'Tuna recommends daily doses of 7 V, grains of ichthyol internally and lotions with ichthyol dissolved in water, washing with ichthyol-soap. Steam or sulphur water douches, pyrogallic acid, and chry sarobin have also been used with good results. Turpentine has also been found efficacious.
Turpentine has a solvent action on the sebaceous secretion; it also exerts a disinfecting action that prevents the spread of the affection. Cases in which it proved very efficacious. It produces violent smarting and redness, but these effects disappear in a few hours. Betz (London Lancet, Jan. 30, '97).
Liquor gutta perches may be used to exert pressure on the vessels and thus encourage resolution of the parts.
A solution of iodine in glycerin, ap plied twice daily during three or four days, is recommended by Kaposi.
Treatment of acne rosacea is divided into constitutional and local. In women any menstrual disorder should be cor rected, all alcoholic stimulants should be stopped, and good plain diet taken. If tongue is very coated alkaline bitter tonic should be ordered. When skin is much thickened, and there are many acne papules and pustules, German green soap is best, used with hot water, and a piece of white flannel, every night, until the skin begins to peel consider ably. In less severe cases white Castile soap is good. Five-per-cent. resorcin soap (Eichhotr's) is very efficacious. Prescrip tion for an ointment is as follows:— 13. Sulph. prtecip., 1 to 4 drachms. Acidi salicyl., 10 to 30 grains. 01. amygdal. dulcis, 1 drachm. Lanolin, 1 ounce.
M. Sig.: Apply at night after wash ing. (The salve should not be gritty. but perfectly smooth.) T. C. Gilchrist (Maryland Med. Jour., Dec. 10, '93).
Blisters, left on but four or five hours, are used by some dermatologists.
Surgical treatment in this disease is the most efficacious. (Brocq.) Kummerfeld's solution, used in vary ing strength according to severity of case, will be found efficacious, especially in connection with scarification:— Sulph. prEecip., 1 to 3 drachms. Pulv. camph., 5 grains.
Pulv. tragacanth., 10 grains.
Aquae calcis, 1 ounce.
Aquae rows, 1 ounce.
M. Sig.: Apply after washing at night.
Scarification or the application of the electrical needle is a very necessary ad junct to the treatment.
Scarification can be done in three ways: 1. By linear scarification. 2. By slitting up the dilated cutaneous blood vessels. 3. By puncturing rapidly. The third plan is best. T. C. Gilchrist (Mary land Med. Jour., Dec. 10, '98).
In typical acne rosacea the pustules are first emptied, then cauterized with a fine-pointed thermo- or galvano- cautery Vascular dilatations promptly yield to cauterization with a very fine point heated by electricity or a simple needle heated in the fire.
Electrolysis is another satisfactory method. A fine platinum needle is in serted alongside of the vessel, and, if possible, into it, and connected with the negative pole, while the patient holds in his hand a cylinder in communication with the positive pole. A large eschar must be avoided. (Hardaway.) The ordinary galvanic or faradic cur rents have been recommended by Cheadle and Pittard.
Scarification is a favorite method. The best instrument is Vidal's ordinary scarificator. The skin is cut obliquely or perpendicularly to the vessels, then slightly obliquely across these so as to form lozenges, and as near together as possible (from one to one and a half mil limetres apart), and not deep enough to penetrate entirely through the dermis, so as to avoid cicatrices.
An hour afterward the part is washed with a corrosive-sublimate solution. 1 to 1000; then in the evening or the follow ing clay compresses dipped into an am monimn-hydrochlorate solution. 1 to 100, or corrosive sublimate, 1 to 500, are applied. If too strong. warm water is to be added. Tf the reaction is too violent, starch-poultices. bland pomatums, or zinc-oxide plasters can be employed.
The treatment should be renewed in from five to eight days. Amelioration will occur in from eight to ten sessions; and marked improvement in from fifteen to twenty-five sessions.
Scarifying should be begun in the lower part of the region to be operated upon, in order not to be troubled by the blood covering the surface. (E. Besnier, A. Doyon.) In the early stage of hypertrophic acne the scarification must be made deeper, and in many cases it is essential to also cauterize the glands deeply.