The vesicular and erythematous types of acute eczema may be treatec upon the above principles, varied to suit the changes which may arise by altering the ointment from time to time to a lotion or dusting powder should the discharge become very profuse or crusts form. The pustular form will also yield to the same remedies, but the crusts must be period ically removed during ointment treatment by the free use of lotions and the occasional application of a r in 2,000 Perchloride of Mercury solution. The addition of io grs. to each ounce of Zinc and Lead ointment of Hydrarg. Amm. Chlorid. is a valuable means of destroying the secondary microbic infection without increasing the inflammatory action.
The following powders may be mentioned as suitable when the profuse secretion prevents the employment of an ointment—viz., powdered Starch, Arrowroot, Carbonate of Lead, Carbonate of Zinc (Calamina), Carbonate of Magnesia, Powdered Fuller's Earth, Kaolin, Cimolite, Emol, Kieselguhr, Oxide of Zinc, French Chalk, Bismuth Oxide, Nitrate or Carbonate, Lycopodium, Powdered Rice and Talc, and these may he mixed in various proportions, according to the amount of astringent required, the lead being the most active in this respect. Where itching is smart, Camphor in fine powder should be added to the above in the propor tion of about io grs. to each ounce of powder.
Tar is not included in the above routine. This is the sovereign remedy in chronic and scaly eczema, but though it relieves the itching in the acute form of the disease its application is fraught with danger, owing to its stimulating properties when used early. In the late stage of acute eczema its use is clearly indicated, hut the physician must feel his way cautiously as this stage is reached, beginning with not more than i 5 mins. Liquor Carbon. Deterg. to each ounce of the lead and zinc ointment.
Itching may be relieved by internal remedies like Antipyrine by teaching the patient to relieve pruritus by scratching the sound skin vigorously at a safe distance from the seat of the eczema, which often affords considerable relief. A small percentage of Menthol or Camphor added to the ointment employed is often efficacious, but it must be omitted if the inflammatory mischief is increased. i per cent. Picric Acid solution often relieves the itching of acute discharging eczema without increasing the vascularity.
Should the acute attack not speedily resolve under the above treatment, more stimulating measures will be called for, and it may clinically be regarded as a case of subacute or chronic eczema, and treated accordingly.
Chronic Eczeina.—Whether this has originated in an acute attack which has proved rebellious to treatment or has commenced in a chronic insidious process before coming under observation, applications of a more stimulat ing nature are demanded. The list of local remedies for chronic eczema seems almost without end. The old drugs, which have stood the test for ages, are after all better, more certain, and more innocent than their modern rivals. Thus Tar, Mercurials, and Lead will cope, if skilfully handled, with most chronic forms of the disease. Upon the whole, ointments will be found more convenient and efficacious than lotions, though these latter are indicated under special circumstances. If there he very much exudation or moisture, the greasy nature of the ointment keeps the secretion in contact with the irritated surface. In some cases this is a serious drawback, and the discharge is, of itself, an irritant, and prolongs the mischief. In these cases a lotion containing an astringent must be first used to check secretion, as in the treatment of acute cases.
After diminishing the amount of secretion a stimulant like Tar can he combined with the astringent lotion. The amount of stimulating ingre dient must be small at first, and gradually increased, the physician cautiously feeling his 'way before employing stronger remedies. A Tar ointment or lotion which may soothe and quickly heal an itchy, dry eczema associated with much infiltration may act like fuel to the fire when applied to a moist, weeping, red eczema. It is therefore a good rule, with chronic weeping eczemas of this kind, to begin with Lead lotions containing a sedative to allay itching and heat ; afterwards Tar can be safely used.
Strong Liquor Plumbi in water (r to 4o), to which a i part of Laudanum or Camphorated Spirit is added, soon allays itching and diminishes secretion, but the number of cases in which an astringent ointment cannot be used instead is small. Liquor Carbonis Deterg. (i to 40) may be added to the above lotion with advantage.
The best routine treatment in all chronic eczemas is application of the following ointment: /3, . Liq. Carbonis Delerg. 3ij.