Homeopathy treatment of Acne, with indicated homeopathic remedies from the Diseases of the Skin by Frederick Myers Dearborn. …

(Acne vulgaris)

Definition. A chronic, inflammatory disease involving the sebaceous glands and the lanugo hair-follicles, characterized by papules, pustules and nodules.

Symptoms. Acne is one of the commonest diseases of the skin, occurring in over 7 per cent. of all cases. It is more noticeable in private practice because that class of patients are more apt to attend to their external appearance.

Acne simplex or simple acne is usually a blemish of youth, appearing from the twelfth to the eighteenth year and lasting from five to ten years if untreated. It is most often seen on the face, especially on the forehead, cheeks and chin, but it is quite common on the upper part of the shoulders and chest and may rarely be found elsewhere. The eruption is bilateral without symmetry and consists of comedones, papules and pustules from pin-head to split-pea in size, varying in number from one or two to hundreds. The papules may appear independently of comedones, but usually the latter will be noted in the center of the papules and later may be seen in the pustule. It is the rule to find all the lesions from the comedo, the bright to dusky red papule, to the yellowish- white pustule with its red areola in the same individual. Besides these the effects of previous lesions, such as stains which disappear gradually and scars which become less distinct in time, may also be found. Except a sore feeling when pressed upon and, occasionally, a slight burning or itching, there is generally little subjective sensation. Essentially a chronic disease acne, if untreated, may last from the advent of puberty to the time of full maturity, which is a somewhat variable period. It may then disappear spontaneously but some cases develop into the deeper-seated acne indurata while in a few cases the two forms coexist in youth.

Acne indurata may occur in the same localities as acne simplex but it is much more common on the back and neck than the former. It is even more chronic in its course, rarely or never disappearing without treatment. The lesions originate as deep-seated, round, avoid or flattish indurations or nodules, often better felt than seen at their onset. They may be few or many, isolated or aggregated, vary in size from a pea to a cherry, and as they enlarge, the covering skin becomes dark red in color. Most are indolent (blind boil), contain little pus and even if incised are apt to reform. Others suppurate quickly but if not opened there is little tendency to spontaneous rupture, and hence resolution is delayed for weeks. Nearby glands may be affected and the coalescence of several suppurating lesions will often lead to the formation of linear tumors or irregularly shaped nodules which need free incision and cause permanent scarring. These scars are a purplish or deep red and the color fades very slowly. Naturally, the lesions are tender and painful to the touch. Keloidal transformations and fibroid degeneration may follow and persist. Comedones may or may not be present, but when found do not bear the direct pathological relation to pustulation that they do in acne simplex.

Seborrheic diseases often complicate either form of acne, and may slightly alter the typical picture presented. A few conditions, many of which are unlike true acne, have been designated by the term acne and because of this confusing prefix or title, it is necessary to say a word of explanation.

Acne cachecticorum usually occurs in poorly nourished, strumous or scorbutic individuals and is probably partly or wholly tubercular in nature (see scrofuloderma). The lesions are chiefly located on the trunk and extremities and are pea to cherry-sized, flat, flaccid, vivid red formations containing a little seropurulent fluid.

Acne artificialis is a papulopustular eruption produced by the internal use of the iodids or bromids, or from external exposure to tar, paraffin or petroleum (see dermatitis medicamentosa).

Acne rosacea and acne erythematosa (see rosacea).

Acne decalvans (see folliculitis decalvans).

Acne keloid (see dermatitis papillaris capillitii).

Etiology and Pathology. This disease is common, its course is varied, and although a parasitic agent may be locally causative, it would appear that predisposing factors are necessary to make possible the proper surface conditions on which this parasite may develop. Hence it does not seem fair to view acne as either a purely local or purely systemic affection but rather as a combination of both. Concerning the local agents such external factors as a lack of cleanliness, dusty or dirty atmosphere and various drug and trade, or other external irritations, should be considered. Admitting the parasitic element, Sabouraud’s microbacillus of seborrhea is readily found in the comedones and causes the seborrhea while the staphylococcus albus butyricus is added for the acne. Unna and Gilchrist have also described a bacillus that they regard as causative. There is no doubt that staphylococci cause the suppurative lesions. In fact it is positive that a few cases are due to local agents or at least their activity is the chief element in causation.

Among the predisposing causes, the greatly increased activity of the sebaceous glands in and about the advent of puberty is the principal factor because the vast majority of cases occur between the ages of fifteen and twenty-five. Among other predisposing factors may be mentioned gastrointestinal, menstrual, genitourinary and catarrhal disturbances, sexual abnormalities, anemia, rapid growth with a weakened circulation, scrofula, tuberculosis and any debility from acute or chronic diseases. Besides the predisposing causes just mentioned which apply to acne in the young, acne in middle life may be due to sedentary living, gout, diabetes, respiratory, urinary, uterine and ovarian diseases, and intemperance of any sort or degree.

Acne is an inflmmatory condition involving the sebaceous ducts and attacking the lanugo hair-follicles, frequently extending to suppuration and destruction of the follicles. It consists briefly in a stoppage of the gland outlet from some extraneous material or comedo formation as a result of hyperkeratosis. Besides this mechanical factor there must be present an agent, unknown as yet, whether it be a microorganism, a chemical or irritating change in the secretion, or some substance eliminated by the glands, to complete the pathological picture. Seborrhea probably occupies the chief place among the local factors that prepare the soil for parasitic invasion.

Diagnosis. The characteristic location of acne, its course, type of lesions, frequency of occurrence, origin at puberty and association with comedones, especially in the simple variety, should make an easy differentiation from the following:

Rosacea usually occurs in mature life, begins with temporary hyperemia, gradually followed by more permanent redness of the skin of the face and dilation of the superficial blood vessels. Acnoid lesions are secondary in occurrence.

Papulopustular eczema has smaller lesions forming in patches with exudation, crusting and itching, unconnected with comedones.

The pustular syphilid occurs in groups and underneath the crusts will be found small ulcers. Besides, there is a history of other syphilitic manifestations and a much wider distribution than is found in acne. The tubercular or gummatous syphilid of the skin occurs in groups and degenerates into ulcers which often spread by one=sided extension. Although this form may resemble acne when the nose only is affected, other evidences of syphilis, together with the effects of treatment, should establish its nature.

Variola presents constitutional symptoms, with an acute course and a typically progressive eruption.

Sycosis is found in adult males, is limited to the bearded area and the center of the lesion is occupied by a hair instead of a comedo as in acne.

Prognosis. A cure may be expected if the proper treatment can be followed systematically and persistently. The duration of treatment depends upon the underlying factors and the ability of the patient to follow directions, even if they embrace continued self-denial. Scarring may be expected in cases of a deep, indurated or long standing nature.

Treatment. This is both constitutional and local and the latter may be all that is necessary in very mild cases, or in those approaching maturity with the well known tendency to spontaneous cure at that time. But ordinarily, systemic treatment is all important if permanent relief is to be expected.

External treatment is employed to insure absolute cleanliness and for stimulation, counterirritation and the destruction of pus. The simpler the local treatment, the better, because the aim is to produce a healthy state of the tissues with as little scarring as possible. Powders, ointments and lotions are employed. The first are best avoided; the second do well as intercurrent remedies; while the lotions should be used as a regular procedure.

Cleanliness is obtained by the use of simple soap and hot water or, rather more often, a salicylic acid, resorcin or ichthyol soap having solvent qualities may be indicated. Occasionally, hot boric acid lotion, or the same diluted with equal parts of alcohol, applied cold, may accomplish the purpose more successfully. When more stimulation is needed, hot and cold water compresses may be applied in alternation, or tincture of green soap may be applied with hot water, but it should not be continued indefinitely or applied too thoroughly, because the congestion desired must be temporary or it will defeat rather than aid the cure. These cleansing applications should be applied at night before retiring so that the irritation may subside before morning.

Frederick Dearborn
Dr Frederick Myers DEARBORN (1876-1960)
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war