Lupus on the hands, body or feet may be treated by II ebra's Paste:— R. Acid. Arsenios. gr. xv.
Hydrg. Sulphid. Rub. gr. xlv.
Ungt. Rosa 5vj. Misce.
This spread on lint may be applied for 48 hours to the patch.
Salicylic Acid is invaluable as a caustic in verrucose or warty lupus, and may be applied as a paste, r dr. tor oz. Glycerin, when large surfaces are involved. For small patches a paste consisting of equal parts Sali cylic Acid and Creosote may be applied, or preferably Unna's lie Acid and Creosote Plaster Mull may be laid on the patch twice daily after brushing it with cocaine, till the nodules are converted into small whitish sloughs. Another convenient method is to apply the acid in the form of an ointment—Creosote 2, Salicylic Acid I, simple ointment 2 — which should be spread upon lint and covered with oiled silk. This must be applied for a considerable period, according to the evidence of its destructive action on the nodules, but the physician and patient must reconcile themselves to the slowness of the process and to a considerable amount of painful smarting after the acid has been able to penetrate the lupoid tissue, but the resulting scar will repay the exercise of patience, since it is much less unsightly than that following surgical procedures.
Pure Lactic Acid acts in a similar manner, and exercises its selective action upon the diseased cells. It is most suitable in the ulcerating stage and may be used in various forms; that of a paste, consisting of about equal quantities of the syrupy acid and kaolin, is the method most re commended. It is also painted on with a brush or injected hypodermically (1 in 2) into the tissue in the diseased area. The simple method devised by the writer, and from which he has never seen any ill-effects, is the following:—After previous cleansing, paint the ulcerated surface over with a 15 per cent. Cocaine solution before applying the acid, and wipe it quite dry with absorbent wool immediately before the acid is brought into contact with it Make a little map of the ulcerated surface, so as to cut out neatly and accurately a folded piece of lint (2 plies) of the same size and shape as the patch. These should be soaked for some minutes
in the pure concentrated acid, the surplus acid being removed by gentle pressure before being accurately ;applied to the patch with a pair of forceps; the margin of healthy skin around the ulcerated patch should be smeared over with lanoline before applying the acid.
The pain is often seN ere„ and lasts sonic hours. The lint may be covered with oiled sill:. but the writer does not do so. Ile appill'S sonic more acid to it with a brush alter a few hours, without disturbing its position. It 111i1V Ise ill" in contact for about four hours. Authorities differ, sonic directing an application of i5 minutes, and others recom mending one of to hours, after which Spirit Lotion on Ent may be applied under oiled silk. The number of applications required in any given case can only he determined by the effect. After three or four (lays the surface should br very minutely examined, and :my suspicious portions subjected Irons time to time to the action of the acid, applied upon little circular islands of lint, for 6, 8, or to hours. The ticatment will extend over several weeks or months, and as parts of the original patch become healed, others may he discovered in which the diseased action is in full swing.
Lactic Acid is one of the most reliable agents for the destruction of lupus in the nose and palate. The syrupy acid may he applied with a hrush after carefully drying the cleansed part with cotton-wool. Both these acids may he advantageously employed in conjunction with light and \-rav treatment wheat the patient's means will not admit of continuous attendance at a hospital far from home for long periods.
Pvrogallic Acid has like selective action on the diseased tissue, and max. be applied as it 25 per cent. plaster. hut it is an agent not free from danger. Vciel uses 1' rogallol diluted with o parts of vaseline.