It will be advisable to freely swab the affected area or the whole scalp in all cases with Weak Tincture of Iodine in order to wash away any lingering stumps which may remain in situ.
After the spirituous solvent has dried by evaporation, Ungt. Sulph. lod. should be well rubbed into the affected areas. When the ointment has been previously prepared for a month its irritating properties, as already mentioned, are much lessened, and it may be applied vigorously to large areas of the scalp with safety. Any irritation which it produces will do good by further loosening and extruding any remaining stumps. By a couple or three months, in most cases, the fungus may be entirely eradicated, a result which often could only be accomplished after as many years before the use of the rays.
A rapid method introduced by Sutton consists in washing the epilated scalp with Weak Tincture of Iodine, wiping it dry and applying a i in 5o Perchloride of Mercury in aqueous solution, the resulting nascent iodide of mercury being a most powerful parasiticide. The theoretical objection to this method lies in the difficulty of getting aqueous or spirituous solutions to penetrate into the recesses of the hair follicles. His alternative plan consists in rubbing in an ointment containing 7 parts Iodine, 5 Iodide of Potassium in too of Goose Grease.
Sabouraud's routine consists of washing the scalp every morning, and after drying it he paints with Tincture of Iodine, which is allowed to evaporate, and each night Oil of Cade (Juniper Tar Oil) mixed with two and a half times its weight of Lanoline is well rubbed into the skin.
Unna's Compound Chrysarobin Ointment is a good routine application, but care must be taken to prevent any reaching the eyelids. It consists of Chrysarobin 5, Salicylic Acid 2, Ichthyol 5, Vaseline 88 parts.
Dr. W. Calwell employs a mixture of equal parts of the Ointments of Chrysarobin, White Precipitate and Sulphur.
Hutchinson's method consists in washing the scalp with a weak solution of Liq. Carb. Detergens twice a week, and rubbing in once or twice daily the following ointment: It. Chrysarobini 3ij.
Hydrarg. Ammon. Chior. gr. xl. Lanolin. Purif.
Adip. Benzoali Siss.
Liq. Garb. Delug. m. xx. Misce.
Any antiseptic ointment may be used, and each practitioner has usually his favourite; thus the ointments of Resorcin, Iodine, Carbolic and Salicylic Acids, Creosote, Eucalyptus, Iodoform, and all the mercury unguents have been in use. The Ungt. Hyd. Nit. is the best of these latter. Copper Oleate (1 in 4 of Lard) was much used by Crocker.
Croton Oil was formerly much employed, but since X-ray epilation there is no justification for its routine use, and the same applies to blistering with cantharidcs.
Some authorities, discarding oily or greasy applications, rely upon liquid preparations; thus Morris dissolves Salicylic Acid 5 grs. in r oz. Chloroform, and applies this frequently to the patches. If for any special reason an ointment is not to be used, the best routine liquid preparation is the Strong Tincture of Iodine. Iodised Phenol, consisting of Iodine liquefied Carbolic Acid 4, or similar amounts of Creosote or Huile de Cade and Iodine, are powerful destroyers of the fungus. If the patches arc soaked in Ether or Chloroform previous to the firm application of these agents with a stiff, short brush the liquid may be made to penetrate the follicles.
Quinquad's routine, like those just mentioned, is a severe one; after shampooing the scalp he applies a solution of 3 grs. Biniodide and 15 grs. Perchloride of Mercury in To drs. strong spirit and 7 oz. water. Strong Acetic Acid like Strong Carbolic and Sulphurous Acids and concentrated spirituous solutions of Thvmol and Menthol have been successfully em ployed. In mild cases the Oleum Menthm Pip., 01. Caryophyl., or any of the essential B.P. Oils except that of mustard, may be used.
Formulae might be given of many hundreds of so-called anti-ringworm specifics, but the young practitioner who flies from the use of one antisep tic to another will make a serious mistake. Life is too short to make him master of the action of more than a few of these, as close observation is required to become familiar with the amount of irritation which the diseased skin will tolerate from each drug. As all of these antiparasitic drugs excite more or less severe dermatitis or even vesication, the tyro is likely to mistake this for evidence of increased activity of the fungus, and by the practice of ringing the changes from one preparation to another he soon ceases to have any confidence in himself or in the agents which he employs. As Hutchinson states, " the secret of success consists in the patient continuance of the same remedy. Those who change every few weeks from one remedy to another find ringworm almost incurable and he has never seen a case resist the persistent application of Chrysaro bin. The writer usually begins and ends with the Ungt. Iod. Sulph., varying the strength of the ointment according to the amount of irritation produced, sometimes suspending its use and substituting a mild antiseptic preparation as Ungt. Acid. Borici till the dermatitis has subsided.