ERYTHEMA.
The first indication is, when possible, to find out the cause of the accompanying dermatitis and remove it. Thus irritants as strong direct sunlight, contact with dyestuffs. certain plants like Primula obconica, the X rays, &c., must he eliminated, after which a mild astringent oint ment as Ungt. Zinci, containing 3o min. Lig. Plumbi F. per oz., may be applied. Dusting powders, as Zinc Oxide, Fuller's Earth, Starch, &c., meet most requirements.
When the cause is some toxic agent circulating in the as seen in the numerous forms of drug dermatitis following the administration of iodides, copaiba, boric acid, sera of various kinds, &c., the first step in the treatment obviously will be to cease the administration of the offending medicine, when, should the eruption not speedily vanish, the above ointment or a dusting powder may be applied.
Erythema following the use of certain articles of food, as shellfish, strawberries, cheese, pork, pastry, &c., as a rule rapidly disappears after the removal of the exciting cause, but in some instances there may be great difficulty in detecting the causal agent, in which ease one article after another must be suspected and eliminated from the dietary, and this should be changed en when possible. Thus the most persistent chronic erythematous rash under the writer's care was eventually found to be due to the use of a small quantity of condensed milk which had been preserved by the addition of boric acid or borax. These food erythemas are often associated with urticaria and the formation of large wheals accompanied by intense pruritus (see under Urticaria).
After the removal of the offending ingredient in the dietary the erythema sometimes tends to become chronic, or the cause may escape detection, when symptomatic treatment will be the only resource left to the physician.
Alkalies internally tend to diminish the skin congestion; Magnesia is the most esteemed of these. They are serviceable in those dyspeptic conditions where some irritant produced in the stomach or intestines during digestion is carried to the blood, and hence to the nerve endings in the skin. The primary condition will require dietetic correction, and
the following combination often proves suitable. If mild purgation does not follow, a smart saline should occasionally he administered. The Tartarised Antimony is supposed to have some specific action on the skin in acute superficial inflammatory conditions.
R. Antint. Tartarati gr. j.
Tr. Rhei Co. 5iss.
Lig. 3lagnesii Bicarb. ad .;xij. Misce.
Ft. mist. Cpl. ass. ter die post cib.
When there is much oedema accompanying the rash, as in urticarial cases, Chloride of Calcium in 2o-gr. doses three times a day is the best routine.
Itching may be relieved by a weak Lead and Tar lotion as the fol lowing: R. Liquor. Plumbi Fort. 3iij.
Liquor. Carbonis Deterg. 3iv.
spt. l'ini Rectif.
Camphorce ad 3xx. Misce.
A warm Sodium Bicarbonate Bath or sponging with the alkaline solution is often of value in relieving the tingling and pruritus.
Erythema Elevatunt Diutinum.—The treatment of this rare and ob stinate type of erythema is unsatisfactory and tedious. The best routine is to envelop the affected parts in an unirritating ointment composed of Zinc Oxide with io per cent. Liq. Plumbi Fort., and apply a bandage with moderately firm pressure. Salicvlate of Soda should he given internally. and a milk diet with farinaceous food and occasional saline purgatives administered.
El:Whew.? Induratam, known as Ilazin's Disease, affecting the skin over the calves of both legs, is best treated by prolonged rest and bandaging or strapping, and the ulcers which form should be dressed with weak Creosote or I )iluted Citrine Ointment. The affection is believed in many cases to he of tuberculous nature, and vaccine treatment has been recom mended. Walker employs the X rays, which can be applied without resorting to prolonged rest. Open-air life and the most generous diet and tonics should be prescribed.