Definition And Description

Chromophytosis is an affection of the skin characterized by the appearance of superficial yellowish brown macules or patches on the upper part of the body - most frequently met with on the chest. It commences by the appearance of macules, very slightly, if at all elevated above the surface of the skin, and covered with barely perceptible scales. It usually begins upon the chest, extends gradually over the greater part of this region, mounts upon the neck, and descends to the abdomen. It may also stretch around to the back and cover this region. It never invades the face, and seldom, if ever, the limbs. The eruption may consist of a few large patches, with very frequently a large number of smaller ones upon the outskirts, or it may be composed almost entirely of macules from the size of a pea to that of a dollar. The patches are sometimes slightly scaly. The progress of the affection is slow, so that months and even years may elapse before it becomes generalized over the trunk. The affection occurs more particularly in persons who are out of health, and not unfrequently appears during the course of phthisis and syphilis. It is most likely to be met with in those who are warmly clad and wear flannel next the chest, and who, at the same time, are negligent in matters of cleanliness. It rarely, if ever, occurs in those who make a practice of bathing daily. The affection is believed to be contagious, but I have never been able to trace a case to this cause.

Course

The affection steadily progresses and may last for years, if untreated. Whether it ever disappears spontaneously I do not know; this termination, however, is probable in some cases.

Diagnosis

Although the appearance of the eruption is so characteristic, I have known frequent errors in diagnosis to have been made. In the first place, if the affection occurs in a person known to be syphilitic, it may itself be incorrectly considered a manifestation of that disease. Secondly, it is sometimes diagnosticated as a syphilitic eruption, even in the absence of all other symptoms of syphilis. This is an unpardonable blunder. Its absence from the face, and confinement to the trunk and neck excludes chloasma, which latter is found upon the face, but not upon the trunk. The neck alone is a doubtful region, may be the seat of either chloasma, chromophytosis, or a pigmentary syphilide, and consequently some difficulty may arise. As a rule, however, the aspect and general features of the discoloration, together with the history and circumstances of the case, permit a diagnosis to be readily made. As a last resort, the microscope may be employed to elucidate the matter.

Prognosis

So far as the eruption is concerned, the prognosis is favorable. The affection can, by proper treatment, always be cured. Despite this fact, it is not uncommon to meet with patients who have had the disease for years, and during that time have sought the advice of many physicians. The fault has been sometimes with the physician, sometimes with the patient, and sometimes with both.

Etiology

Chromophytosis depends on the germination and growth, among the epidermic cells, of a microscopic fungus, discovered by Eich-stedt, in 1846, and known as the Microsporon furfur (Fig. 6). The spores are, as the name implies, exceedingly small, but of varying size and uniformly round; the mycelium is sometimes simple and sometimes branched. The fungus is readily detected by scraping a few scales from the surface, washing them first in ether, and afterward in alcohol, to remove the adherent sebum, etc., and then examining them in a little glycerine with an amplifying power of five hundred diameters. The spores are found only in the epidermis and do not invade the hair-follicles or hairs.

Treatment

Chromophytosis, as well as the other vegeto-parasitic diseases of the skin, are favored and promoted by cachectic conditions, and any indications of ill-health on the part of the patient should be carefully considered and remedied, if possible. To this end, good air, good food, suitable clothing should be secured. In addition, proper internal medication, either ferruginous, cinchonic, or oleaginous, should not be forgotten. If the patient also suffers from phthisis or syphilis, the usual constitutional treatment for these diseases should be maintained. These points being attended to, the local treatment is then to be decided on. As the cause of the disease is a fungus flourishing among the epidermic cells, the first and main indication is to get rid of it. This can only be accomplished by means that will succeed in causing the death and exfoliation of the stratum corneum. The epidermicide which I at present prefer, and find amply sufficient, is chrysophanic acid. A five per cent. ointment is to be rubbed into the patches once or twice daily, until sufficient irritation has been produced to loosen the outer epidermic cells. When these begin to loosen. the patient is thoroughly rubbed with green soap, put into a warm bath, scrubbed with a soft flesh-brush, and the affected epidermis removed. After the bath ho is thoroughly dried, rubbed with an emollient, and put to bed until the next day. If the treatment has been sufficiently thorough the patient is rid of his disease. In the majority of cases, however, this is not the case. A few patches, perhaps almost invisible, have escaped, and if nothing more is done, the affection will spread from these until its original extent is gained. It is well, then, for the patient to sponge the surface daily with the Acidum Sulphurosum of the pharmacopoeia, or with a solution (1 - 10) of hyposulphite of sodium. This should be kept up for ten days or two weeks, at the end of which time the patient's skin should be thoroughly inspected, and if there are the slightest indications of a return of the trouble, the chrysophanic acid, green soap, warm bath, flesh-brush, etc., are to be again brought into use. Two or three courses of this sort are usually sufficient to eradicate the affection. One caution, however, should be remembered. During the progress of the affection the patient's underclothes become contaminated with the fungus, which is not removed or destroyed by ordinary washing, and if these garments be resumed after the treatment is finished, a relapse is very likely to occur. With this in view we usually direct the patient to destroy the undershirts worn during and before the treatment.

Instead of chrysophanic acid, the tincture of iodine may be painted

Fig. 6 - Microsporon furfur on the affected surface once or twice a day, until the epidermis begins to peel; after which the green soap, etc., are employed as already mentioned.

In addition to the drugs mentioned, the following have been recommended: Anisum, 18; Argent. Nit.., 2l; Ferri Chlor., 55; Hydrarg. Amnion., 63; Hydrarg. Chlor. Corros., 64; Silica, 105; Sodii Boras, 106; Sodii Sulphis, 107, and Veratria, 102.