Ungt. Hyd. Nit. Dil. is sometimes very valuable, and Calomel ointment (t in 8) often acts well. These mercurials may be combined with Zinc, Lead, Tar, or other remedies. The Unguentum Metallorum, containing Zinc, Mercury and Lead, is a favourite with many skin specialists. It maybe made bvmixing equal quantities of the B.P. Zinc, Acetate of Lead, and Nitrate of Mercury Ointments.
To alter or stimulate the sluggish nature of the diseased action in chronic weeping eczema excellent effects are often obtained by occasionally paint ing the surface with solution of Nitrate of Silver (3o per oz.), and a favourite solvent for the caustic is Spt. Ether. Nit. For a similar reason in chronic very dry eczema, painting over the patches with Blistering Liquid or Liquor Potassm sometimes gives good results, and contrary to what might be expected it often relieves all pruritus and tingling. This really causes an acute dermatitis, which can then be treated as a case of acute eczema by soothing remedies. Other irritating applications of milder nature are used in dry eczemas for the same purpose as Pyrogallic Acid and Chrysarobin (3o grs. per oz.), Alcoholic Solution of Soft Soap, Salicylic Acid (40 grs. per oz.), strong Alkaline lotions, Chloral, Eucalyptol, Thymol, Iodine, etc. Thickened epidermis may be removed by Salicylic Collodion, Resorcin, or a paste made with I'apain or Pancreatin.
For seborrhwic errxma Unna uses Resorcin. He states that there is no stage, no region, no age, no skin, nor any complication in which this drug may not be used, save in those rare cases of resorcin idiosyncrasy. He gets the best results from a solution of r part of Resorcin and r part of Glycerin in 18 of strong spirit. Thin layers of cotton-wool are soaked in a mixture of i part of this solution with 4 of water, laid upon the part and covered with oiled silk. The horny layer swells, and soon all thickening and induration pass away after the resorcin has been stopped and a greasy ointment applied to finish the cure.
Trimble injects in this type of the disease a stock Acne Vaccine. The list of agents employed in chronic eczema might be prolonged indefinitely, but the physician who selects the older remedial agents, as Lead, Mercury, Tar and Zinc, will be surprised to find how seldom he will fail to cure with them, and how seldom he will have to seek the newer drugs for the relief of symptoms or complications.
Very chronic cases of scaly eczema with much induration have been successfully treated by the N and Ultra-Violet rays and also by the high frequency current.
Without a special description of the treatment of each of the so-called special local varieties of the disease, the recognition of the principles discussed and a careful adherence to the details already mentioned will enable the student to treat eczema upon whatever part of the body it may be located.
Ectenza madidans, the red weeping variety which attacks the legs especially in patients haying varicose veins, is a most inveterate form.
This is the same type of disease found elsewhere, only modified by the abnormal local circulatory conditions, which also tend to produce ulcers. It cannot be treated by any local applications with hope of success unless the passive congestion of the integuments be removed by rest in bed with elevation of the lower limbs. A good routine is to employ a Tar and Lead lotion (2 parts Liq. Carb. Deterg. and r part Liq. Plumbi F. to 2o parts water), and after exudation has been checked and all crusts removed to bandage the leg over lint smeared with the lead, tar and mercury oint ment already described. The occasional application of the solution of caustic in Spt. Ether. Nit. (3o grs. to i oz.) often works wonders. When the patient is permitted to move about in the later stages of the treatment Unna's Zinc Gelatin should be melted and brushed over the limb. This forms an elastic coating of great value in the treatment of all eczemas of the lower extremities and of ulcers of the legs. It consists of Gelatin 4) water 16, Zinc Oxide 6, and Glycerin 12, and with it various antiseptics and astringents may be incorporated.
When rest of the lower extremities cannot be carried out, the eczema may often be successfully treated by the ordinary remedies applied on lint and covered up by the Martin rubber, or preferably by a woven rubber bandage.
Eczema of the anus should be treated upon the same principles as guide the physician in the management of the disease in other parts, but owing to the greater sensibility of the cutaneous nerve supply and to the moisture of the skin in this neighbourhood much pruritus and intertrigo are always present. The treatment should be prefaced by a careful examination of the urine for sugar, and if this he found a rigorous diabetic dietary must be instituted. When there is much discharge present a Lead lotion with a small percentage of tar is indicated, but owing to the difficulty of apply ing this unless the patient takes to bed a dusting powder must be freely used, any caking following being remedied by the application of the lotion at night. At a later stage the use of Lasses paste with the addition of Tar and Lead may be resorted to, but the Zinc, Lead and Tar Ointment answers in most cases, all folds of skin being carefully separated by pieces of lint smeared on both sides with the ointment. In women, leucorrhccal discharges may be the exciting cause, and the condition of the vagina and uterus must be seen to. Pruritus, when severe and not yielding to tar, may be relieved locally by the addition of Menthol or Camphor to the ointment and occasionally warm stupes, cocaine being contra-indicated. Internal sedatives or a Morphia suppository may be used, and sometimes counter-irritation over the lumbar spine affords relief. Anal pruritus may be relieved when due to eczema by the use of the tar and lead oint ment, substituting Ungt. Conii for the vaseline and lanolin basis. (See under Anus, Pruritus of, p. 50.)