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.
Rarely mild agents, like boric acid 20 to 40 grains or slaicylic acid or resorcin 5 to 20 grains to the ounce of cold cream, may be employed after a washing. In a few cases dusting powders of boric acid, calendula, bismuth, calomel, ichthyol or aristol in strengths of 1 to 8 parts to 15 of powdered starch or stearate of zinc may be preferred. Ordinarily the use of powder or grease in any form, no matter how simple, is to be avoided. In this connection I might say it is my routine practice to insist, after local cleanliness is established, that toilet powders, soaps, creams and hot water must never be used. Cold water applied frequently in the form of compresses with or without the necessary “elbow grease” to remove the dirt, is the safest course for most acne patients to pursue.
Comedones should always be removed, not hurriedly, but gradually with thoroughness in the manner heretofore described. While it is not essential to open the smaller pustules, because these and some of the larger ones as well, care for themselves, it assists in the treatment to incise such lesions and gently express the contents. After puncture the cavity and surrounding surface should be cleansed with a solution of alcohol, carbolic acid, hydrogen peroxide or thymol. The same object will be achieved and in some instances more satisfactorily by the application of Bier’s suction or exhaustion cups. In any case the patient should not be allowed to open the pustules or remove blackheads with his finger nails or with some home implement, such as a watch key.