A system of practical medicine. By American authors. Vol. 4

by Unknown

M.—Sig. Use with a brush as a paint.

A lotion containing one to four drachms of precipitated sulphur, twenty or thirty grains of camphor, thirty to sixty grains of tragacanth, in two ounces each of lime-water and orange-flower water, or one of the same quantity of sulphur, two or three drachms of ether, and three and a half ounces of alcohol, will in many cases prove serviceable. A lotion of one or two drachms each of sulphide of potassium and sulphate of zinc, in four ounces of water, is one of great value.

Concerning the mercurials, corrosive sublimate, calomel, and white precipitate are in some cases of service. Corrosive sublimate is prescribed as a lotion of the strength of one-half to four grains to the ounce of water or water and alcohol. Calomel and white precipitate are prescribed in ointment, twenty grains to two drachms of either to the ounce, or they may be used in the form of a powder, full strength or weakened with starch powder, dusted over the surface.

To a great extent, the treatment of acne rosacea is the same as simple acne, and for other formulæ and for the method of applying the various remedies the reader is referred to that disease. When dilated blood-vessels are present, however, other measures, in addition to those advised above, are to be adopted. There are two methods of destroying the blood-vessels. One plan is by the knife, cutting across the vessels at several points or slitting their whole length, permitting them to bleed; subsequently cold water may be applied. The other method is by means of electrolysis, according to the procedure fully described in the treatment of hypertrichosis. If the vessel is long, inserting the needle at several points along its length will be necessary; if short, insertion at one or two points will suffice. While either of these methods will, if properly managed, destroy the vessels, neither will prevent the growth of new vessels. In those cases, however, in which the cause has long ceased to operate destruction of the existing vessels may not be followed by new growth. Excessive connective-tissue hypertrophy may require ablation by the knife.

Sycosis.

Sycosis (syn., sycosis non-parasitica, folliculitis barbæ) is a chronic inflammatory, non-contagious affection, involving the hair-follicles, appearing generally upon the bearded region, and characterized by papules, tubercles and pustules perforated by hairs. The disease is seen, as a rule, only on the bearded part of the face, either about the cheeks, chin, or upper lip, involving a small portion or the whole of these parts. The hairy portion of the neck may also be invaded. The disease may begin by the formation of papules and pustules about the hair-follicles on previously healthy skin, or chronic hyperæmia, or even eczema, may have preceded. The lesions generally occur in numbers, in close proximity, and, together with the accompanying inflammation, make up a patch of disease involving a greater or less area. The pustules are discrete, flat or acuminated, small in size, yellowish in color, perforated by hairs, show no disposition to rupture, and are, as a rule, apt to appear in crops. They dry to thin yellowish-brown crusts. There is more or less swelling and infiltration. Papules and tubercles may usually be seen intermingled with the pustules, or the former may constitute the greater part of the eruption. At first the hairs are firmly seated, but later, when suppuration has involved the follicles, they may be easily extracted. Not infrequently the hair-follicles are completely destroyed, in which case scarring and alopecia result. The process is chronic, it being of a subacute or chronic character, with, usually, acute exacerbations. Burning sensations, and at times pain or itching, accompany the disease.

According to Robinson, the affection is primarily a perifolliculitis, the first changes, which are those usually observed in vascular connective-tissue inflammations, taking place around the follicle. Later, the follicle and its sheath become involved, the pus and transuded serum finding their way into these structures. At times pus does not enter within the follicle, the changes observed therein being due to the transuded serum. The pus reaches the surface by forcing its way through the epidermis close to the hair. The causes of the disease are not understood. It is usually seen in those between the ages of twenty-five and fifty, in all classes of society, and in those in good or bad health. Persons with eczematous skin and those having thick and stiff hair are especially predisposed to the disease. Local irritation may serve as the exciting cause. The affection is not common. It is not contagious.

The disease is to be distinguished from tinea sycosis and eczema. Tinea sycosis usually begins as a circular scaly patch—in fact, as simple ringworm—later invading the hairs and follicles and giving rise to papules and tubercles. These lesions are larger than in simple sycosis, and appear and feel like lumps and nodules. Moreover, the changes in the hairs in the parasitic disease are characteristic: they become opaque, brittle, loose, and can be readily extracted. If necessary, a microscopical examination of the hairs may be resorted to. In eczema there is either an oozing, red, crusted surface, or it is dry and scaly; the lesions, as a rule, do not remain discrete, are not perforated by hairs, and the eruption is apt to involve other parts of the face. It is scarcely possible to confound the disease with syphilis.

The disease is essentially a chronic one, and under the best management is often rebellious. Relapses are not uncommon. The treatment consists mainly of external measures. Suitable internal remedies are, however, in some cases, as in plethoric or in broken-down subjects, of value. The digestive apparatus is to be looked after. The extremes of heat and cold are to be, as far as possible, avoided. Clipping the hair, or shaving if not too painful, will permit a more thorough application of remedies. If the disease be of an acute type, soothing applications are at first to be advised. If there is crusting, it should be removed by poultices or oily applications. The use of lotio nigra, and subsequently a cloth spread with oxide-of-zinc ointment, as in acute vesicular eczema, may be advised to allay inflammation. Cold cream, vaseline, or applications of lead-water and like remedies, will also be found useful in the acute stage. As a rule, however, astringent and stimulating ointments may be prescribed when the case first comes under observation. As an astringent ointment there is in the average case nothing superior to a good unguentum diachyli. It should be spread thickly on muslin and bound down to the parts, renewing every six or twelve hours. If stimulation is permissible, twenty grains to a drachm of ammoniated mercury or calomel to the ounce of ointment may be prescribed.

If the process be chronic in character, the parts may be washed with sapo viridis and water, and then diachylon ointment applied, repeating the washing every day and the application of the ointment twice or thrice daily. Sulphur, one to three drachms to the ounce of ointment, is a valuable stimulating remedy, and should be applied thoroughly twice daily; citrine ointment, two or three drachms to the ounce of lard or cold cream, will sometimes have a good effect. Shaving will be found useful in many cases. In some instances epilation proves a valuable adjunct to the treatment. In acute stages the hairs should be extracted from the pustules only—in the chronic stage both from papules and pustules. The operation will be rendered less painful by previously steaming or applying hot water to the parts. After the operation the surface should be dressed with a mild ointment. Epilation at the proper time will often save follicles from irreparable destruction; if for any reason it is not advisable, the pustules should be incised, so that free egress may be given to the pus.