I would still like to discuss the various localizations of eczema in nurslings and older children, together with the corresponding therapy.
In head and face eczema of little children an oil bandage should be first applied to the head (the best being of gutta perchn or parchment paper, Billroth's batiste) in order to remove the scab formation. For this purpose the head is washed daily with lukewarm chamomile water, well rubbed with (I.Tnna's) tar soap, then with pure ccalliver oil, and firmly bandaged. Better than simple eodliver oil is a 2-10 per cent. mixture of salicylic oil (Neisser), to which castor oil is added to dis solve the salicylic! acid (salicylic acid 2-10.0, ol. ricini 40.0, ol. oliv. ad 100.0). This procedure is continued daily, until after the lapse of a few (lays the scabs come off and the eczematous base is freely exposed. The head is then bandaged for another few (lays with the oil cap, and later with suitable ointments (Rifle's vaselin or Ncisser's ointment of bismuth and zinc. In very obstinate eases a weak concen tration of tar may be carefully added to the final applications of these ointments. But for a long time afterward eczema of the head requires energetic care and attention by keeping the scalp in a fatty condition.
Exudative facial eczema, espeeially of nurslings, requires most diligent application and careful bandaging. Here again the exudate is to be removed first by moist bandages (especially at the (edematous swellings) and then dried up by zinc pastes (to which lenigaliol or tumenol may be added according to requirements). The desired effect having been accomplished, the pastes may be gradually changed to ointment by the addition of olive oil, so as to soften the skin. An execi lent effect is here produced by Lassar's zinc oil, oxide of zinc, ol. oliv. aa 50.0 (or Schlossmann's paste of oxide of zinc and vasenol) in the place of the paste and oil. Should, however, the facial eczema continue to exude, it is advisable to stop the exudation by slight caustic appli cations either of lenigallol paste or of nitrate of silver. The painting with silver (Burchardt) has an excellent effect upon the exudation through the formation of silver chloride. The exuding fissures are blocked up, the exudation ceases, and if this procedure is repeated daily for 3 or 4 days, and later every other day, the usual result is a dry skin in the second week; the treatment niay then be eontinued with paste. While the painting is carried on, it is advisable to apply powder or paste. As soon as: the skin is dry; and there is reason to belic;ve that there will he no more exudations, ointment will also in the.se eases take the place of paste. In these conditions Ehrmann recommends a 5 per cent. xeroform ointment; personally I have seen the best success with liebra's ointment, Neisser's ointment of zinc hisniuth leniens and Wilson's zinc oxide ointment. Where there are old places to be softened, careful application of tar will also have to be made. In place of the tar,
anthrarobin (10 per cent. solution in tinct. benzoes), proposed by Behrencl, or Arning's painting with tumenol S.0, anthrarobin 2.0, ether 20.0, tinct. benzoes 30.0, can be recommended.
Eczema of the eyelids is best treatecl with yellow oxicle of mercury. Eczema of the nasal apertures and folds is first treated with zinc paste and later with ointment, having special regard to catarrh of the nasal mucous membrane, which is frequently responsible to a certain extent for this condition. Here again a bandage should be applied, so far as may be possible_ Frequently eczema about the mouth is caused by the use of mouth washes; this should be met by stopping any and every kind of mouth washes, after which the usual eczema treatment should be applied.
Particular attention should be paid to eczematous intertrigo. Here again cleanliness by bathing is of importance. During the first stages powder and lint (the best being boric lint) should be applied to the anal and genito-crural folds so as to prevent friction and favor the absorption of the secretion. In exudative eczema, it may also here become neces sary to resort to treatment with moist bandages and paste. The open gangrenous and ecthyma-like plaees which are often present in inter trigo around the anus, arc, best treated by baths and irrigations. Be sides, aristol and dermatol pastes (5 per cent. of which is added to the zinc paste) should be used to promote skin formation and granulation. Also powdering with aristol and dermatol is indicated.
Eczema of the extremities is treated upon the same principles. Very frequently it is advisable to treat a crusty and no longer exuding eczema with gelatin and zinc (see p. 436), because underneath this bandage the eczema heals, while the bandages need not be renewed very- frequently.
At a more advanced age eczema occurring in conjunction with pediculosis requires special treatment. The removal of the vermin is best effected by petroleum or 5 per cent. naphthol, in order to ensure a minimal irritation of the underlying eczema. The eczema will then heal under applications of salicylic oil and mild ointments. Cutting off the hair is only necessary, where thc hair is so matted that it refuses to separate. Generally speaking, the hair should be saved, whenever possible.
Eczema ruhruna which attacks large areas of the entire body is best treated by Lassar's cream zinc oil, and later by baths and oint ments. In children a hand and finger eczema occurs very frequently between the hands, accompanied by hyperldrosis; this should be treated with hot hand baths of boric acid and weak resorcin paste (1 to 1 per cent. added to the zinc paste).
The question in how far older and chronic eczema, also that in infantile periods, can be cured by the application of Rfintgen rays, has not yet been sufficiently tested.