This section is from the book "A Treatise On The Materia Medica And Therapeutics Of The Skin", by Henry G. Piffard. Also available from Amazon: A Treatise On The Materia Medica And Therapeutics Of The Skin.
* This aggravation by water has induced some dermatologists to go to the length of recommending that washing be abstained from for days and even weeks at a time. I am not of the opinion, however, that the accumulation of dirt and filth that necessarily results is a useful accompaniment to the eruption.
In the fissured form of eczema, more particularly of the hands and behind the ears, I have found Graphite (plumbago)* in ointment (1 - 10) or mixed with some inert powder, as Lycopodium or precipitated Phosphate of Calcium, exceedingly valuable.
When an eczema becomes chronic, it does so either from sheer indolence, or in consequence of excessive infiltration. If the indolence is marked by decided venous retardation, with dark bluish red color, Ha-mamelis will be found specially useful. If, however, this feature is not present, or the color of the patch rather paler than usual, it will not be of much, if any, use. Under these circumstances we need stimulating, i.e., irritating applications. The bases of these may be Hydrarg. Biniod., Hy-drarg, Bichlor. Potass. Iod., Iodine, Cantharides, Croton-oil Cardol, and many others that will immediately suggest themselves. A single application of either of these is often sufficient to change an indolent patch of eczema into an active one, which then only requires the treatment appropriate to the second stage of ordinary acute eczema to bring about a cure within a reasonable period. For a few years past we have obtained excellent results by the hypodermic injection of the Arseniate of Sodium into the eczematous patch. We use solutions of one-fifth, one-half, and one per cent. If there be a single patch of moderate size, a single injection of five to ten minims of the one or one-half per cent. solution is made. If the patch is larger, or if there are several patches, the weaker solutions are employed, and two or more injections made into the larger patches, or distributed among the smaller ones. The injections are to be repeated at intervals of two or three days. As yet we have seen neither abscess nor undue reaction. If the physician will take the precaution to obtain pure Arseniate of Sodium and distilled water, and carefully make the solution himself, he will be more likely to obtain good results than if he leaves the fabrication of the solution to some apothecary's clerk.
A chronic eczema, characterized by excessive infiltration, rarely exhibits any tendency to heal until the infiltration has in a measure been dissipated. The lead, zinc, ami mercurial ointments will rarely prove of much service in these conditions. The special irritant applications just mentioned will do more harm than good, and will probably increase the infiltration. Its removal, however, may frequently be accomplished by the strong alkaline lotions. If Liq. Potassae, or a stronger solution of potash, be applied to the infiltrated patch, we will observe, in a few minutes, a more or less copious exudation of clear serum, with, perhaps, a slight temporary increase of swelling. The exudation may continue for some hours, and then gradually diminish. Coincident with the decline of the irritation, the infiltration in part subsides. The application may be renewed at the end of three or four days or a week. The modus operandi of the alkaline application is not quite clear. The effects are possibly due to exosmosis, as we have seen the same result follow the application of strong glycerine. Instead of the potash solutions, Sapo Viridis, or ordinary soft-soap, may be used. This should be well rubbed on with a bit of moistened flannel, till the exuding serum has a slight tinge of red; the application to be repeated as often as necessary - emollients to be used in the intervals.
* The finest and beat Graphite that I have met with for thin purpose is manufac-tured for the use of photographers, and is to be obtained from dealers in photographic chemicals.
We may also attempt the reduction of the infiltration by stimulating the absorptive function of the sanguineous and lymphatic capillaries. The pathological condition present consists in a superabundance of small white cells. Whether these are outwandered leucocytes, or proliferated connec-tiv.-tissue corpuscles, is a question not yet settled. The present problem is to get them away from the part of the skin in which they have accumulated. Which set of capillaries performs the principal, of perhaps the entire work in this matter, we frankly confess we do not know. Certain it is, however, that "stimulation of the absorbents" may be effected in several ways. The most effective of these is kathodic galvanism. When this is impracticable, we are accustomed to rely upon some of the more active so-called " acro-narcotics" of the indigenous materia medica. Among these Hydrastis and its derivatives hold a first rank. Next in usefulness, in our own experience, has been the Iris versicolor.
After the infiltration has been in part or wholly removed by some of the means indicated, the patch of eruption will be in a condition somewhat similar to that presented by the second stage of an ordinary acute eczema, and prepared to benefit by mercurial and other ointments, followed, if necessary, by tarry applications.
The whole of the foregoing relates to eczematous patches on the general surface, and indicates the main points to be considered in connection with their local treatment. The influence of locality, however, in modifying the aspect of the eruption, has already been noticed, and this influence will necessitate certain modifications of, or additions to, the treatment above detailed.
In eczema of the scalp, if at all severe, great benefit will be derived from cutting the hair short. In children and in male adults this is usually practicable - but in women it often is not. Care, however, should be taken that all crusts are carefully removed in order that the local applications may be brought into direct contact with the skin. Simply smearing the ointment on the hair as one would use pomade will not answer. If the scalp is infested with pediculi these must be gotten rid of by the means spoken of in the article on Phthiriasis Capitis (q. v.).
When Eczema attacks the hairy portions of the face, the morbid action is sometimes propagated to the lining membranes of the hair-follicle. These membranes are simply involutions of the stratum corneum and stratum Malpighii, and the eczema extends to them by direct continuity of tissue. In these cases it is necessary first of all to remove, by epilation, all the hairs that proceed from diseased follicles in order that remedial applications may penetrate them.
A similar condition, requiring the same treatment, is sometimes met with on and in the neighborhood of the mons veneris.
In fleshy persons an Intertrigo may be the exciting cause of an outbreak of eczema. Here dusting powders are useful, and the treatment of Intertrigo (q. v.) must be combined with that of Eczema.
In Eczema of the lower extremities, varicosis and very considerable infiltration are frequently met with. In the former of these conditions, Hamamelis, and in both elastic compression will prove of great service. The application of the Martin rubber bandage is specially useful in this connection, as it not only affords great comfort to the patient, but rapidly induces absorption of the infiltration. Next in usefulness is the ordinary elastic stocking. This should be worn after the Martin bandage has been discontinued, and even for a considerable time after the eruption has entirely disappeared. Under all circumstances an elevated position of the limb is more desirable than a dependent one.
Indolent and thickened eczemas of the palmar and plantar regions are often exceedingly obstinate. In these cases the thickened epidermis may be rubbed down with sand-paper, or with pumice-stone dipped into Vlem-ingk's solution or soap spirit, and the parts enclosed with some impermeable fabric, as oiled-silk or rubber-gloves. The cutaneous exhalations thus retained macerate and soften the parts, and tend to bring them into a healthier condition. The fissures which are so frequently present should be dusted with graphite, as already mentioned.
The successful management of eczematous lesions necessarily demands an exact appreciation of the conditions present, a knowledge of the means by which they may be remedied, and the proper application of these means.
In addition to the drugs already mentioned the following have been recommended:
Acid. Saliciyl., 10; Amnion. Acet., 14; Amman. Arsen., 14; Asafoetida, 29; Barii Chlor., 31; Calcii Chlorid., 34; Canna-bis, 38; Cichorium, 42; Coffea, 46; Corydalis, 48; Dulcamara, 51; Eupatorium, 52; Ferri Iodidum, 55; Ferri Sulphid., 55; Hydrarg. Chlor.
Cor., 64; Hydrarg. Iod, Flav., 65; Hydrocotyle Asiat., 68; Juniperus, 73; Mezereon, 76; Pilocarpus, 76; Potassii Acet., 90: Potas. Carb., 92; Potas Sulphid., 95; Sabina, 102; Scabiosa, 104; Sisymbrium, 106; Sodii
Citrus Limon., 45; Collod.,46; Creosot., 48; Cupri Sulpl., 49; Euphorb.
Lath., 53; Sulphas, 55; Fumaria, 55; Hydrarg. Cyan., 65; Hydrarq., Sulpho- Cyanid, 67; Imperatoria, 69; Mandragora, 75; Ol. Ory-zoe, 79; Pix Lithan, 88; Plumbi Carb., 89; Plumbi Iod., 89; Potassii,
Silicas, 95; Potass. Sulphid., 95; Quillaya, 96; Rhus Ven., 100; Sabina, 102; Scabiosa, 104; Silica, 105; Sodii Bicarb., 106; Sodii Carb., 106;