DERMATITIS.
The cause must be searched for, and when this is removed the condi tion rapidly subsides under local treatment such as is indicated in the management of a case of simple eczema or inlertrigo in its early stages— viz., a bland Ointment like Zinc Oxide or an unirritating drying powder such as Starch, Zinc Oleate, Fuller's Earth, &c.
Many of the cases described as dermatitis are examples of drug eruptions, and this class is known by dermatologists as Dermatitis Illedicamentosa. It includes not only the inflammations of the skin resulting from internal remedies like bromides, iodides, arsenic, copaiba, different sera, belladonna, the synthetic coal-tar preparations, &c., but the eruptions which follow the local application of irritants as the primula plant (obconica), poisonous rhus, X rays, certain aniline dyes, hair dyes, and explosive substances, as well as the entire group of rubefacient remedies.
Treatment consists in the instant removal of the local irritant or the suspension of the drug which has caused it, and the skin lesion itself should be treated upon the general principles which are indicated in dealing with each type of eruption. Thus for erythematous rashes a dry dusting powder should be used; urticarial eruptions are best treated 3y weak alkaline lotions, pustular or vesicular ones by antiseptic oint ments, or by astringent lotions containing lead when there is much discharge.
Geyser's preventive treatment of X-ray dermatitis consists in the use cif a special form of tube made of lead glass with a flat flint glass window which can be placed in contact with the skin which is to be influenced by the rays. Pads of lint soaked in solution of tungstate of soda and dried lave proved useful. Operators should protect their hands by the use of thick leather gloves upon which oxychloride of bismuth has been precipitated. When the dermatitis has already appeared it should be treated on general principles by soothing applications. An ointment containing Menthol and Cocaine relieves the severe pain and smarting. The resulting warts should be excised or rubbed flat with sand-paper; chronic cases have been treated by Fibrolysin.
Dermatitis Exfaliativa.—The treatment of this cutaneous affection, better known under its first name of Pityriasis Rubra, will be described under Pityriasis.
The treatment of Dermatitis Ilerpetiformis, or Ilydroa, is very unsatis factory. The best routine is Sulphur Ointment (1 in 4), which relieves the itching when freely rubbed in so as to break up the vesicles and bullze. Ichthyol may be applied when the bull:x are numerous and there is much pustulation. Warm baths are always useful, and the discharge may be controlled by Lead Acetate combined with a weak Tar ointment.
Constitutional treatment is of more value than local applications. Rest in bed and if possible a total change of environment are necessary. The food should be such as will not likely tend to the formation of toxic products in the intestines; and some recommend a vegetarian diet. Upon this theory of autogenous toxa:mia saline purgatives and diuretics are vaunted, and the use of an autogenous vaccine has been tried, but without avail.
Arsenic exercises a marked influence over the disease, as it does in pemphigus, and should be always administered as a routine in gradually increasing doses till the limit of toleration is reached, and Antimony has been also recommended. Crocker recommends Belladonna in full doses, and Pringle advocates Ichthyol in large amounts.
Intense itching will often demand hypnotics for the control of insomnia, and a combination of Chloral Hydrate with small doses of Antipyrine and Atropine is to be preferred to morphia; bromides are contra-indicated.
Ilydroa Gestatiouis, the form which appears in the late months of pregnancy, may be treated on similar lines.
Dermatitis Factitia, produced by hysterical subjects to gain sympathy or by malingerers to escape some undesired service, can be detected sometimes only after careful scrutiny; the treatment is obviously moral after the management of the lesions, which may have become accidentally infected by various microbic agents.