it and the surrounding skin twice a day with 2 percent tincture of iodine. Let the solution dry on the skin and apply no dressing of any kind for one hour. This will help to protect the surrounding skin from infection.

3. After the skin has been left dry for an hour as directed in (2) above, apply dressings of several layers of gauze kept wet with a warm saturated solution of magnesium sulfate (Epsom salts) on a repeat schedule of two hours on and one hour off. The dressings may be covered with waxed paper, oiled silk, or plastic to prevent their drying out. It is helpful to keep them warm by covering with a hot-water bottle with a layer or two of Turkish toweling between dressing and bottle. Other preparations have been recommended for dressings instead of magnesium sul¬fate. Five percent ammoniated mercury ointment is good.

4. The pain of the boil will be considerably relieved if the course of treatment outlined in (2) and (3) above is followed, and the boil will probably come to a head and break
within a few days without other help. The boil should never be squeezed, and it should not be opened too soon. If instrumental opening becomes necessary, it is better to have a physician do it.

5. Penicillin injections and sulfadiazine by mouth are recommended for a carbuncle or a severe boil. The use of these requires the supervision of a physician.

6. From the start, but especially after the discharge of pus begins, it is wise to keep a wide area of skin surrounding the boil disinfected by frequent applications of rubbing alcohol or the mild tincture of iodine described in (2) above, to prevent the germs in the pus from getting a foothold in the skin and possibly starting new boils.

7. A "run of boils" should always lead to consultation with a physician. Special examinations and laboratory tests are necessary to determine the identity and nature of the causative germs and other possible causative factors, especially if diabetes happens to be one of them. Diabetes must be treated if found present, and sometimes it is advisable to build up resistance to the special strain of staphylococcus germ causing the boils by giving a long course of injections of "autogenous vaccine," which the physician can have made. Frequent changes of clothing, alcohol sponging, and frequent baths are also important and helpful.

CELLULITIS.
Cellulitis is a spreading, inflammatory infection, somewhat similar to erysipelas but usually less acute. It most commonly affects the skin, but it usually involves deeper structures as well. It is often found elsewhere than on the face, and the affected skin area does not show a distinct border. It may be caused by either streptococci or staphylococci, which gain entrance through a break in the skin but do not cause pus formation. The skin area concerned is hot, red, and painful. Without proper treatment, the condition is persistent and tends to recur. The involved area may become permanently swollen or thickened, especially after persistent or recurrent attacks.

What to Do
Call a physician at once. Home treatments are of little use, but treatments by a physician using antibiotics and/or sulfas is usually promptly effective.

CHANCRE (HARD CHANCRE, HUNTERIAN SORE).
CHANCROID (SOFT CHANCRE).
ERYSIPELAS.
Erysipelas is caused by a virulent strain of streptococci affecting the skin and the tissues immediately beneath it. It is characterized by redness, discoloration, small blisters, and swelling, most commonly attacking the face, and accompanied by high fever and other manifestations of acute illness.

The skin shows a glazed appearance, and the affected area has a combined itching and burning sensation and shows a clearly defined margin. The swollen area feels firm and hot to the touch. There may be only a small patch of affected skin at first, but it tends to spread in all directions from the original site.

The victim of erysipelas feels extremely ill, with a marked feeling of lassitude, chills, headache, vomiting, joint and back pains, and a rapidly rising fever, which may go even higher than 104° F. (40° C.). He is likely to have an unusually rapid pulse. In severe cases, delirium is common. In children, vomiting and convulsions often occur. The disease is serious, possibly even proving fatal in aged people, in babies, and in women who have recently given birth. It is likely to cause abortion in pregnant women.

The serious nature of erysipelas makes it impossible for a layman to administer effective remedies or treatments. Prompt attention by a physician is important, but the suggestions outlined below may be helpful in delaying the multiplication of germs and slowing the progress of the disease until a physician can begin treatment. At present, penicillin and wide-spectrum antibiotics are the most successful known remedies, but there may be other treatments or remedies that the individual physician has found valuable.

What to Do
1. Call a physician at once, but until he comes keep the patient in bed and isolated from all except the person caring for him.
2. Give him a liquid diet. See that he takes at least three quarts (liters) of water or other fluids a day.
3. Keep the affected skin areas covered with ice bags or ice-cold compresses (twenty minutes on and ten minutes off) until a physician takes charge of the treatment.
4. Cold compresses to the head are useful in relieving the headache, which is frequently distressing.
5. Remember that erysipelas is contagious. The person nursing the patient must wear rubber gloves, and should never come in contact with or care for children or other sick persons at the same time. Ice bags applied to the patient should be disinfected by immersion for five minutes in a solution of lysol—one teaspoonful to the pint (450 c.c.) of water. Cloths used for compresses should be soaked in the same solution for ten minutes before being laundered.

FELON (WHITLOW).
A felon is a condition of swelling, throbbing pain, and extreme tenderness, characteristically affecting a finger or a thumb. It may at first seem to be an infection or inflammation of the skin, and for this reason it is discussed in this chapter. The germs causing the infection are usually virulent staphylococci, carried in through the skin by a deep pinprick, a thorn, a splinter, or some other sharp object.

The inflammation and pus are deep down among the tendons and tendon sheaths, or even near the bone. If thorough lancing is not done promptly, the tendons may slough or the bone be damaged, causing a crippled or deformed thumb or finger. If the pus is not drained, there is danger that the infection may travel to other parts of the hand, resulting in more serious crippling. Or the infection may reach the bloodstream, causing a possibly fatal "blood poisoning."

What to Do
Call a physician promptly and have the felon lanced. Because of the need for deep lancing and the extreme tenderness of the involved area, it is often necessary to use a local or general anesthetic. The physician will prescribe and supervise the aftercare.

FOLLICULITIS.
Folliculitis is caused by a staphylococcic infection of one or more hair follicles, with pustule formation. It is related to boils, but is a much milder infection, apparently caused by much less virulent germs. It is most common in men and tends to involve the bearded areas of the skin, but may attack any area in which hair follicles are found.

When deep-seated and chronic, it is called sycosis; and the skin around the pustules becomes reddened and crusted. In most cases of sycosis, several to many follicles are involved. Symptoms are not usually acute, being limited to mild burning and itching, with pain only when an involved hair is pulled. Contamination of other skin areas by pus from a pustule is likely to lead to infection of other follicles.

If not properly treated, folliculitis may become chronic and persist, for months or even years. It is sometimes confused with barber's itch, which it resembles to some extent


What to Do
1. Apply 2 percent or 5 percent ammoniated mercury ointment several times a day, spreading the remedy onto the surrounding skin to help protect it from pus contamination.
2. If this treatment clears up the condition within one week, apply any antibiotic ointment except penicillin twice a day for another week to help prevent new infections.
3. If a pustule is on the upper lip, the nose, the eyelids, or the face on either side of the nose, or if it does not clear up within one week, consult a physician. A deep or persistent infection, or one located in any of the indicated areas, may be dangerous.

IMPETIGO.
Impetigo is an acute, contagious disease, usually attacking the skin of the face, in children more commonly than in adults. It begins as a reddening of one or more small spots on the skin, soon followed by small blisters.

These become pustules, which dry into loosely attached, golden-yellow or honey-colored crusts, each with a narrow zone of reddened skin around it. All of these stages may develop within one or two days. If the crust is forcibly removed, a red area that oozes a little blood will be found beneath it.

Impetigo causes considerable itching, but no pain. It is so mild that there is seldom any feeling of illness. It is a pest, however, because it easily spreads from child to child, because it makes them look so repulsive, and because it is often resistant to treatment; but it is seldom dangerous to anybody but infants.

Both streptococci and staphylococci are often found in cases of this disease, but they are of only slight virulence. They work only on the skin or a short distance below the surface. Rarely are scars left after recovery.

What to Do
1. See that the patient's fingers are kept away from the crusts. Scratch¬ing the crusts is the usual means by which the disease is spread.

2. Twice a day use a soft cloth or a piece of gauze dipped in "alibour water" or magnesium sulfate (Epsom salts) solution to soak and loosen the crusts. Gently but completely remove the crusts. Then cover the raw area with Neosporin ointment or 2 percent ammoniated mercury ointment. Apply more ointment every one or two hours.

3. If the ointment gets rubbed off between treatments, put on more.Except when the crusts are being removed, the affected skin areas should be kept liberally covered with ointment.

4. See that nobody else uses the towels and washcloths used by the patient. Boil them for five minutes after using. Disinfect them by soaking for thirty minutes in a solution of lysol--one teaspoonful to the pint (450 c.c.) of water before laundering.
5. To protect the skin surrounding the crusts from infection, sponge it several times a day with rubbing alcohol.

6. Germs may become resistant to any remedy within a week or two, making it necessary to alternate remedies from week to week. If an increase in inflammation should occur, it may be because the skin has become sensitive to the remedy being used at the time. In this case, do not use this remedy again.

7. Calling for the services of a physician is recommended in severe cases or in cases that persist longer than two weeks under the treatment described in (2) and (6) above; and the physician may prescribe penicillin or other antibiotic injections, sulfadiazine by mouth, or other local treatments.

8. Special care needs to be exercised in cases involving young babies. Impetigo spreads rapidly on their tender skin, and their bodies seem unable to build antibodies against the germs. They are unable to do anything to cooperate in the treatment, and the disease may prove fatal.

WHITLOW
Fungous Diseases
Fungous diseases may attack various parts of the body, but probably attack the skin most often. Fungi, a more complex form of vegetable organisms than bacteria, usually multiply by means of spores, a characteristic that classifies them midway between bacteria and seed plants. Diseases caused by fungi are rarely acute, but tend to be persistent. They seldom cause fever or result in true pus formation unless complicated by a secondary bacterial infection.

Many fungi are enemies of most of the common disease-producing bacteria, and other bacteria are enemies to them: This fact is the basis for the production of most of the antibiotic remedies. But these fungi are also enemies of certain bacteria which abound in the body and are friendly to it. This is especially true of certain bacteria commonly found in the intestine and/ or the vagina of a normally healthy person.

So, when antibiotic remedies have been used for a considerable period of time, the friendly bacteria may have been killed off, and certain fungous diseases or yeasts which ordinarily are held in check by these friendly bacteria may take hold and begin to cause trouble.

Generally speaking, ordinary antibiotics are not only useless in treating fungous diseases, but may actually help prepare the way for their development. The outstanding exception to this rule is a special antibiotic—griseofulvin—an effective oral remedy for many fungous skin diseases. It may, however, give a variety of uncomfortable side reactions, so it should be taken only under the supervision of a physician. Also, since many fungous diseases may be caused by more than one variety of fungus, and different varieties of fungi differ in their response to treatment with griseofulvin, laboratory tests are often needed to determine what variety of fungus is present, as a guide to the physician in his use of this or perhaps some other remedy.


ATHLETE'S FOOT (DERMATOPHY- TOSIS, TINEA PEDIS).
Athlete's foot is caused by one or another of a group of parasitic fungi which almost always attack the skin of the feet. Many people are plagued by this malady, since the organisms which cause it are spread from contaminated floors surrounding pools, showers, and other public places.

The skin between the outer few toes is most frequently attacked, but the disease may spread to any part of the feet, and it is possible for it to break out on the hands. However, what appears on the hands is usually caused by absorbed toxins circulating in the bloodstream rather than directly by the causative organisms themselves. Nevertheless, by scratching the sores on the feet, one may carry the infection on the hands or under the nails and spread it to other parts of the body.

As athlete's foot develops, blisters or cracks, or more often both, appear in the skin, which softens, turns white, and tends to peel off in flakes. Pustules and ulcers may form in severe cases, and there is more or less itching and burning occasionally pain. The dis¬ease is more severe in warm weather than in cool weather, and it is aggravated by any condition which keeps the feet warm, moist, and sweaty.

What to Do
1. Keep the affected skin areas as cool and dry as possible. Wearing sandals or open-toed shoes will help.
2. Protect other members of the household from infection by refraining from walking barefoot about the house, especially about the bathroom. Do not use the family shower, and before using the bathtub soak the feet for at least five minutes in a warm 1:5,000 solution of potassium permanganate.
3. Every night at bedtime wash the feet briefly with mild soap and warm water, avoiding too much soaking and softening of the skin. Then with a bit of gauze pick and rub away all loose bits of skin, taking care not to get any of the contaminated material under your fingernails. Then apply some half-strength Whitfield's ointment or, preferably, some 10 percent undecylenic acid ointment, such as Desenex.
4. Every morning, wipe away the remaining ointment with dry gauze and dust the skin area thickly with antiseptic powder. The following are two prescriptions for good powders to use in such cases:

I

Menthol ...........................................|1
Thymol iodide ...............................1|
Zinc stearate .................................3|
Boric acid powder ......................10|
Talcum powder .......................100|

II

Undecylenic acid ..........................1|
Zinc stearate ................................3|
Zinc undecylenate .....................10|
Talcum powder .........................50|

5. Sometimes soaking the feet for half an hour in a warm 1:5,000 solution of potassium permanganate or a 15 percent solution of sodium thiosulfate works better than the brief washing described in (3) above. Any blisters present should be opened before such a soaking begins. Dry the feet thoroughly after soaking. If the skin is much inflamed, reduce the Whitfield's ointment to quarter strength or less with petrolatum, but do not omit the use of powder as ad¬vised in (4) above.

6. Wear cotton hose, preferably white, changing to a fresh pair every day. To launder hose, boil for ten minutes to kill the organisms, or reinfection is certain and a cure may be impossible.

7. If sores appear on the hands, unless an examination has been made and the causative organisms found, do not use any treatment on them except mild and soothing ointments. If itching is severe, apply 1 percent phenol in calamine lotion. When the sores on the feet have healed, those on the hands will probably disappear.

8. To prevent a relapse after the infection appears to be cured, apply 2 percent ammoniated mercury ointment each evening, and talcum powder containing 1 percent of salicylic acid each morning, continuing the treatment for several weeks. Dust the same powder into the shoes daily.

9. In severe cases, keep off the feet, if possible, and use permanganate soaks and ointment as in (5) twice a day instead of once.

10. Consult a dermatologist, if possible, in all persistent cases of athlete's foot. Griseofulvin is not of as much value in this type of fungous infection as it is in some others, but it is worth trying; and X rays, stronger fungicide creams, or other effective treatments, difficult or impossible to use without a physician's supervision, may be necessary.

11. Protect others by not going into public showers or swimming pools. If you do not have this disease, it is best to keep away from public swimming pools unless you wear rubber or wooden sandals when walking about the pools, showers, or dressing rooms. Tanks of supposedly disinfectant solution have not proved very effective preventives of infection.