Acne is a local disease whose anatom ical element is the sebaceous gland, the physiological element being the over secretion of fat, while probably there is a third bacteriological element. Malcolm Morris (Brit. Jour. of Derm., Oct., '94).
Acne is due to an epithelial secretion of fat beyond what could be consumed by the integument: a deposit of unusual fat collected in the duets of the glands, giving rise to microbic changes. Leslie Roberts (Brit. Jour. of Berm., Oct., '94).
Bacteriological examination of come dones and pustules: The staphylococcus pyogenes albus is constantly present in the pustules of acne; there are also present occasionally a yeast-fungus and a bacillus, but always in small numbers. In the non-inflamed comedo there is an abundant development of microbes, the staphylococcus albus always being pres ent. At the moment that inflammation occurs in the comedo a considerable diminution in the number of kinds of microbes occurs.
The skin of those not affected by acne is just as rich in microbic species as that of the acneic patient.
The presence of certain microbes is not sufficient to explain the occurrence of the malady. One cannot accept the theory of a specific cause in acne.
Unna's special bacillus is only a small virulent variety of the bacterium soli. Lomry (Derm. Zeit., B. 3, H. 4, '96).
In all cases a high specific gravity of the urine and an increase of the crystal line sediments noted. The increase of the salts in the blood causes an irritation in the sebaceous glands or in their vessels. Bardacb (Berm. Zeit., vol. ii, No. 2, '96).
Diagnosis. — Acne is to be differenti ated from the papular, papulo-pustular, and pustular syphiloderms, and also from variola.
SYPHILIS.—In the syphilitic eruption the distribution is more or less general, and more acute in its outbreak, darker hued, and occurring occasionally with special groupings and the presence of other symptoms of the disease. VARIOLA.—In small-pox the premoni tory constitutional symptoms, the sudden outbreak, the uniformity of the lesions, and many other symptoms of differential character will serve to differentiate. Treatment.—In this connection acne may be divided into (1) an irritable or inflammatory variety, in which the skin is fine and thin and easily irritated by stimulating applications, and where gen eral treatment is important on account of the close union between the acneic eruption and various constitutional dis turbances. Local treatment should, at
first at least, be of a mild character. (2) An 'indolent variety, where the integu ment is thick, rough, and oily, with en larged and obstructed gland-orifices, and where the most energetic local applica tions are well borne; here the local treat ment is important. Probably most of the cases met with occupy a middle around between these two extreme vari ,, eties.
—Prophylactic measures, such as the avoidance of ex ternal irritants, drugs and food liable to cause acne, such as coffee, tea, alcohol, pure wine, pork, veal, game too far gone, preserved fish, shell-fish, fats, and cheeses.
Increase in the solids of the blood causes an irritation of the sebaceous glands. Rapid cure is effected in these cases by increasing diuresis and local applications of a soap containing about per cent. of iodate and bromate of sodium. Bardach (Derm. Zcit., vol. ii, No. 2, '96).
Any disorder of digestion must be counteracted in order to avoid the con gestion of the face following meals.
Attention to the condition of the ali mentary canal and other disorders, as well as well-directed local treatment, is a quicker and more efficacious method than local treatment only. Radcliffe Crocker (Brit. Jour. of Derm., Oct., '94).
Acne can be cured with certainty and in a comparatively short time. The ma jority of cases are benefited by the tonic and aperient iron and magnesia mixture between meals, others by an alkaline bis muth mixture before food. In all cases an ointment which contains 30 grains of sulphur, 10 grains of ammoniated mer cury. 10 grains of sulphide of mercury, and an ounce of vaselin should be used, oxide of zinc being added if there is much inflammation. Before its application the patient should bathe the face with hot water and a 10-per-cent. ichthyol soap well lathered on. An important part of the treatment is the careful application to each pimple of a minute drop of pure carbolic acid, just liquefied with a little water. P. S. Abraham (Lancet, Sept. 22, 1900).