As many months are necessary for a cure, various methods have been introduced in order to hasten the process; one of the most effective of these is to puncture each nodule with a pointed piece of wood or a goose berry-thorn dipped in pure Carbolic Acid. Another is to resort to vaccine therapy by Tuberculin in minute doses.
Direct concentrated sunlight in the tropics or subtropical countries has been tried with excellent results.
in some cases is even more reliable than Finsen light, especially in the hypertrophic and ulcerative types of lupus, but it is decidedly less valuable in the nodular form of the disease. The sittings are shorter and are much less painful, and much larger areas can be operated upon each time at longer intervals, and it possesses the great advantage of penetrating to the diseased nasal membrane, which Rankin has emphasised as being almost invariably affected in facial lupus. There are great practical difficulties in the way of submitting the nasal mucosa to Finsen light, so that when this latter method of treatment is persisted in it is always necessary to resort to the galvano-cautery, curetting or caustics. Many observers point to the danger of cancer supervening after prolonged X-ray treatment, and some highly recommend alternat ing courses with Finsen light; during the intervals tuberculin injections may be also employed.
Radium Treatment.—Emanations of radium have hitherto failed to produce results comparable to Finsen light and X rays. Injections of water submitted to the emanations of this marvellous agent, Wickham's method of injecting solutions of radium and the application of radium ointment are all being tested. Thorium Paste is extolled by Bulkley, who states that its radio-active properties reinforce its caustic action.
Electricity has been employed in the form of the static brush by Suchier's method, and excellent results have been recorded. The appli cation of Hot Air (300°) by Hollander's method under anesthesia has few adherents.
Cataphoresis, or Ionisation (using Zinc solutions), after linear scarifica tion, has recently become a favourite method with some dermatologists, but this line of treatment is better suited to the erythematous type of lupus. Reyn has reported successful cases treated by Iodine ionisation.
Surgical Treatment.—Excision of the patch of lupoid tissue and the supplying of the lost skin by grafting afford the most rapid and complete means of getting rid of the disease, but this method of treatment is mani festly inadmissible where the face is affected and where any considerable patch on the body or limbs is present, especially as the incisions must be carried far outside the active margin of the disease. It is really only applicable to the smallest patches outside the face and neck, and there fore needs but to be mentioned.
Curetting or scraping is a futile procedure in most cases, but never theless it is often a valuable adjuvant to light, X-ray, radium or caustic treatment by preparing the diseased surface for the reception of these powerful agents.
The Galvano- or Thermo-cautery is more reliable when thoroughly employed, hut the great objection to its use lies in the disfiguring results following cicatrisation. It is, however, a most valuable method of dealing with lupus of the nasal mucosa, which should be treated by numerous fine punctures made by the galvano-cautery, and this latter method may still be advantageously employed in selected cases in conjunction with the light treatment where the nodules in the ulcerated surface are obstinate, each nodule being separately dealt with by a fine-pointed terminal.
Scarification by linear incisions, as in lupus crythematosus, is some times resorted to in conjunction with the application of caustics and other methods, but it has a very limited range of usefulness.
known form of chemical destructive substance has been employed in the treatment of lupus, and though these agents have been largely discarded since the introduction of the light and X-ray methods, nevertheless in selected cases, when skilfully employed, excellent results may be obtained, especially when they are used in conjunction with photo-therapy in face lupus.
Arsenic is the most powerful, but it should never be employed on the face.