External Treatment. —Better success is achieved by external than internal treatment. In the first place baths are indicated to act favorably on the skin.
Aside from their general effect upon the body (acceleration of metabolism, circulation, etc.), warm or hot baths have a strongly macerating, keratolytic and detergent effect upon the epidermis and are therefore indicated in all hyperkeratotic processes, hyperamia of the skin, urticarial and erythematous processes and the large number of eczematous eruption,: as soon as the acute stage is over. To warm baths may be admixed with advantage: bran, chamomile or wild thyme, according to whether it is desired to produce a soothing or astringent effect. Baths with a more astringent effect are prepared by an addition of 2 to 4 pounds of oak bark (decoction) or walnut leaves (a decoction of a handful boiled in water). In France a favorite bath for children is made with starch, I to 2 pounds of which arc dissolved in hot water. Of other baths there are the following: Glue baths (1 to 8 pounds of carpenter's glue added to each bath), in fro:A-bites and pritrigo.
Green soap baths in all pathological conditions where an increased keratolytic effect is desired, especially in psoriasis and ichthyosis. Sulphur baths (wooden bath tub, not to be used in sitting rooms).
The sulphur bath may be given in three ways: By adding 20 to 50 Gm. (5-16 dr.) Vlemingkx's solution to the bath; by adding sodium hypo sulphite (the weakest dose for children's baths being 50 Gin.); by adding 20 to 30 Gm. r5-16 dr.) sulphurated potash. Of natural salts for bath ing purposes may be mentioned those of Aaehen and Nenndorf.
Sublimate baths (wooden bath tub), 0.5 to 1 Gm. (7-15 gr.) per
bath in all conditions where disinfection of the skin is intended.
Potassium permanganate bath, is less disinfecting than the former and slightly astringent (with the unpleasant by-effect of discoloring the skin). Dose: 3 Gm. (45 gr.) per bath.
Tar baths, to be prescribed for older children in all such cases in which a mild tar effect is desired (chronic, coarsely infiltrated eczema, psoriasis, etc.).
Salt baths.—These arc prepared by adding 1 to 5 pounds of sea salt or Stassfmt salt to the bath, or 1 to 2 pounds of mother lye. For after-treatment of scrofulous enema, but only after it has healed, also for long-continued treatment in urticarial affections. Caution should be exercised in all cases which have a tendency to eczematous dermatitis.
Aside from bathing purposes, water, in conjunction with various medicaments, is employed for moist bandages. Those most frequently used (with parchment or india rubber paper) are prepared with 3 per cent. boric acid, 1 to 3 per cent. acetic alumina, per cent. to 1 per cent. resorcin. Their effect is absorbing, desiccating and antiphlogistic in exuding eczema and bullous dermatitis. Weak sublimate bandages (0.1 per cent. solution) are employed for skin formation and healing of cauterized lupus foei.
Hot steam in the form of facial steam baths have been recommended, especially by Saalfeld, to remove eornedones and oil in acne.
In conjunction with the bath treatment the employment of drugs is the principal part of the external treatment of skin diseases. This consists of powder treatment proper, treatment with fatty substances, ointment, pastes, paintable substances (glue, liniments, etc.). washing with spirits, plasters, and soaps.