The acute disease is usually of short duration, disappearing spontaneously or as the result of treatment, in several hours or days; it may recur upon exposure to the exciting cause. The prognosis of chronic urticaria is to be guarded, and will depend upon the ability to discover and remove or modify the predisposing condition.
What systemic measures are to be prescribed in acute urticaria?
Removal of the etiological factor is of first importance. This will be found in most cases to be gastric disturbance from the ingestion of improper or indigestible food, and in such cases a saline purgative is to be given, probably the best for this purpose being the laxative antacid, magnesia; or if the case is severe and food is still in the stomach, an emetic, such as mustard or ipecac, will act more promptly. Alkalies, especially sodium salicylate, and intestinal antiseptics are useful. Calcium chloride in doses of five to twenty grains should be tried in obstinate cases. The diet should be, for the time, of a simple character.
What systemic measures are to be prescribed in chronic and recurrent urticaria?
The cause must be sought for and treatment directed toward its removal or modification. Treatment will, therefore, depend upon indications. In obscure cases, quinine, sodium salicylate, arsenic, pilocarpine, atropia, potassium bromide, calcium chloride, and ichthyol are to be variously tried; general galvanization is at times useful, as is also a change of scene and climate. A proper dietary and the maintenance of free action of the bowels, preferably, as a rule, with a saline laxative, is of great importance in these chronic cases.
In acute circumscribed œdema treatment is essentially that of urticaria, the diet being given special attention.
What external applications would you advise for the relief of the subjective symptoms?
Cooling lotions of alcohol and water or vinegar and water; lotions of carbolic acid, one to three drachms to the pint; of thymol, one-fourth to one drachm to the pint of alcohol and water; of liquor carbonis detergens, one to three ounces to the pint of water, or the following:—
℞ Acidi carbolici, ................................. ʒj-ʒiij
Acidi borici, .................................... ʒiv
Glycerinæ, ...................................... fʒj
Alcoholis, ...................................... f℥ij
Aquæ, ........................................... f℥xiv. M.
Alkaline baths are also useful, and may advantageously be followed by dusting-powders of starch and zinc oxide.