ROSACEA.
Reflex irritation from the stomach, ovaries or nasal cavities is main tained to be the cause of this disfiguring condition of the nose by some, whilst others believe it to arise from invasion by the seborrhoea microbe. The first step in treatment should therefore be a preliminary scrutiny of the condition of the digestive and menstrual functions, and any departure from the normal standard will demand rectification. Though the disease is not necessarily associated with alcoholism, it is made worse by it.
The diet should be such as experience dictates to be freest from any local reflex consequences. Leredde strongly advocates a purely vege tarian regimen, and undoubtedly fresh and easily digested vegetables should form a large proportion of the dietary in all cases, with moderate amounts of white meat, fish, and farinaceous foods, when the latter cause no dyspeptic symptoms. Strong tea and strong coffee and alcohol should be entirely given up, cocoa or a weak China tea being substituted for these. Exposure to cold winds increases the erythematous condition, and this may to a certain extent be neutralised by the application of a skin-coloured powder like Calamine (or the lotion about to be mentioned) before the patient exposes himself in cold weather.
Constipation should be guarded against, and a morning saline purge always affords some relief.
Sulphur internally is a favourite drug, hut better results are obtainable from the sulphur-containing I clithyol in to-min. capsules after each meal, but even this treatment should not be employed when dyspeptic symptoms follow the administration of the drug. In the presence of a marked gastric sensory neurosis large doses of Sodium Bicarbonate, Creosote in capsule or small doses of Antipyrine with 20 mins. Liquid Extract of Coca may be administered.
Local Treatment—When the disease is found in the early or ervthe matous stage a simple drying lotion like the following may he appli,_d as often as convenient: R. Zinci Oxidi 3ij.
Calamine Preparati 5iv. Spirit. Vini Rectif.
Aqua Rosa ad S'x.
Ft. Lotio. Signa.—" To be applied with a small sponge twice a day or oftener to the affected skin." When the skin is very dry, 4 or 6 drs. Glycerin may be substituted for the spirit, or the same ingredients may be combined in an ointment, as: Calamine Prcep. gr. xl.
Zinci Oxidi gr. xx.
Lanolin. et Vaselin. ati 3j. Misce.
As a rule applications such as are suitable in the treatment of acne are indicated. Sulphur is a valuable application, especially when then is much accompanying inflammation of the sebaceous glands; it may be added in the amount of 2 drs. to the above lotion and 4o grs. to th( ointment, the precipitated being preferable to the sublimed preparation.
In cases of longer standing, Resorcin or Salicylic Acid is indicated whey there is considerable induration of the skin, in order to hasten desquamatior and get rid of the horny layer.
The resorcin may be employed in almost any strength according to the effect desired. A mild application like the following may be painted or daily for 3 or 4 days, viz.: R. Resorcini ass.
Ichthyol 3j.
Collodium ad 5ij. .1fisce.
Lassar's Strong Resorcin Paste consists of Resorcin, Zinc Oxide, Starch of each i mixed with 2 of Liquid Paraffin (i.e., r in 5). Ihle's Paste is only in 24, and from this strength up tor in z is employed.
The dilatation of the small vessels which causes much unsightliness may be treated by electrolysis or multiple scarification and the applicatior of Adrenalin. Some dermatologists succeed by passing the electro of thermo-cautery lightly over the congeries of permanently enlarged vessels, and Abrahams injects a few minims of 95 per cent. Alcohol around the dilated vessels.
Good results have been obtained by exposure to Ultra-violet Rays When the condition known as Rhinophyma exists in which large tomato like or pendulous hypertrophic masses are present, these must be deals with by the surgeon. Where much pustulation is present the existin{ acne may he considerably relieved by Vaccine treatment, but this cannot be expected to influence the extensive excrescences or lobular tumours.
The most radical and only satisfactory surgical procedure in cases of very great deformity is that of " decortication " practised by Oilier, who dissects out the entire hypertrophic growths down to the osteo-cartilagi nous skeleton of the nose, leaving the raw surface to granulate under Iodoform dressing. Skin-grafting when skilfully carried out shortens the healing process and lessens the scar deformity.