ROYAL SOCIETY OF MEDICINE SECTION OF DERMATOLOGY

4 years he has noticed swelling of tlie finger tips and changes in the finger nails. On examination.—Paronychial swelling of most fingers with dystrophy of tin* nails (Fig. 1). The sides of the nails are darkened and hyperkeratotic. 8caly rash of both insteps with hyperkeratosis of tiu> plantar creasos. Right 1st, 2nd and 4tli toe nails dystrophic. Left big toe nail discoloured and dystrophic. Investitjations.—Microscopy: potash preparations of the tingcr nail showed tliat the infecting fuTigus was not a dermatophyte. The hyphal walls were olive brown and the arthrospores were thick walled, robust structures. In one sample the young hyphao extending from tho brown mycelium were colourless and indistinguishable fniin those of a dermatophyte. Culture: media used routinely for culture: (i) Sabouraud's glucose agar incorptjrating cydoliexamidc (0-5 mg/ml) and chloramphcnicol (0-05 nig/ml). (ii) Mait extract agar, incorporating chloramplicnicol (O-Ofl nig/ml). Inoculated IVtri dishes wore incubated at :J7"C. No isolations occurred on the Sabouraud's agar with cyclohexamide. Growth of //. loruloidea on malt extract agar without eyclohexamido «as rapid, reaching a colony diamrtor of 35 mm in 4 days. The aerial growth was niousc-grey, loosely fluffy, 5-10 mm high and exhibits! marked growth rings (Fig. 2). Tho reverse was mottled, black in the centre, becoming colourless at the margin. Microscopically the only significant feature was tlie abundance of arthrosptjros formed from the fragmentation of the older hyphac. These wore colourless, long ublong (3-5 /x wide /.. II ^ long) to olive-brow 11, barrel shaped,