Tar and kerosene paint for tinea complicating leprosy.

Various forms of tinea constitute one of the most distressing complications of the more chronic forms of leprosy. Some of these infections seem to flourish because of the hyperhidrotic condition of the skin of the trunk, which compensates the suppression of the sweat function in the limbs. Other forms of tinea appear to prefer the dry epithelium left by old tuberculoid lesions. The back of the trunk is a favorite site when one or more large tuberculoid patches, after overrunning the whole dorsal area, have receded to leave a dry, insensitive, atrophic surface. On this surface the dermatophyte spreads causing a rough, scaly, shiny condition which is often mistakenly supposed to be a result of leprosy itself. In other cases a congenial soil is found on the hands or feet, after the neural form of leprosy has died out. The condition produced is illustrated by the accompanying photographs Plate (3). The patient's first appearance gave the impression that he had drawn on thick gloves of rough Morocco leather. He was treated at the outpatient clinic with the application of tar-kerosene paint on two occasions with an interval of one week. Within a month the condition had entirely resolved, as is shown in Figs. 2 and 4, leaving only the original neural deformities of the hands. This case is an outstanding example, but tinea is one of the commonest complications 'of leprosy in India and Africa and other warm countries. Often it underlies a chronic folliculitis or dermatitis of the legs, extending from the ankles to the knees. Sometimes it is confined to the feet, affecting either the dorsal or plantar surface, or both. In our experience tar-kerosene paint is generally effective in all the ordinary wide-spread forms of tinea, and in many cases it clears up septic complications at the same time. If, however, there are hard thick crusts these should first be removed with poultices; or if there is a weeping surface, it should first be dried with lead lotion or some other astringent. Tar is of course one of the oldest and best known remedies of the dermatologist, but generally the more refined tar prepara-