RHINOSCLEROMA. — In this disorder there are hard or ivory-like masses im bedded in the nose.
Prognosis. — Acne rosacea does not always increase; it may remain station ary or even recede, especially in women after the menopause. It may also, how ever, assume malignancy, but this sequel is very rarely met with.
Case of a man, 67 years old, with a well-marked hypertrophic acne of the nose; one of the masses having been re moved by ligature, an epitheliomatous ulcer supervened, and the growth grad ually took on epitheliomatous transfor mation. Matignon (Jour. de Med. de Bordeaux, Dec. 6, 'DI).
Treatment.—As to general treatment, it is especially necessary to pay strict attention to the good condition of the stomach and intestines, by appropriate measures and suitable diet. Purgatives are absolutely necessary from time to time; laxatives should frequently be given and constipation should be avoided (Brocq). • Proper circulation of lower limbs should be insured by adequate clothing. Any abnormal condition of the genito urinary tract or of the upper respiratory tract, especially the nose, should be cor rected, while anything tending to cause congestion of the face, such as tight collars or stays, should carefully be avoided. Sedentary intellectual work, especially by gaslight, frequently aggra vates these cases.
As a rheumatic diathesis is a dominant etiological factor, various alkalies have been recommended, especially ate of soda or the various alkaline waters.
Where the face is intermittently con gested, quinine, ergotine, belladonna, digitalis, and hamamelis have seemed useful. These may be combined in a mixture, with or without the tincture of aconite-root. Vasoconstrictor drugs have but little influence.
Perchloride of iron, tannin, ergot, and tincture of hamamelis are recommended by E. Besnier and A. Doyon.
The following preparation is extolled by Brocq:— R Quinine hydrobromate, Ergotine, of each, 30 grains. Belladonna extract, 6 to 12 grains.
Lithium benzoate, 30 grains.
Excipient and glycerin, q. s.
M. For forty pills.
Sig.: Two before each of the two principal meals.
Rhubarb or aloes may also be added if necessary.
Amyl-nitrite may be inhaled or taken internally by patients suffering from congestive attacks of the face. (Sidney Ringer.) The local therapeutic agents are the same as in acne vulgaris; though some irritable varieties of acne rosacea exist, it is usually necessary to act with greater energy.
Hot water and mercurial preparations are often of value. Mercurial ointment may be rubbed in pure or weakened with lard, twice daily, according to individual susceptibility. (Hardy.) The following has been employed by Bazin with success:— R, Mercury biniodide, 7 to 15 grains.
Lard, 1 ounce.—M.
Sulphur preparations are also useful; but, as the preparations should be strong enough to cause irritation of the integu ments, it is well to use sulphur pastes mixed with green soap.
In cases of average intensity derma tologists frequently employ Vleminckx's solution, at first with 5 parts of water, then gradually making it stronger until it is used pure. It should be left on several minutes, and followed by very hot water.
Green soap gives the best result in ob stinate acne rosacea, alone or when used in conjunction with sulphur, naphthol, or salicylic acid. It may be used as in acne vulgaris or spread on a piece of flannel; the latter is then cut out to fit the affected region, and left on as long as possible. When the irritation be comes too great, the application should cease and cooling preparations, such as the following, be used: 4 Salicylic acid, 7 grains.
Zinc oxide, Bismuth subnitrate, of each, 30 grains.
Lycopodium, drachm.
Vaselin, 2 drachms. Lanolin, 3 drachms.
Ichthyol does not seem to be as effi cacious in acne rosacea as in some other varieties of acne (Brocq).
Ichthyol is often better than sulphur as a reducing agent. Purdow (Dublin Jour. Med. Sci., May, '94).