手掌の角質増殖型皮膚カンジダ症の2例—ならびに副甲状腺機能低下症（hypoparathyroidism）と表在性カンジダ症との合併に関する文献的考察

TWO CASES OF SUPERFICIAL HYPERKERATOTIC CANDIDIASIS OF THE PALMS;REVIEW OF LITERATURE AND DISCUSSION ON THE COMBINATION OF HYPOPARATHYROIDISM AND SUPERFICIAL CANDIDIASIS

　皮膚カンジダ症は白癬についで多くみられる皮膚真菌症であるが，その多くは間擦部に限局性発生を示し，手掌，足蹠といつた角質層の厚い皮膚に原発あるいは続発することははなはだ稀である。通常みられる皮膚カンジダ症の症状は，ときに浸軟，糜爛を伴なう落屑性紅斑であつて，浸潤，角化，肥厚を合併することはほとんどない。われわれは，これまでに記載をみない，手掌に原発し，角質増殖性病変を伴なつた皮膚カンジダ症の2例を経験したのでその詳細について報告する。

　なお，そのうちの1例は特発性副甲状腺機能低下症に合併したものであるが，近年この両疾患の合併例が少なからず報告され，両者の因果関係が問題にされている。そこでこのような症例をひろく収集し，この問題について文献的考察をも合せ行なつた。

Two cases of a hyperkeratotic type of candidiasis of the palms were reported.

Case 1 : A 16-year-old girl with chronic idiopathic hypoparathyroidism has been suffering from thrush since 1 year of age and from onychia paronychia and erythemato-squamous lesions with hyperkeratosis on the palms and fingers since 4 years of age. Topical and systemic antifungal treatments for 9 years showed no improvement and the lesions enlarged.

The morphology of the tissue form of Candida in the horny layer was atypical and looked like that of Trichophyton.

Case 2 : A 23-year-old man, a Sushi cook has been suffering from polycyclic erythemato-hyperkeratotic plaques on the thenar and hypothenar eminences of both hands for 6 months. No lesions were found on the nails and webs. The volar aspects of the toes and the sole of the left foot were atudded with small erythematous plaques with hyperkeratosis. No atypicalities of the tissue form of Candida in the horny layer were proved. The lesions completely disappeared after a 40 day topical treatment.

Cutaneous candidiasis with severe hyperkeratosis on the palms and soles can not be found in the literature.

Not a few cases of candidiasis accompanied by chronic idiopathic hypoparathyroidism, as seen in the case 1, have been reported. It has been recognized that the skin of the patient with hypoparathyroidism is apt to be affected by candidiasis but the pathogenesis is still unknown.