Essentials of Diseases of the Skin Part 26

_Alteratives_--calomel, colchic.u.m, a.r.s.enic, and pota.s.sium iodide.

_Diuretics_--pota.s.sium acetate, pota.s.sium citrate, and oil of copaiba.

_Laxatives_--the various salines, aperient spring waters, castor oil, cascara sagrada, aloes and other vegetable cathartics.

_Digestives_--pepsin, pancreatin, muriatic acid and the various bitter tonics.

Are there any remedies which have a specific influence?

No; although a.r.s.enic, in exceptional instances, seems to exert a special action. Cod-liver oil is also of great value in some cases.

Upon the whole the most important remedies are those which keep in view the maintenance of a proper and healthful condition of the gastro-intestinal tract, and especially with regular and rather free action of the bowels.

In what cla.s.s of cases does a.r.s.enic often prove of service?

In the sluggish, dry, erythematous, scaly and papular types.

In what cases is a.r.s.enic usually contraindicated?

It should never be employed in acute cases; nor in any instance (unless its action is watched), in which the degree of inflammatory action is marked, as an aggravation of the disease usually results.

What should be the character of the external treatment?

It depends mainly upon the degree of inflammatory action; but the stage of the disease, the extent involved, and the ability of the patient to carry out the details of treatment, also have a bearing upon the selection of the plan to be advised.

What is to be said about the use of soap and water in eczema?

In acute and subacute conditions soap and water are to be employed, as a rule, as infrequently and as sparingly as possible, as the disease is often aggravated by their too free use. Washing is necessary, however, for cleanliness and occasionally, also, for the removal of the crusts.

On the other hand, in chronic, sluggish types the use of soap and water frequently has a therapeutic value.

How often should remedial applications be made?

Usually twice daily, although in some case, and especially those of an acute type, applications should be made every few hours.

Mention several remedies or plans of treatment to be used in the acute or actively inflammatory cases.

Black wash and oxide-of-zinc ointment conjointly, the wash thoroughly dabbed on, allowed to dry, the parts gently smeared with ointment; or the ointment may be applied spread on lint as a plaster.

Boric-acid wash (15 grains to the ounce) and oxide-of-zinc ointment, applied in the same manner as the above.

A lotion containing calamine and zinc oxide, the sediment drying and coating over the affected surface:--

[Rx] Calaminae, Zinci oxidi, ... [=a][=a] ......... [dram]ij-[dram]iij Glycerinae, Alcoholis, ..... [=a][=a] ......... f[dram]ss Liq. calcis, ...................... f[Oz]ij Aquae, .......... q.s. ad .......... f[Oz]vj. M.

Another excellent lotion somewhat similar to the last, but of oily character, is made up of three drachms each of calamine and zinc oxide, one drachm of boric acid, ten to thirty drops of carbolic acid, and three ounces each of lime-water and oil of sweet almonds.

Carbolic-acid lotion, about two drachms to the pint of water, to which may be added two or three drachms each of glycerin and alcohol; or, if there is intense itching, carbolic acid may be added to the several washes already mentioned.

A lotion made of one or two drachms of liquor carbonis detergens[A] to four ounces of water.

The following wash, especially in the dry form of the disease:--

[Rx] Ac. borici, .......................... [dram]iv Ac. carbolici, ....................... [dram]j Glycerinae, ........................... [dram]ij Alcoholis, ........................... [dram]ij Aquae, ............. q.s. ad .......... Oj. M.

[Footnote A: Liquor carbonis detergens is made by mixing together nine ounces of tincture soap bark and four ounces of coal tar, allowing to digest for eight days, and filtering. The tincture of soap bark used is made with one pound of soap bark to one gallon of 95 per cent. alcohol, digesting for a week or so. Instead of the proprietary name above, Prof.

Duhring has suggested that of tinctura picis mineralis comp.]

Dusting-powders, of starch, zinc oxide and Venetian talc, alone or severally combined, applied freely and often, so as to afford protection to the inflamed surface:--

[Rx] Talci venet, Zinci oxidi, ....... [=a][=a] ........ [dram]iv Amyli, ............................... [Oz]j M.

If washes or dusting-powders should disagree or are not desirable or practicable, ointments may be employed, such as--

Oxide-of-zinc ointment, cold cream, petrolatum, plain or carbolated, diachylon ointment (if fresh and well prepared), and a paste-like ointment, as the following, usually called "salicylic-acid paste"; in markedly itchy cases, five to fifteen grains of carbolic may be added to each ounce:

[Rx] Ac. salicylici, ...................... gr. v-x Pulv. amyli, Pulv. zinci oxidi, .... [=a][=a] ..... [dram]ij Petrolati, ........................... [dram]iv M.

Or the following ointment:--

[Rx] Calaminae, ............................ [dram]j Ungt. zinci oxidi, ................... [dram]vij. M.

Name several external remedies and combinations useful in eczema of a subacute or mildly inflammatory type.

The various remedies and combinations useful when the symptoms are acute or markedly inflammatory (mentioned above), and more especially the several following:--

[Rx] Zinci oxidi, ......................... [dram]ij Liq. plumbi subacetat. dilut., ....... f[dram]vj Glycerinae, ........................... f[dram]ij Infus. picis liq., ................... f[Oz]iij M.

A lotion containing resorcin, five to thirty grains to the ounce.

Solution of zinc sulphate, one-half to three grains to the ounce.

An ointment containing calomel or ammoniated mercury, as in the annexed formula:--

[Rx] Hydrargyri ammoniat. seu Hydrargyri chloridi mit., ................... gr. x-x.x.x Ac. carbolici, ..................... gr. v-x Ungt. zinci oxidi, ................. [Oz]j M.

Another formula, more especially useful in eczema of the hands and legs, is the following:--

[Rx] Ac. salicylici, ...................... gr. x.x.x Emp. plumbi, Emp. saponis, Petrolati, ...... [=a][=a] ........... [Oz]j. M.

(This is to be applied as a plaster, spread on strips of lint, and changed every twelve or twenty-four hours.)