ACNE VULGAR'S By comedo we designate a core which is formed in the excretory ducts of the sebaceous glands from cornified epithelial cells, sebum and bacteria. Should these comcdones become ulcerative, acne pustules develop, which lead to the formation of smaller or larger, more or less hypermnic papules around the hair follicles chiefly in the face (forehead, cheeks, chin, nose), on the chest and back as high as the scapula. These papules are cither hard and red, or they may be in the ulcerative stage, or in the process of healing, the patient displaying all stages on account of the continuous occurrence of fresh outbreaks. The affection generally commences at the period of puberty and may continue for many years; it is sometimes accompanied by an arnemic or chlorotic general condition, or else by a bloated hypera,mic skin tending to urticaria which reacts to each irritation with an urticarial hypermmia.
Pathological affection consists in an inflam matory infiltration in the perifollicular tissue, an ulcerous combination in and around the follicles with the microorganisms already referred to, various staphylococci and the acarus folliculoruni. What part this parasite plays in the development of the comedones, is as yet unknown.
for acne are furnished by the seborrhata state (status seborrhoicus) (see page 49S), hypertemia during menstruation, anternia and chlorosis, intestinal irritations (autointoxication) and the various forms of bacteria (staphylococci, etc.).
prognosis is favorable, although the course of the affection is a protracted ono.
The diagnosis is not difficult in view of the presence of comedones and seborrhma.
should be directed in the first place to the internal causes, chlorosis, anmmia, and intestinal disorders. The fol lowing are of foremost importance: of internal remedies iron and arsenic preparations (administered either in pills or in solution; ichthyol pre parations, when there is a tendency to urticarial irritation: best with iron in the form of ferri ichthyol tablets). At the same time there should be a strict milk diet; this together with baker's yeast—thc point of a knife full three times a day in a wineglassful of water—has often effected improvement. Aside from the treatment of seborrlicea (q.v.)
the comcdones and pustules should be removed. This is done by opening them with a knife or hy pressing them out with the come done squeezer (Unna). The task of the local treatt»ent is further to dissolve the fat, remove the horny masses and open the follicles. This is done by washing with hot water and soap (either the mild "Basis Seife" or a stronger sulphur soap), washing with benzene, hot douches especially over the body) and steaming the face (Saalfeld). An excel lent effect is also produced by bathing the skin with alcoholic solutions of resorcin (I to per cent.), salicylic acid (i to 15 per cent.) and acetic acid (1 to 3 per cent.), but in using these remedies the tender skin of young women and children should always be taken into consideration by commencing with the weakest solutions which should often be made still ntilder by adding 5 to 10 per cent. glycerin. Among the ointments I recommend for the treatment of acne the keratolytic, slightly des. quatnative sulphuratcd resorcin ointments. For acne of the body stronger solutions may be applied. For acne of the neck, this part should be treated with a wash containing spirits of camphor 6.0 Gm., tinct. benz. 6.0 Gm., acetic acid 3.0 Gm.:100 alcohol. If in severe cases of acne these measures are not sufficient, desquamation cures should be instituted, that is, aside from the treatment by washes and ointments, one to three tittles a week, desquamation pastes should be applied in order to denude the affected parts. In children the best plan is to apply a 5-30 per cent. resorcin-zinc paste, once, twice or three times a week, to be kept on over night, for instance resorcin 9.0 Gm., zinc oxide 1.0 Gm., amylum, vaselin aa 10.0 Gm. On the intermediate days sul phurated resorcin ointmeuts are applied. Also moist bandages of per cent. resorcin or 10 per cent. acetic alumina may be applied over night in order to soften the acne.