TREATMENT The object of the therapy of skin diseases consists in the first place in the treatment of the causative factors; in the second place in the alleviation of the subjective complaints; the curing of diseased portions of the skin; the protection of the skin from a spreading of the disease; the after-treatment; and prophylactic measures to prevent the return of the trouble. Therefore, the treatment will chiefly be external, and besides very often internal (medicinal or dietetic) if the pathological conditions may be assumed to have an internal causation. Prolonged after-treatment will be necessary, in order to protect the easily irri table skin from relapses. The treatment should be as simple as possible; the less medicine is given, the better, the dermatologist's duty consist ing in the art of favorably influencing a disease without the promiscu ous use of drugs.
Internal Treatment.—For the internal treatment of skin dis eases comparatively few remedies are at our disposal. The one best known and best tested as to its efficacy is arsenic. The prescription for children is best given in the form of lig. potas. arsenicosi (Fowler's solution) 2.0 Gin. (30 et): aq. destill. S.0 Gm. (2 drams) t.i.d. 5 drops (each 5 drops corresponding to 1 drop of Fowler's solution); instead of the distilled water it is often well to prescribe elixir aurantiorurn COM pos. (P.G.), which the stomach bears very well. The dose for children from 1-2 years is 0.05 Gm. (4 grain) per dose; from 3-4 years also 0.05 Gni. (1 grain); from 5-10 years 0.1 Gm. grain); from 10-15 years 0.15 Gm. (2 grains). The effect of arsenic is best shown in psoria sis, acne, eczema and forms of prurigo and urticaria, although the effect is not certain and only slow.
Cacodylic acid and atoxyl have frequently been recommended as a substitute for arsenic. The former contains 54 per cent. of arsenic and its salt, eacodylate of soda; while the latter contains 37.69 per cent. of arsenic and is 40 per cent. less poisonous than Fowler's solution.
Piloearpin is frequently administered subcutaneously or internally in all such pathological conditions in which it is intended to soften the skin without undue secretion of sweat (all forms of prurigo, etc.). The
dose for injection up to the first year is 0.001 Gm. (A gr.); from the first to the third year, 0.002 Gm. (TN- gr.); from the third to the fifth year 0.003 Gin. (A- gr.); front the sixth to the tenth year 0.004-0.005 Gm. (-Je-Y, gr.). Internally twice the subcutaneous dose is administered. Syrup of jaborandi can be recommended (and is always employed by me) as a substitute for piloearpin. Children like to take it, and when given in tea, it produces almost the same sudoriparous effect as pilo carpin. Dose to three teaspoons.
Ergotin has been recommended by Ilialoch as a hannostatic in all sanguineous exudations (purpura, etc.). Dose: Extr. sec. cornuti 0.25 Gin. (4 grains), aqua destill. ad 150.0 GM. (5 oz.), (1 teaspoonful every 3 hours).
Lactic acid (colorless syrupy fluid) has been recommended by Du Castel, especially for all forms of prurigo which are referable to the intestinal tract. Dose, 3-20 drops a day in raspberry water.
Preparations of iron in conjunction with arsenic are very effica cious in the period of puberty, especially in amemic and chlorotic chil dren for the internal treatment of the sebaceous glands.
chthalbin (albumin of ichthyol; a fine grayish brown power, almost tasteless, is only resorbed in the Intestine), acts as an appetizer with little children, regulates the peristalsis, also in dermatoses caused by engorgement (eczema of obese anamic children) and in all intestinal. disorders (urticarial conditions).
Oleum jecoris aselli (P.G.) (often superior even to phosphorated codliver oil) should always be given in lichen scrof ulosuni and in scroful ous eczema. It is recommended by Besnier especially also in prurigo. Dose: 4-8 teaspoonfuls, continued for a long time.
This practically exhausts the number of internal remedies which may be administered in childhood. It may be mentioned that weak doses of salicylic preparations may be prescribed in urtiearial and ery thematous conditions, and antipyrin preferably in conjunction with potassium bromide as a inean.s to relieve itching in all pathological conditions in which there is violent pruritic irritation.