ACNE.
Acne vulgar/s often, but not always, arises from the comedone forma tions (acne punctata), which involve the plugging by retained secretion of the sebaceous glands on the face and upper portions of the trunk. These so-called " black heads " are only affected by local treatment; this con sists in daily vigorous scrubbing of the parts with a coarse towel after the liberal use of soap and warm water, followed by the expression of the sebaceous matter by a suitable instrument formed like the end of a watch-key, which is forcibly pressed against the kin surrounding the comedones. After the emptying of these, any antiseptic ointment should be firmly rubbed in so as to reach the interior of the dilated follicles, the best application being Sulphur ointment rip per cent., or Resorcin 5 per cent. Where greasy applications are objectionable to the patient the skin may be freely swabbed by the sulphur lotion given below.
A true inflammatory condition is present in and around the sebaceous glands when acne vulgaris has become already established, and a less vigorous friction is indicated; nevertheless, thorough cleansing twice a day of the skin by steaming or washing with hot water and soap and rubbing dry with a coarse linen towel are essential. After this has been accomplished each pustule should be incised with a sharp-pointed, narrow-bladed abscess-knife, and the contents gently squeezed out. The next step in the treatment should be directed to the local destruction of the acne bacillus along with the staphylococcus, which almost invariably accompanies it. This is best achieved by rubbing in the following oint ment of Unna : R. Hydrargyri Perchlor. gr. iij.
Rcsorcin. PurU. gr. xxx. Polo. Amyli (Oryzce) 5v. Ungt. Zinci Ben. ad Sij. Miscc.
The novice is bewildered with the number of formulae recommended for the treatment of acne, and is tempted to try one after another without due regard to the principle upon which the success of all of them depends —viz., the evacuation of the sebaceous pustules and the thorough dis infection of the greasy skin and follicles. Lotions are valueless until the oily secretion has been thoroughly removed by a superfatted basis soap, or by Crocker's Alkaline Liquid Soap, which consists of equal parts of Soft Soap and Spirit to which 6 per cent. of Thymol is added. Some times powdered Borax mixed with water more thoroughly removes the seborrhceic secretion. After the use of these detergents, should there
be much irritation remaining, the following lotion may be freely applied with advantage and allowed to dry upon the face: R. Sulphur. Prcecip. 5rj.
Calamina' Prapar. ass.
Eau de Cologne 5iv.
Aq2t Rosce Aquee Calcis ad ,;xij. Misce.
After the cleansing and evacuation of the pustules a weak Sublimate solution—Hyd. Perchlor., gr. x.; Spt. Rectif., Glycerin., and Mist.
Amygdal. ad 5xij.—may be applied two or three times a day, but this should not be used at the same time as the sulphur lotion. It is a good plan to use ointments at night such as Unna's above-described or Sulphur I part, Resorcin i part, and Lard so parts, or Unna's Sulphur Paste Sulph. 5iv.; Terne Silicex 5j.; Zinc. Ox., 3iij.; Adeps Benz., or Hypochloride of Sulphur i dr. to i oz. Lard. In the daytime the sublimate or sulphur lotions may be applied several times after the com plete removal of all traces of the previous night's ointment by steaming the lace and washing with soap and borax.
When the eruption is of limited extent a very successful plan is to insert into each incised pustule a small pointed piece of wood dipped in pure Carbolic Acid. Walter Smith touches the summit of each pustule with strong Carbolic Acid, and covers over the spot with a layer of collodion.
Vlemingkx's solution may be applied as in the treatment of scabies where there is much seborrhoea. When great induration is present, after steaming and washing, Diluted Citrine Ointment may be forcibly rubbed in or Hebra's Solution—Green Soap— diluted with half its weight of strong spirit may be applied. Sometimes benefit in such cases follows a short series of exposure to the X rays, and this plan is especially suitable in acne scrofulosornm ; Chromotherapy has been successful in ordinary acne, violet or green light being used in acute cases. The best results arc obtainable from the use of ultra-violet rays, which, moreover, are much less liable to cause irritation. In the rare tuberculidc form known as Acnitis, little good is to be expected from any local applications; the papules should be incised and then curetted by a suitable instrument, after which intestinal antiseptics may be given with advantage.