982                    DISEASES OF THE APPENDAGES

LEPOTHRLX

Synonym.—Trichomycosis palmellina (Pick).

Lepothrix is the name given by Wilson to a peculiar, roughly nodular
affection of the hairs of the axilla or genital region, which had been first
described by Paxton. The axilla is its usual site. The hairs, examined
by the naked eye, are found lusterless, somewhat uneven, and jagged.
They usually break readily, especially when dry. Examined more closely,
with some magnification, they appear irregularly nodular, the nodular
masses being arranged continuously along the whole length of the shaft,
or in clumps here and there, but not encompassing the whole surface of the
hair. The accumulation increases the thickness of the hair considerably.
They are small, grayish-yellow to yellowish-red, rough concretions,
their outer edge directed upward toward the end of the hair-shaft. This
seems to be due to the fact that the cells of the cuticle, which, shingle-like,
overlap in this direction, are probably loosened or softened by the heat,
moisture, and sebaceous and sweat secretions of the part, and the bacteria
of which the concretions are composed find a convenient place to lodge
and multiply. They are firmly attached to the hair, a bacterial secretion
probably forming a hard, gluey mass of which the concretions are partly
made up. An added micrococcus in the axilla is occasionally observed,
which gives the concretions the red color, and by which also the sweat is
rendered of the same tinge (Pick, Balzer, Barthélemy, and others);
the same concretions are seen on the scrotal hairs without the red color
(Crocker). It is a rare affection according to ordinary observations or
statistics, but both Behrend and Crocker consider it quite common, but
as it seldom gives rise to trouble, advice is not sought, or affected individ­
uals may remain unconscious of its existence. Behrend states that it
exists to some degree in 20 per cent, of all people The disease has been
investigated by Behrend, Payne, Patterson, Eisner, Sonnenberg,¹ Cas-
tellani, and others, and the concretions found to be due to parasitic
growths; the last-named observer has noted several varieties.² Appar­
ently, however, there is some difference in the findings.

The condition is persistent and it is rebellious to treatment. Fre­
quent washings with soap and water and the application of antiseptic
lotions, such as one of corrosive sublimate, 1: 2000 up to 1: 500, are
employed. Castellani advises dabbing the hair two or three times daily,
with a 2 per cent, solution of formalin in spirit; and applying at night a
2 per cent, sulphur ointment. A preliminary shaving of the parts has
also been advised.

¹ Sonnenburg, Monatshefte, 1898, vol. xxvii, p. 538 (with review of the subject and
literature references); see also literature references under red sweat.

² Castellani, Brit. Jour. Derm., 1911, p. 341 and 1913, p. 14, describes three varieties
in the axillary regions, found in the hot damp district of Ceylon—trichomycosis flava,
trichomycosis nigra, and trichomycosis rubra—but the formations are of rather soft
consistency, and easily removed from the hairs by scraping. It is quite common in
Ceylon. He ascribes the yellow variety to a bacillary-like fungus, probably a strepto-
thrix or a microsporoides; the pigmentation in the black and red varieties is caused by
coccus-like organisms, which grow on the hair in symbiosis with the fungus. He
considered these several varieties as closely allied to lepothrix, as above described.
The papers are illustrated.

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