Of the above two methods of local treatment, that in which the entire cutaneous surface (except the face and head) is submitted to the drug is certainly more efficacious and speedier than the plan of confining the application to the diseased patches. The selection of the method is determined by the patient's circumstances—if he can give himself entirely up to a few weeks' treatment in bed, the inunction should be general, but if he must continue in his usual avocation the partial method can only be carried out. Tarry compounds may be tried with advantage in these cases.
The treatment of psoriasis of the scalp is one of great importance but also one of much difficulty. Walker maintains that as long as the eruption is left untreated on the scalp it is certain to again spread over the entire body. Chrysarobin cannot usually be employed owing to its power of staining the hair and causing severe irritation about the eyelids and conjunctiva. It must therefore be treated by other methods, and there is no use in smearing ointments over the thick crusts amongst the hair; these must be first removed by prolonged washing and scrubbing with Borax or with a solution of Soft Soap in spirit, after which an ointment (r in 2o) of Salicylic Acid may be rubbed in twice daily.
Oil of Cade emulsified with a few minims of fluid extract of Quillaia and diluted with an equal bulk of Glycerin of Starch is employed by Graham Little. White Precipitate Ointment to which [5 per cent. Liq. Carhonis is added is another excellent application to the scalp.
A radical method is to shave the scalp and apply Saalfield's ointment (Chrysarobin and Salicylic Acid of each ro parts, Green Soap and Vaselin of each 25 parts) or a solution of Chrysarobin (r dr. in r oz. of equal parts Chloroform and Glycerin.
As substitutes for the application of Chrysarobin, innumerable compounds have been advocated in the treatment of psoriasis of the body.
Anthrarobin, a powerful deoxidising agent obtained by reducing alizarin, is employed as a i in 8 ointment and does not stain.
Pyrogallol (Pyrogallic Acid) is a powerful antiseptic introduced by Jarisch in the form of a r in 8 ointment, but it is a dangerous remedy; the writer has seen sloughing follow its application in psoriasis. Lenigallol is quite safe but of little use. Eugallol, another derivative of pyrogallol, is a most valuable drug; it may be brushed over the patches after diluting it with an equal bulk of Acetone. Saligallol is used in the same manner.
Pyrogallol Oxide (Pyraloxin) and Gallacetophenone, r in io ointments, are also efficacious applications, but it cannot be said that these compounds are able to hold their own with chrysarobin, and the same may be said of Eurobin and Lenirobin, which are acetates of chrysarobin and do not stain.
Various antiseptics have been combined with chrysarobin in the routine treatment of psoriasis carried out as before described; the most frequently employed of these are Salicylic Acid and compounds of Tar. Unna's Compound Chrysarobin Ointment consists of Chrysarobin 5, Salicylic Acid 2, I clithyol 5, Vaselin 88. Another very valuable formula of Unna's is Chrysarobin io, Salicylic Acid 5, Birch Tar (Oleum Rusci) ro, Soft Soap 12-5, and Vaselin 12.5. This latter ointment should not be used as a general inunction owing to its strength in chrysarobin and soap, but it may be safely rubbed into isolated patches of the disease. Many derma tologists advocate the addition of Sulphur to the tarry ointments especi ally for the treatment of the scalp.
'car Ointment B.P. has been much used formerly, but the Liquor Carbonis is more cleanly and equally efficacious. It may be used as a in 4 ointment with lanoline and vaselin, or brushed in its full strength over the patches and allowed to dry, or used as a s in io lotion with spirit and water and covered over with oiled silk.
Juniper Tar Oil, Huile de Cade or Oleum Cadinum is a favourite still. It may be mixed with Ungt. Cetacei (I in 4) or diluted with 2 to 5 times its volume of Olive Oil, or made into an ointment by heating it with its own weight of Yellow Wax. Vidal makes it into a soap with an equal amount of Glycerole of Starch by adding 5 per cent. Green Soap, which should be rubbed into the diseased patches at night and washed off in the morning.
Ifutchinson's Ointment combines the majority of the most reliable agents together in one compound: Chrysarobini gr. x. Liq. Carbonis D. lkx. Hydrg. Amnon. gr. x. Creosoti 111xx.
:Idipis Benz. 5j.
(Amu Fagi Pyroligneum (Beech 'far) and Oleum Rusci Pyroligneum (Birch Tar) may be employed as substitutes for the official Pix Carbonis Prieparata (Coal Tar), from which the B.P. Liquor is prepared, and for the official Pix Liquida (Stockholm Tar) prepared from Scotch Fir.