| Rx. | Kaolini, Ol. lini, aa. | drachm vj; |
| Zinci oxidi, | ounce ss; | |
| Liq. plumbi subacetat., | fluidounce ss. M. |
This is painted on and allowed to dry, and then bandaged for twenty-four hours. In some skins, however, glycerin invariably irritates.
In the papular form the tarry lotions named and carbolic-acid lotion are of most benefit. These cases are from the beginning inclined to take on the chronic type, and the more stimulating applications are well borne. Thymol, one or two grains to the ounce of alcohol and water, is also useful.
In chronic eczema, and, in fact, in all cases of eczema, after the active inflammatory symptoms have more or less subsided—which usually takes place soon after the beginning of the outbreak—stimulating applications are to be resorted to. In fact, the dividing-line between acute and chronic eczema is difficult to define. The products of the disease, be they crusts or scales, must be removed in order that the remedial application may be brought in contact with the diseased surface. Thoroughly saturating the part with oil, and subsequently washing with warm water and soap, will usually suffice to remove the accumulations. On the non-hairy surface a bland oil, lard, or a non-irritating ointment thickly spread on the parts, will soon be followed by softening and removal of the crusts or scales. If these more simple measures are not sufficient, washings with sapo viridis and warm water are to be advised for this purpose, immediately afterward applying a mild unguent. On the scalp, instead of the pure green soap, the spiritus saponatus kalinus is more satisfactory. In patches which are covered with thickened epidermic masses, as in eczema of the palms, strong applications are necessary to remove the accumulations. For this purpose green soap or salicylic acid may be used. Of these, salicylic acid is in most cases to be preferred. It may be applied as an alcoholic solution, 5 or 8 per cent. strength, or in ointment form, fifteen to forty grains to the ounce.
After a removal of the products of the disease the remedies proper are to be applied. The various ointments already named for the treatment of the acute and subacute types may also be employed in the chronic cases. In some instances they may prove sufficient, but in the majority it will be found necessary to have immediate recourse to the stronger ointments and lotions. In small patches washing the parts with green soap and hot water and following with unguentum diachlyi or a similar ointment will be sufficient.
The mercurials are of great value in the treatment of eczema, used either alone or in combination with various other remedies. An ointment of the mild chloride of mercury, twenty to eighty grains to the ounce, is valuable in many cases. Citrine ointment, weakened, and ammoniated mercury, in the same proportion as calomel, are also well-known and very useful preparations, likewise acceptable in many cases. To these ointments tar may often be advantageously added, in the strength of one or two drachms to the ounce. Carbolic acid in ointment, ten to twenty grains to the ounce, may also be mentioned as often proving serviceable. A compound ointment, prized in the Blackfriars Hospital for Skin Diseases, London, is composed of acetate of lead, ten grains; oxide of zinc, twenty grains; calomel, ten grains; citrine ointment, twenty grains; palm oil, half an ounce; benzoated lard, enough to make one ounce. Another mildly stimulating preparation is composed of bisulphide of mercury and red precipitate, each six grains; lard, one ounce.
Tarry preparations constitute the most generally efficacious applications in the treatment of all forms of chronic eczema, where this remedy is at all tolerated by the skin, especially in the squamous variety of the disease. A good formula, and one that is often of service even in the subacute variety, is the following:
| Rx. | Picis liquidæ, Zinci oxidi, aa. | drachm j; |
| Ugt. aquæ rosæ, | drachm vj. |
M. Ft. ugt.—This is to be gently but thoroughly rubbed into the diseased skin. There are three preparations of tar that may be interchangeably employed: these are the ordinary pix liquida, oleum cadinum, and oleum rusci. The oleum rusci is the least unpleasant. They may be employed in the strength of 10 to 50 per cent., either in ointment form or with alcohol. If used upon the scalp, the lotion form, with alcohol, is to be preferred. In the use of a tarry preparation, to be efficient it is to be gently but thoroughly worked into the patches, so that it permeates the skin; the excess may be wiped off. The liquor picis alkalinus, already mentioned in speaking of the treatment of acute eczema, may be used either in the form of an ointment, in the strength of one or two drachms to the ounce, or in the form of a lotion, in the strength of two to eight drachms to the half pint. This tarry preparation may even be employed in full strength to small and thickened patches, applying carefully and using no other treatment, or following the application immediately with a simple or tarry ointment. In cases of verrucous eczema or in patches of thickened papular or squamous eczema, used in the manner described, it is often curative. It is a strong remedy, and is to be employed with caution. The liquor carbonis detergens, in the strength of one or two drachms to the ounce of water, is also valuable in these chronic cases. It is a safe plan in the use of these tarry preparations to begin with a mild strength and then increase if advisable. An equally efficacious formula for the thick, leathery patches of chronic eczema is the following:
| Rx. | Saponis viridis, Picis liquidæ, Alcoholis, aa. | drachm iv. |