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.
The internal use of sulphur for many skin diseases rests on an old tradition, but is not much adopted in modern practice. I have tried it extensively, and although the alkaline sulphurous waters are useful sometimes, and in acne rosacea the calcium sulphide, in 1/4 to 1/2 gr. doses thrice daily, seems to help absorption of the tubercles and abate venous hyperaemia, yet, with these exceptions, I have not seen much advantage. Dr. Cane refers to sixteen cases of acne in which the last-named remedy was useful (Lancet, ii., 1878).
In all forms of dry, scaly, skin disease (whether syphilitic or not) warm baths (especially when made emollient and alkaline) and vapor-baths are useful. In acne, hot bathing or steaming opens up the glands and relieves congestion. In psoriasis, ichthyosis, lichen, prurigo, "pityriasis rubra," and chronic dry eczema and seborrhoea, for removing accumulated secretion or preventing contact of air, water compresses are serviceable. Hebra has tried the prolonged warm bath for from two hours to nine months at a time, in. some such cases, and in extensive burns, etc., and has ascertained that nutrition, respiration, and secretion go on in the continued bath in a normal manner (Medical Record, 1877). On the other hand, in some skins, and especially when the epidermis is removed, as it commonly is in acute eczema, water is apt to excite much irritation.
In chronic syphilitic cutaneous eruption, such as rupia or psoriasis, this acid has been rightly commended. In ordinary, non-specific disorder, it is indicated whenever general debility is a marked symptom, and especially when nerve-power is impaired. Dr. Tilbury Fox frequently gave it, in conjunction with a bitter tonic, for psoriasis in weakly subjects.
In some forms of discharging skin disease, such as chronic eczema, an alum lotion of moderate strength (1 dr. to 6 or 8 oz.) will act favorably as an astringent; it is also useful if sponged over the surface in profuse or exhausting perspirations. On indolent sores and fungous granulations the powder may be sprinkled, opium being added, if desirable, to lessen the pain that may be caused: this combination, combined with catechu, has also been praised in hospital gangrene. The "lapis divinus," which is prepared with equal parts of alum, blue stone, and nitre, fused together, is a stimulant application to ulcerated and discharging surfaces, much used on the Continent, and compounds of alumina have lately proved very serviceable as disinfectant and alterative dressings.
The acetate of alumina, and the double sulphate of alumina and zinc, have been specially recommended in lotion for foetid perspiration and ulceration. Thorey prescribed the chloride for diphtheritic and gangrenous sores, though others report it unduly irritating.
For antiseptic surgery Professor Maas and Dr. Pinner have recently reported favorably, after extensive trial, of alumina acetate (Berlin. Klin. Woch., 12-13, 1880, and Medical Times, i., 1880). Since the salt is not stable as a solid, they make a solution of 1,000 parts of "colloidal alumina" in 800 parts of dilute acetic acid (thus giving a proportion of about 15 per cent.) for preparing an antiseptic gauze, which is cheaper than, and quite as efficient as, the carbolic. For the spray, a strength of 2 1/2 per cent. is chosen; this is strong enough to lessen hemorrhage, and does not anaesthetize the hands: for washing the skin and the instru-ments, carbolic solutions are still retained.
In pustular and erythematous skin diseases, preparations of lime are often very useful. In chronic acne, I have often ordered lime-water, mixed with an equal part of rose-water, and applied three or four times daily with the best results. In ecthyma, it is commended by Mr. Wilson, and in the discharging stages of eczema and impetigo, it makes a useful lotion. In impetigo capitis, and in fissured nipples, lime-water mixed with oil is good. In chronic eczematous and scrofulous disease, lime salts are often useful when given internally (Tilbury Fox speaks well of "saccharated wheat phosphate" in such conditions). Caz-enave thought the chloride good in lupus. In carbuncles and boils, a compress soaked in lime-water and covered with oiled silk, often acts beneficially; it checks inflammation, soothes pain, and promotes suppuration more quickly than ordinary poultices. In erythema and the pruritus of reddened and irritable skin, lime-water has a sedative, moderately con-stringing effect, and may be used either alone, or as a vehicle for other similar remedies. In pruritus pudendi it is often useful when applied freely and tepid, and in osmidrosis it will relieve the unpleasant secretion from the sweat-glands. Dusting powders containing precipitated carbonate of lime are used for erysipelas and erythema, and in cases of much sebaceous secretion, especially about the face. Combined with lard as "chalk-ointment" it is often a good application for indolent and irritable sores. In tinea capitis, after thorough cleansing, lime-water may be brushed in, but as a rule stronger remedies are necessary: a lotion of chloride is more satisfactory. In scabies, a strength of 1 oz. of chloride to 1 pint of water has been found sufficient to cure, but a more dependable preparation is made by boiling together 1 part of quick-lime and 2 of sulphur with 10 of water; this should be constantly stirred till well mixed, and then the liquid poured off for use; it is too strong to be rubbed in like sulphur ointment, but should be applied lightly with a brush, and afterward removed with a warm sponge, if necessary (Lancet, i., 1865). Pharmaceutists now commonly make such a preparation under the name of liquor calcis c. sulphure (vol. i., p. 33).
In parasitic cases, such as ringworm and scabies, the sulphate of copper has been applied with success: in the former Dr. Graves recommended a wash containing 10 gr. in the ounce, a strength which may, with advantage, be doubled: an ointment containing a similar proportion mixed with lard has cured scabies (Lancet, i., 1846). In ichthyosis, this ointment has also been recommended by Mr. E. Wilson, and the solid crystal is often used for verruca (wart) and molluscum.
In congestive and exudative forms of skin disease much benefit may be obtained from the tincture of iron; thus, severe pruritis may be relieved by it (Lancet, ii., 1874, p. 715). In a case of chronic infiltrated eczema, when tarry preparations had failed, painting with the tincture, and afterwards with collodion, not only cured the intense itching, but also the malady itself, leaving only a dry and brown, but sound skin, and I have seen a case of pityriasis rubra in which the intensely red, dry, and scaly condition was more relieved by the application of this remedy combined with glycerin than by anything else. Lichen agrius is also relieved by it. Devergie drew attention to its value in chronic pustular disorders, such as rupia, ecthyma, and impetigo or pustular eczema (Medical Times, ii., 1860), in which it may be locally applied as well as taken internally. It is a good application for variolous pustules (Medical Times, ii., 1856, p. 498, Ranking, ii., 1866), and has favorably influenced the course of anthrax; a striking case is reported by Dauvergne (Bulletin, 1867).
The same remark applies to the use of an ointment made with the oxide of manganese (3 ij. to 3 j. adipis), which has been recommended in scabies and ringworm, and, combined with sulphur, in porrigo.
Several forms of cutaneous disease are connected with a gouty or rheumatic diathesis, especially forms of eczema and psoriasis; in such cases the urine is often scanty and loaded, and then alkaline diuretics are of service. Mr. Easton has shown the advantages of the acetate (Edinburgh Monthly Journal, May, 1850); the liquor potassae is also given successfully.