Cod-Liver Oil always does some good in the treatment of the affection in children, and in lean adult subjects it often appears to assist the action of arsenic and other drugs.
Local treatment must be employed assiduously, whether internal medication be resorted to or avoided, and of all the host of drugs applied to the diseased patches none have stood the test of time and experience like the following: drug should be employed in every chronic case, whilst in very acute cases it will be well to wait for a few weeks, keeping the patient on slightly nauseating doses of Tartarated Antimony or Salicylates before resorting to vigorous local chrysarobin treatment.
The best routine method of applying the drug is that recommended by Norman Walker and Graham Little, and now usually followed. The patient should have a warm bath in which he lies for half an hour till the skin is thoroughly soaked and the scales softened; by using a hair-brush or coarse piece of flannel on the thickened patches much dead epithelial debris may be removed. After drying the body, an ointment consisting of r oz. Chrysarobin in fine powder blended with 15 oz. Vaselin should be rubbed over the entire cutaneous surface, the head and neck only being left alone. It will be observed that this 7 per cent. (or dr. to the ounce) ointment is much stronger than the B.P. preparation, which is only of the strength of r in 25 or 4 per cent.
Walker now uses a 5 per cent. ointment, and it will be wise to select this in all individuals with fine or delicate skin; he uses it in the same manner as the stronger preparation—i.e., the ointment is to be well rubbed in over both the healthy skin and the diseased patches, and a layer of lint covered with the unguent should be left in contact with each patch and when practicable fastened by bandaging.
The applications should be made twice daily, and a warm bath taken every morning before the first inunction. The skin becomes rapidly stained, and an ervthematous inflammation or dermatitis attacks the general cutaneous surface, being much less marked over the diseased patches, which at first present a white or anaemic appearance. It will
often be necessary to apply a stronger preparation to the patches by apply ing it on the lint after the general rubbing-in of the weaker ointment. In the carrying out of the above plan of attack the patient must take to bed and give himself up entirely to the treatment, owing to the deep staining of the skin and linen by the drug. The face must be carefully protected by a lint or linen mask, and it is a wise precaution for the patient to wear cotton gloves in order to prevent the chrvsarobin being transferred by the fingers to the eye. The above treatment will require at least a fortnight, and where the erythema is severe the B.F. Ungt. Zinci or a powder of Calamina and Starch or Fuller's Earth or any bland oil may be applied over the skin, the patches being still treated by the chrysarobin on lint till every trace of the disease disappears on the trunk and limbs.
In chronic cases where the thickened patches are few, large and well circumscribed, the best procedure is to make a hard cerate in the form of a salve-stick consisting or Chrysarobin 3, Wax 2, and Lanolin 5; this may be well rubbed in over each patch, which can then be covered with a layer of Traumaticin or a piece of rubber plaster. A pigment consisting of I part of chrysarobin dissolved in 9 parts of Gutta Fercha solution is often employed. The writer has sometimes obtained excellent results by paint ing over, after the scales have been removed, very indolent patches with the powdered chrysarobin reduced to a creamy consistence by rubbing with a little water in a mortar; after drying, the patch may be covered with collodion, traumaticin or rubber plaster. The drug may also be obtained in the plaster form for application to the skin.
There seems little doubt but that a portion of the chrysarobin rubbed into the skin is absorbed and aids in the removal of other patches of the disease to which the drug has not been directly applied. When any alkali has been used in the bath to soften the scales, before the application of the ointment this should be washed away, otherwise some decomposition occurs in the chrysarobin.