Tinea Capitis Ebook

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Ringworm Tinea Dermatophytosis

Favus (Latin for honeycomb ), a distinctive type of ringworm, was described by Celsus in the first century. He called it porrigo, a term also used by Pliny in the same century and by dermatologists up to the nineteenth century. It is now, however, obsolete, having been replaced by tinea. Celsus also described the inflammatory lesion of some forms of ringworm, which is termed the kerion of Celsus. A period of mycologic confusion followed, complicated by the difficulty of determining the life histories of the pathogens and whether there was one ringworm fungus or many. Gruby's findings were forgotten and had to be rediscovered during the 1890s by Parisian dermatologist Raymond Sabouraud, who published his research in 1910. Many ringworm fungi were classified variously according to mycologic and clinical features. Some thousand different names had been proposed up to 1934 when C. W. Emmons in the United States showed that the many species could be accommodated in three genera...

Ringworm Tinea Dermatophytosis History

Favus (Latin for honeycomb ), a distinctive type of ringworm because of the characteristic scutula, was described by Celsus in the first century, A.D., in his De Medicina. He called it porrigo, a term also used by Pliny in his Historia Naturalis of the same century and by dermatologists up to the nineteenth century. It is now, however, obsolete, having been replaced by tinea (derived from Tineola, the generic name of the clothes moth). Celsus also described the inflammatory lesion of some forms of ringworm, which has been known ever since as the kerion of Celsus. A period of mycologic confusion followed, complicated by the difficulty of determining the life histories of the pathogens (largely due to deficiencies in culture technique) and settling the question as to whether there was one ringworm fungus or many. Gruby's findings had been forgotten and had to be rediscovered during the 1890s by Raymond Sabour-aud, a famous Parisian dermatologist, who consolidated his researches in an...

Dermatophytosis Tinea

Mucocutaneous fungal infections are caused by dermatophytes (Microsporum, Epidermophyton, and Trichophyton) and yeasts. About 40 species in the three dermatophyte genera can cause tinea pedis and manus, tinea capitis, tinea corpo-ris, tinea cruris, and onychomycosis. Yeasts of Candida can cause diaper dermatitis, balanitis, vulvovaginitis, and thrush (Fig. 33-40). The yeastlike organism of Malassezia (Pityros-porum) causes tinea versicolor and contributes to seborrhea. Although tinea versicolor has the name tinea in it, it is not a true dermatophyte.

Tinea Cruris

Tinea cruris, commonly called jock itch, is a dermatophyte infection of the groin. This dermatophytosis is more common in men than women and is frequently associated with tinea pedis. Tinea cruris occurs when ambient temperature and humidity are high. Occlusion from wet or tight-fitting clothing provides an optimal environment for infection. Tinea cruris involves the proximal medial thighs and may extend to the buttocks and lower abdomen (Fig. 33-46). The scrotum tends to be spared. Patients with this dermatophy-tosis frequently complain of burning and pruritus. Pustules and vesicles at the active edge of the infected area, along with maceration, are present on a background of red scaling lesions with raised borders. Care should be taken to evaluate the feet as a source of infection. In addition to topical antifungals, treatment can include a low-dose corticosteroid for the first few days to reduce the inflammation of the involved skin. Oral antifungal therapy is needed if the tinea...

Tinea Cruris Cura

Fungal Infection Gluteal Cleft

Tinea corporis is ringworm infection. Fungal infections of the skin produce a scaling, ery-thematous patch, often with a reddened, raised, serpiginous border. The term tinea indicates the fungal cause, and the second word denotes the area of the body involved tinea corporis is infection in the body tinea pedis, in the foot tinea faciale, in the face tinea barbae, in the beard and moustache area in men tinea cruris, in the groin and tinea capitis, in the head. In all cases, the epidermis is thickened, and the stratum corneum is infiltrated with fungal hyphae. Figure 8-56 Cross section through an area of tinea corporis. Note the thickened stratum corneum, which is infiltrated by the fungus. Figure 8-56 Cross section through an area of tinea corporis. Note the thickened stratum corneum, which is infiltrated by the fungus. Figure 8-57 Tinea corporis. The underlying dermis displays mild inflammation. Figures 8-56 and 8-57 illustrate the classic annular lesion of tinea corporis with its...

Tinea Pedis

Macerated Tinea Pedis

Tinea pedis is most often caused by Trichophyton rubrum. Typically, patients describe pruritic scaly soles, often with painful fissures between the toes. Vesicular or ulcerative lesions may also be present. The most characteristic type of infection is interdigital (Fig. 33-44). Erythema, maceration, and fissur-ing occur between the toes and are accompanied by intense pruritus. Patients may also have chronic hyperkeratotic tinea pedis, characterized by plantar erythema and hyperkerato-sis that may be completely asymptomatic or mildly pruritic. This is described as a moccasin distribution (Fig. 33-45). Inflammatory tinea pedis causes painful vesicles on the foot (see Fig. 33-1). Figure 33-41 Trichophyton rubrum seen after KOH preparation using fungal stain. Richard P. Usatine.) Figure 33-41 Trichophyton rubrum seen after KOH preparation using fungal stain. Richard P. Usatine.) Figure 33-42 Tinea corporis showing concentric circles. J Richard P. Usatine.) Figure 33-42 Tinea corporis...

Tinea Capitis

Tinea Cruris

Tinea capitis, the most common dermatophytosis in children, is an infection of the scalp and hair follicle. Transmission is fostered by poor hygiene and overcrowding and can occur through contaminated hats, brushes, and pillowcases. After being shed, affected hairs can harbor viable organisms for more than 1 year. Tinea capitis is characterized by irregular or well-demarcated alopecia and scaling (Fig. 33-49). Cervical and occipital lymphadenopathy may be prominent. When hairs fracture a few millimeters from the scalp, black dot alopecia is produced. Tinea scalp infection also may result in a cell-mediated immune response termed a kerion, which is a boggy, sterile, inflammatory scalp mass Figure 33-46 Tinea cruris in woman. ( Richard P. Usatine.) Figure 33-46 Tinea cruris in woman. ( Richard P. Usatine.) Figure 33-47 Tinea cruris that has spread up to umbilicus. ( Richard P. Usatine.) Figure 33-47 Tinea cruris that has spread up to umbilicus. ( Richard P. Usatine.) Oral griseofulvin...

Tinea Corporis

Tinea corporis is a superficial dermatophyte infection of the cornified layers of skin on the trunk and extremities. Lesions are typically annular with central clearing and a scaling border and may be pruritic (Fig. 33-42). Infection may be transmitted from person to person, by animals such as household pets or farm animals, and through fomites. Because the cornified layer of skin is involved, topical therapy is usually sufficient for localized cases. A topical antifungal should be applied to the lesion and proximal surrounding skin twice daily for a minimum of 2 weeks. Various agents have demonstrated effectiveness, including the azoles (micon-azole, clotrimazole, ketoconazole, itraconazole) and the allylamines (naftifine, terbinafine). Terbinafine 1 cream (available OTC as Lamisil AF) produced a mycologic cure of 84.2 , versus 23.3 with placebo (Budimulja et al., 2001). In another study, patients with mycologically diagnosed tinea corporis and tinea cruris were randomly allocated to...

Fungus Infections Mycoses

Although some 200 fungi are established as pathogenic for humans, through the mid-nineteenth century only two human diseases caused by fungi were generally recognized. These were ringworm and thrush, known since Roman times. Two important additions came at the end of the century mycetoma of the foot and aspergillosis. Fungi were the first pathogenic microorganisms to be recognized. By the early nineteenth century, they had been shown to cause disease in plants and insects, and during the 1840s both ringworm and thrush were shown to be mycotic in origin. For a short period, fungi were blamed for many diseases (for example, cholera). But with recognition of the role played by bacteria Some fungi causing human disease show clear adaptations for the pathogenic state, whereas others do not. Probably none are dependent on a human or animal host for survival. Most are also pathogenic for animals, both domesticated and wild. Many fungi pathogenic for humans apparently belong to the normal...

Id Reaction Clinical Summary

Inflammatory tinea capitis and tinea pedis can induce a focal or generalized reaction. These typically result in vesicular or eczematous eruptions, but can be generalized morbilliform eruptions. Characteristically, the secondary id reaction is intensely pruritic. Id reactions are thought to represent a systemic reaction to fungal antigens and can present with systemic symptoms (fever, lymphadenopathy, anorexia, and leukocytosis). The id reaction will not demonstrate fungal elements and will not respond to topical steroids.

Emergency Department Treatment and Disposition

Evaluation of alopecia in the emergency department should focus on the history and infectious etiologies. Treatment for tinea capitis and kerions requires systemic antifungals, long-term treatment, and periodic laboratory monitoring. Referral to a dermatologist or primary care physician is recommended. In an at-risk patient, screening for syphilis should be considered. Bacterial infections should be treated with antibiotics after bacterial cultures are obtained. Other forms of alopecia can be referred to a dermatologist.

Erysipelas St Anthonys Fire

In cases involving the extremities, elevation and rest of the affected limb are recommended to reduce local swelling and inflammation. Oral or intramuscular (IM) penicillin for 10 to 14 days is sufficient for many cases of erysipelas. A macrolide such as erythromycin or azithromycin may be used if the patient is allergic to penicillin. Hospitaliza-tion for close monitoring and intravenous (IV) antibiotics are recommended for severe cases and for infants, older adults, and immunocompromised patients. Facial erysipelas should be treated empirically with a penicillinase-resis-tant antibiotic such as dicloxacillin to cover for possible S. aureus. Predisposing skin lesions, such as tinea pedis and stasis ulcers, should be treated aggressively to prevent superinfection.

Microscopic examination

The specimen is examined under low and then high power. It can be useful to examine a normal hair for comparison. Infected hairs appear broken and damaged. The cortex and cuticle are irregular and have a fuzzy outline because of the presence of the branching hyphae and arthroconidia (spores). The arthroconidia of M. canis are small, bead-like and form a dense mosaic pattern on the outside (ectothrix) of the hair shaft. Those of T. mentagrophytes are larger and occur as sparse chains (Fig. 31.12). Those of M. gypseum are much larger, less numerous and in chains. Care should be taken not to confuse the melanin pigment found within the hair shaft with the fungal growth. The microscopic characteristics of the arthro-conidia can be used to identify the ringworm species.

Clinical Manifestations and Pathology

Circinate (annular or ringworm) yaws lesions tend to encircle an area of skin, which may be several centimeters in diameter. Macular eruptions may occur and can be depigmented or partly hyper-pigmented (peripherally). These disappear within a few weeks or months. The papular or lichenous rash can be regional or cover the whole body with small papules, usually for not more than a few weeks. Plantar and palmar lesions can be ulcerative or nonulcerative. In the case of painful ulcerating soles, the individual tends to walk on the outer border of the foot in a crablike fashion ( crab yaws ). Alternatively, in the nonulcerating lesions, there may later be a worm-eaten appearance associated with thickened dry hyperkeratotic skin. In the moist parts of the body (anus, vagina, mouth, nose, axillae), raised

Onychomycosis and its treatment

Purulent Drainage

Dermatophytes Plantar scaling due to Trichophyton rubrum infection in a patient with DLSO. Plantar scaling due to Trichophyton rubrum infection in a patient with DLSO. Tinea cruris in a patient affected by DLSO of several finger nails due to Trichophyton rubrum. Tinea cruris in a patient affected by DLSO of several finger nails due to Trichophyton rubrum. Fungal melanonychia due to Trichophyton rubrum. Fungal melanonychia due to Trichophyton rubrum. fungi (Table 8.1) include dermatophytes (most frequently Trichophyton rubrum), moulds (Scytalidium spp., Scopulariopsis spp., Fusarium spp., Acremonium spp., Onychocola canadensis) and yeasts (Candida spp.). The skin of the palms and soles is frequently involved, especially in dermatophytic infections with plantar scaling (Figure 8.2). Tinea cruris is common in patients with onychomycosis due to T. rubrum and Epidermophyton floccosum (see Figure 8.7). by Trichophyton rubrum in people infected with human immunodeficiency virus (HIV). Finger...

Notion Of Bucco-dental Superinfections

The essential oil of Citrus aurantium var. amara was used to treat 60 patients with tinea corporis, cruris, or pedis. One group received a 25 bitter orange (BO) oil emulsion thrice daily, a second group was treated with 20 bitter orange oil in alcohol (BOa) thrice daily, and a third group used undiluted BO oil once daily. The trial lasted for 4 weeks and clinical and mycological examinations were performed every week until cure, which was defined as an elimination of signs and symptoms. In the BO group, 80 of patients were cured in 1-2 weeks and the rest within 2-3 weeks. By using BOa, 50 of patients were cured in 1-2 weeks, 30 in 2-3 weeks, and 20 in 3-4 weeks. With the undiluted essential oil, 25 of patients did not continue treatment, 33.3 were cured in 1 week, 60 in 1-2 weeks, and 6.7 in 2-3 weeks (Ramadan et al., 1996). After an initial in vitro study, which showed that the essential oil of Eucalyptuspauciflora had a strong fungicidal activity against Epidermophyton floccosum,...

Epidemiology and etiology

Tinea infections are second only to acne in frequency of reported skin disease. The common tinea infections are tinea pedis, tinea corporis, and tinea cruris. Tinea pedis, the most prevalent cutaneous fungal infection, afflicts more than 25 million people annually in the United States. Fungal skin infections are primarily caused by dermatophytes such as Trichophyton, Microsporum, and Epidermophyton. T. rubrum accounts for more than 75

Mycotic infections of the skin hair and nails

Tinea infections are superficial fungal infections in which the pathogen remains within the keratinous layers of the skin or nails (Table 83-5). Typically these infections are named for the affected body part, such as tinea pedis (feet), tinea cruris (groin), and tinea corporis (body). Tinea infections are commonly referred to as ringworm due to the characteristic circular lesions. In actuality, tinea lesions can vary from rings to scales and single or multiple lesions.

Nummular Dermatitis Nummular Eczema

Nummular Eczema

Nummular dermatitis consists of well-demarcated, coin-shaped lesions of eczema, typically on the extremities and less often the trunk (Fig. 33-33). Nummular dermatitis tends to worsen in dry, cold weather. Lesions may be mildly to severely pruritic and as a result become excoriated or even lichenified with scratching. Nummular dermatitis can be confused with plaques of psoriasis or tinea corporis but skin scrapings will not reveal hyphae on KOH preparation. Also, lesions lack the typical central sparing of tinea corporis. If necessary, a biopsy can help differentiate nummular eczema from psoriasis.

Opportunistic and Iatrogenic Infections

During World War II, for example, ringworm symptoms disappeared in prisoners held under starvation conditions only to reappear on the restoration of a full diet. Tinea capitis (M. audouinii) in children, although persistent, resolves spontaneously at puberty for reasons not fully understood. Tinea pedis has been claimed as an occupational disease of workers who wear heavy boots. Candida infection is affected by pregnancy, and metabolic disorders such as diabetes are frequently associated with it. Iatrogenic mycoses have resulted from the use of antibacterials. Moreover, immuno-suppressive drugs used in organ transplantation have resulted in Candida endocarditis and my-cotic septicemia. Antimycotic therapy is now a routine supplementary practice.

Use Of Essential Oils Mainly As Chemical Agents And Not For Their Odor

A 10 tea tree oil was used on 104 patients with athlete's foot Tinea pedis) in a randomized double-blind study against 1 tolnaflate and placebo creams. The tolnaflate group showed a better effect tea tree oil was as effective in improving the condition, but was no better than the placebo at curing it (Tong et al., 1992). Surprisingly, tea tree oil is sold as a cure for athlete's foot.

Candidiasis including Thrush

Reports and studies of the many and diverse manifestations of candidiasis caused by Candida albicans and other species of Candida (e.g., Candida guillier-mondii, Candida krusei, Candida stellatoidea, Candida tropicalis) have made a major contribution to the literature of medical mycology, as they still do. As for ringworm, a stable taxonomic base was necessary to underpin both clinical and microbiological observations and research on this mycotic complex because C. albicans was described as new on a number of occasions and acquired some 90 specific names distributed among a dozen genera. Much confusion resulted. One taxonomic error that the reader must still remember when consulting the earlier literature is the assignment back in 1890 of the thrush fungus to the genus Monilia because moniliasis became the generally accepted, worldwide name for candidiasis. It was mainly a group of yeast specialists working in the Netherlands who clarified the taxonomy the genus Candida was proposed...

Diseases of the Premodern Period in Japan

In addition to the plentiful information on diseases supplied by court histories, literature, and other records, medical texts and an encyclopedia called the Wamyo ruiju sho also list medical terminology (Hattori 1945). Among the infections included are idiopathic cholera (shiri yori kuchi yori koku yamai, kakuran), leprosy (raibyd), elephantiasis igeju), bronchitis (shiwabuki yami), hepatitis (kibamu yamai), dropsy (harafukuru yamai), asca-rids (kaichu), threadworms (gyochu), meningitis (fubyo), infantile dysentery (shoji kakuran), diphtheria (bahi), bronchial asthma (zensoku), epilepsy (tenkari), chronic nephritis (shokatsu), tonsilitis (kdhi), osteomyelitis (fukotsuso), thyroiditis (ei), erysipelas (tandokuso), ringworm (senso), gastritis (iso), palsy (kuchi yugamu), and scabies (kaiso). Records from the era 700-1050 also have led scholars to infer the existence of cancer, pneumonia, tapeworms, rheumatoid arthritis, and hookworms.

Ancyclostoma Brazillienses Force Out Of The Skin

Digital Sclerosis

Bacterial and fungal infections are common in diabetic patients. Figure 20-75 depicts bacterial cellulitis and tinea pedis in a diabetic patient. Tinea pedis produces macerated, scaling, fissured toe webs inflammatory epidermis and thick, hypertrophic, discolored nails. Necrotizing fasciitis is a very severe form of cellulitis that can develop in diabetic patients. It involves the deep fascial structures underlying the skin and is caused by a mixture of aerobic and anaerobic gram-negative organisms. Figure 20-76 shows necrotizing fasciitis. Notice the sharply demarcated painful area of the infection. Surgical debridement and broad-spectrum antibiotics are necessary to treat the infection.

Alopecia Clinical Summary

It can be classified into scarring (absence of follicles) and nonscarring (presence of follicles) alopecia. Scarring alopecia is commonly caused by discoid lupus erythematosus (erythematous mottled pigmentation and atrophic scalp scarring) and folliculitis decalvans (multiple crops of pustules on the scalp). Occasionally, prolonged bacterial and inflammatory fungal infections (kerion) can induce scarring on the scalp. Nonscarring alopecia results from alopecia areata (annular areas of alopecia on the scalp or beard area), telogen effluvium (diffuse scalp shedding of hair 2 to 3 months after a stressful event, illness, or new medication), anagen effluvium (diffuse scalp shedding after chemotherapy), trichotillomania (constant pulling of the hair), traction alopecia (chronic tension of braided hair causing alopecia), and tinea capitis. Syphilis can cause a patchy, moth-eaten alopecia.

Seals of Excavated Tombs

In places where there is too much light (chhing, clear) water, disease of the scalp (thu alopecia, ringworm, psoriasis, etc.) and goitre (ying) are commonly found. In places where there is too much heavy (chung, turbid) water, people suffering from swellings and oedematous ulcers of the lower leg (thung1) are commonly found and there are many seriously affected who are unable to walk at all (pi). Where sweet (kan) water abounds, men and women will be health y and handsome. Where acrid (hsin) water abounds there will be many skin lesions, such as abscesses (chii) and smaller boils (iso) where bitter (khu) water abounds there will be many people with bent bones (wang yii).

Category C Severely Symptomatic

History should be obtained including a review of risk factors for HIV-1 exposure, drug and alcohol history, sexual history, travel history, and medical history. A complete baseline physical examination should be performed. Focused follow- up examinations are then recommended with attention directed to findings that indicate disease progression such as general appearance and weight loss, dermatological conditions (seborrheic dermatitis, folliculitis, dermatophytosis, Kaposi's sarcoma, bacillary angiomatosis), oral lesions (candidiasis, hairy leukoplakia, aphthous ulcers, periodontal disease), localized lymphadenopathy, splenomegaly and signs or symptoms of neurological neuropsychiatric involvement (mood or affective disorders, psychomotor slowing, abnormal eye movements, hyperreflexia, change of gait).

Diseases in Antiquity

Apart from evidence derived from archeological research, the earliest available sources of information on disease in Southeast Asia are references in inscriptions and accounts appearing in traditional texts. Khmer inscriptions of the seventh and eighth centuries A.D., for example, make reference to lice, eye impairments, and dermatitis or ringworm (Jenner 1981). It is difficult to date some of these sources, especially texts, but it is clear that by the time of their appearance there had already been considerable contact between Southeast Asia and


1930s and the 1940s was frequently given for thymic, adenoid, and tonsillar enlargement, facial acne, and even tinea capitis. As many as 30 to 40 of such patients later operated on for thyroid nodules were discovered to have differentiated thyroid carcinoma, usually papillary and often only microscopic.16 When this etiologic association became apparent, such low-dose radiation therapy disappeared from clinical practice, and as a result few patients today are seen with a history of radiation treatment. Thyroid gland abnormalities in survivors of the nuclear bomb explosions in Japan and the Pacific atolls are well described.17 These nodules were both benign and malignant, but in almost half of the cases of cancer, the lesion was a microscopic or small focus in thyroid tissue adjacent to a benign nodule.

Fungal Infections

Tinea (ringworm) is one of the most common fungal infections. Tinea pedis is frequently seen in athletes secondary to group showering, and it can be prevented to some extent by having athletes regularly change socks and use wicking materials in socks to keep feet dry, drying powders (many of which contain prophylactic topical antifungals), and shower shoes. Treatment with topical antifungals and oral therapy for severe cases are effective. Fungal infections are spread directly from person to person through contact sports, with the type seen in wrestlers (tinea corporis gladiatorum) being the most problematic. Tinea tonsurans occurs most often, with infection rates in high school wrestlers of 24 to 75 (Adams, 2000 Beller and Gessner, 1994). Infection is caused by contact with an infected opponent and usually occurs on the arms, neck, or head. The lesions often appear initially as annular plaques with raised erythematous borders and may progress without the central clearing often...

Transplanted Hairs

Possible causes Patchy hair loss may be the result of ringworm (especially if the scalp is inflamed and itchy). Alopecia areata, a condition in which the body's immune system attacks the hair follicles, is also a possibility. Consult your doctor. action Ringworm is usually treated with a course of antifungal drugs. Your hair should then regrow. Alopecia areata often clears up without treatment, with new hair growing in over the next 6-9 months. However, in rare cases hair loss may be permanent.

Skin and hair

Laboratory tests can prove invaluable in the diagnosis of many skin conditions. It is important, when handling animals with skin disease, to avoid transmission of the condition to humans (zoonosis) and cross-contamination of other patients. Examples of potential zoonoses include ringworm, Cheyletiella and Sarcoptes. To reduce the risk, gloves and aprons should be worn when handling suspect patients and samples. The animal should be adequately restrained while the samples are taken, as few people as possible should handle the patient and care should be taken to avoid contact with other animals. The owner should also be made aware of the risks and precautions that need to be taken to reduce them.

Diagnosis Woods lamp

This is an ultraviolet lamp that emits light of a wavelength of 365-366 nm. When the light is directed on to a hair or claw affected with M. canis, ideally in a darkened room, it will emit a characteristic yellowish green fluorescence, similar to that seen on a luminous clock dial. This is due to the presence of a fluorescent metabolite produced by the fungus. However, it must be remembered that only 60 of cases of M. canis show this fluorescence, so the only significant result is a positive one. A negative result does not mean that the animal does not have ringworm, as it might have non-fluorescing M. canis or one of the other species that do not fluoresce.


Superficial white onychomycosis is easy to diagnose a tangential biopsy of the nail plate is taken with a no. 15 scalpel and sent to the laboratory. Formalin fixation is not necessary. The thin nail slice is processed and cut as usual and stained with periodic acid-Schiff reagent (PAS) or another stain for fungi. Under the microscope, chains of small, regularly sized fungal spores are seen on the nail plate surface and in its splits, giving evidence of a Trichophyton mentagrophytes infection. Larger spores and short, thick-walled hyphae of irregular calibre are characteristic of a mould infection. The nail plate does not exhibit any further pathological alterations and the subungual structures remain normal.

Initial Evaluation

Trichophyton Mouth

Figure 33-1 Vesicular tinea pedis leading to autosensitization reaction. Figure 33-1 Vesicular tinea pedis leading to autosensitization reaction. Figure 33-2 Autosensitization reaction secondary to vesicular tinea pedis (id reaction). Richard P. Usatine.) Figure 33-2 Autosensitization reaction secondary to vesicular tinea pedis (id reaction). Richard P. Usatine.) hydroxide (KOH) (best with dimethyl sulfoxide DMSO and fungal stain), and look for the hyphae of dermatophytes or the pseudohyphae of Candida or Pityrosporum species. Wood's light examination. This is helpful in diagnosing tinea capitis and erythrasma. Tinea capitis caused by Microsporum spp. produces green fluorescence, but Trichophyton spp. do not fluoresce. Erythrasma has a coral-red fluorescence. Wood's lamp also helps distinguish lesions of vitiligo in patients with fair skin.

Other Diseases

Other health problems frequently mentioned in contemporary literature include beriberi, toothaches, hemorrhoids, ringworm, coughing disease, kidney problems, and food poisoning. In addition to these common ailments, there are two others, which are called senki and shaku. These two terms, used in Japan as early as the tenth century, appear to refer to a host of diseases that cause stomach, intestinal, or back pain. Senki seems to refer to chronic disease, and shaku to more acute problems.

Indigenous Diseases

Those European explorers who commented upon the health of the indigenous people they contacted described them as strong, well-shaped, clean, noble, and generally healthy (Moodie 1973 Howe 1984). Because the weak, ill, or deformed were unlikely to be among the greeting party, such an appearance might be made even if endemic diseases were present. Although geographic isolation had protected Pacific peoples from the epidemic diseases that had swept Europe, Africa, and the New World, their continued if infrequent contacts with Southeast Asia, ever since the initial migrations to Australia and New Guinea, exposed them to some of the diseases extant there (Ramenofsky 1989). Diseases known (from explorers' journals or dated skeletal remains) to be present in the region before first contact with Europeans include malaria (restricted to Melanesia as far south as Vanuatu), respiratory infections, enteritis, rheumatism and degenerative arthritis, dental wear and decay, eye infections,...

Subject Index

Ringworm, 130 scarlet fever, 289 rickettsii dermatitis, 165, 242 dermatophytosis, 128-30 dermatosis, 263 desert sores, 95 desquamation, 289 devil's fire, 120 dew poison, 165 diabetes mellitus (DM), 88-92 candida infection and, 132 characteristics, 91-92 eclampsia and, 111 gangrene in, 137 gestational, 88, 91 glomerulopathies, 145 Epidermophyton, 129 Epidermophyton floccosum, 129 epilepsy, 31, 111, 116-19 Epstein-Barr virus, 162, 174-75 equine encephalitis, 115, 173 equine rabies, 270 ergot intoxication, 288 ergotism, 120-21 characteristics, 120 gangrene in, 136-37 history, 120-21 as Plague of Athens, 252-53 Saint Anthony's fire in, 287-88 sweating sickness and, 312 erosive arthritis, 42. See also arthritis erosive inflammatory osteoarthritis, 235 erosive joint disease, 41 erysipelas, 121-22, 136, 257, 288, 304-5 erysipelas grave internum, 122 erythema, 208 ringworm, 129 fungus infections (mycoses), 128-32 blastomycosis, 130-31 candidiasis, 2, 130 coccidioidomycosis, 130...