This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
With the exception of scabies, acne is the skin disease in which sulphur is most frequently used and gives the best results; the degree of stimulus or irritation supplied by it seems more appropriate than that of any other application, unless it be sometimes mercury. In the simple acne of young people, occurring in the sebaceous glands about the face and shoulders, accompanied by comedo and without much general congestion, a fairly strong preparation may be used, such as the sulphur ointment of the Pharmacopoeia; or potash may be added to it (Lancet, ii., 1878), or a lotion containing 6 dr. of precipitated sulphur and 1 dr. of glycerin, with 6 oz. of rectified spirit (Anderson). When a moderate degree of irritation is present the proportions may be altered; thus, 1 dr. of sublimed sulphur may be rubbed up with a little alcohol, and then 2 dr. of the smoother variety may be added, with water to dilute sufficiently (Morris: Lancet, i., 1855); or a lotion that I commonly use with advantage is made with 2 to 4 dr. of precipitated sulphur, with the same quantity of spirit and glycerin, in 6 oz. of rose-water. Spirits of camphor or ether may be added, to relieve itching or heat, and special indications for internal treatment must be considered. Sometimes dusting with the pure, dry precipitated sulphur answers better than anything (Parsons: British Medical Journal, i., 1879). The local remedies should be lightly or firmly applied, according as they can be borne, left in contact all night, and washed off with mucilaginous decoctions or water in the morning.
For acne rosacea, one of the best applications is an ointment containing 2 dr. of the hypochloride of sulphur in the ounce of rumex ointment (Wilson), or a lotion of 1/2 oz. of sublimed sulphur in 4 oz. of elderflower water. The ointment of iodide of sulphur, which is still stronger, may be carefully used to chronic cases of any form of acne. A certain amount of temporary irritation must be expected from these remedies, and may require their occasional intermission and the use of sedatives; but some compound of sulphur, judiciously employed, will be found the most effective cure. The internal use of calcium sulphide should be conjoined with this treatment.
In chronic cases of acne simplex with comedones, a lotion containing the chloride with alum and sulphuret of potash is sometimes an effective resource.
In acne it should be the exception to prescribe arsenic. Mr. E. Wilson goes so far as to say that "no one having even a rudimentary acquaintance with cutaneous pathology and therapeutics would think of doing so," and yet I have certainly seen cases cured by this remedy after others had failed. According to Dr. Bulkley, this has occurred with all forms of acne - the simple, the indurated, and the rosaceous - and his best results have been attained with De Valangin's solution of chloride. Dr. Duhring speaks well of it in the indolent papular form, and many special authorities might be quoted to the same effect. This does not seem to me so unreasonable as it does to Mr. Wilson, for acne is frequently connected with gastric and uterine irritation, and we have seen that arsenic has great power to relieve various forms of this malady.
In "bromic acne" - the pustular rash which frequently follows the use of full doses of any bromide - arsenic is decidedly useful. If given concurrently with the bromide it will often prevent any skin trouble (Bartho-low; also Gowers, Lancet, i., 1878), and I can corroborate this observation.
The last formula is suitable for many cases of acne when sulphur would not be well borne; but the pustules of this disorder may often be aborted with still more satisfactory results by means of the acid nitrate of mercury. The apex of the pustules should be lightly touched with this, on a glass brush, or a match point, and the drop of liquid should be soon removed by blotting paper or sponge: some temporary irritation may be expected.