Systemic Disturbances in Recalcitrant Trichophyton Rubrum (Purpureum) Infections

MATERIAL THE MATERIAL presented here consists of 20 adult patients suffering from therapy-resistant Trichophyton rubrum (purpureum) infections of the palms, soles, toenails, and fingernails observed within the last three years at the University of Chicago Clinics. The palmar and plantar manifestations included superficial circinate and annular scaling lesions reminiscent of keratolysis exfoliativa, punctate hyperkeratotic lesions, and diffuse hyperkeratotic and callous lesions. The infected nails showed the well-known disintegration of the plates starting at the distal end but eventually involving the whole plate. In some cases an unusually hard subungual rippled hyperkeratosis was present. Vesicle formation and interdigital maceration were either not seen at all, or if they were present they responded readily to local application of fungistatic agents. In some cases the hyperkeratosis extended to the interdigital spaces, and such hyperkeratoses were as resistant as those on palms and soles. No other areas but palms, soles, and nails