LUPUS ERYTHEMATOSUS.
The treatment of this affection is most tedious and unsatisfactory, and must remain so as long as its pathology is unsolved.
Oral and intestinal sepsis have been suspected. Any departure from the healthy standard is to be carefully remedied and every means utilised whereby the general nutrition of the body is to be improved.
Internal drugs are useless as curative agents. Arsenic, Salicin, Phos phorus, Ichthyol, Quinine, Iodides, Ergot, Iron, Mercury and a host of alterative and antiseptic substances have been from time to time vaunted as remedies.
Probably the best results have been achieved by Quinine and Ichthyol, and these should be given in combination with Cod-Liver Oil, which always is useful as a nutrient. In acute cases accompanied by much erythema Chloride or Lactate of Calcium may be tried in order to increase the coagulability of the blood and check the accompanying hyperxmia.
The local treatment is a difficult subject to discuss in the limited space of a short article like the present, especially as a survey of its literature would almost lead one to conclude that nearly every known inorganic remedy had been recommended for its destruction at some time or other.
This is the more remarkable as the affection is a comparatively rare one. Another inherent difficulty, apart from the extraordinary multiplicity of so-called remedies, is the task of giving a clear idea of the agents indicated at the different stages and variations of the disease without a minute description of these stages, which vary in almost every instance. The treatment of crytliematous lupus is that of the milder forms of lupus vulgaris, stimulating or soothing applications generally taking the place of caustics, cautery or the curette.
Soothing lotions or ointments are indicated to relieve congestion and pain in the early or crythematous stage. Speaking generally, cases at this period of the disease may receive the treatment most useful in acute eczema. Thus a bland, unirritating ointment, such as the B.P. Ungt.
Zinci, to which Liq. Plumbi Fort. (t in 2o) is added, or a cream or paste made by rubbing up the Oxide of Zinc with Olive Oil, may be smeared over the parts with a brush several times a day. A weak Lead lotion (i in 2o), and Calamine or Zinc Oxide lotion (t in 25) containing a little Alcohol may be applied and allowed to evaporate. Adrenalin in weak solution may be painted over congested areas.
The best routine local application for the relief of hyperaemia and itching is Ichthyol made into a cream or paste (s in 3) with lanoline, but before this can become efficacious it will be necessary to remove the scales, especially in the seborrhceic type of the affection, by the applica tion of a solution of Soft Soap in Alcohol (t in 2).
Flexile Collodion painted constantly over the part and permitted to dry causes compression of the vessels, and, provided one layer be added before the peeling of the former one renders its action void, a continuous action may be kept up which, with great care and patience, may starve out the small-celled growth and promote absorption of effused inflamma tory products.
Stimulating applications at a later stage may be tried, but in this sometimes a difficulty presents itself, one part of the patch being dis tinctly erythematous, whilst the other shows infiltration or scarring. Tarry compounds arc valuable, and, if employed with skill and caution at this stage, may give good results. The most suitable is an ointment varying in strength from to 2 drs. of the Liquor Carbonis Detergens tor oz. of Lanoline. When this fails the next best method of treatment will consist in the application of the B.P. Unguentum Ifydrargyri, or a so per cent. ointment of the Oleate of Mercury upon lint, which should be kept in contact with the part constantly.
Caustics must be used with great discrimination, and are only admissible for very limited patches, and deep corrosives like Chloride of Zinc must be avoided, but a superficial caustic like pure Carbolic or Lactic Acid may be cautiously applied to a circumscribed area. Pyrogallic Acid applied in the form of a to per cent. ointment for 3 or 4 days till the brown eschar forms, after the separation of which Iodoform ointment and gauze are used, is advocated by Veiel. MacLeod recommends the painting on of a spirituous solution of Resorcin i in so.
Carbonic Snow has given excellent results when employed by MacLeod's method of collecting the snow in a small vulcanite funnel and pressing it upon the part to be acted upon by a piston introduced into the funnel. Liquid Air has been employed by Crocker.
Good effects were formerly obtained by Squire's linear multiple scari fications made by a suitable instrument. With great care these incisions may be made with the point of a fine, very sharp scalpel or tenotomy knife, so as to leave the healthy skin untouched. The object is to cause destruction of new vessels, and so starve out the growth and cause its absorption. The punctures should not exceed -4 inch in depth, and they should be as close together as possible. The phvious hypodermic injec tion of Adrenalin with Eucaine renders the operation painless and blood