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.
Many liquid preparations have been suggested for acne and among the best are those containing sulphur or its compounds. Ichthyol, resorcin and mercuric chlorid have also been successfully used, and the following stimulating prescriptions will present a fair variety of these formulas:
Rx Sulphuris precipitati,
Glycerini,
Aquae rosae,
Lac magnesia,
3ss;
aa z3ss;
q.s.ad z3iv;
@
Rx Calcis,
Sulphur. sublimat.,
Aquae,
M. To be boiled down to six ounces and filtered. Dilute one part to ten. (Velminckx).
z3ss;
z3j;
z3x;
Rx Zinci sulphat.,
Potassii sulphuret.,
Aquae rosae.,
aa 3ij;
q.s. ad z3iv;
Rx Ichthyol.,
Etheris.
Spts. vin. rect.,
3ssj;
aa z3ss;
@
Rx Sulph. praecip.,
Pulv. camphorae,
Pulv. tragacanth,
Aq. Calcis,
Aq. rosae,
M. (Kummerfeld)
3j-ij;
gr. xv;
gr. xxv;
aa z3ij;
@
Rx Hydrarg. bichlorid.,
Spr. vini rect.,
Aquae distil.,
gr. viij;
3ij;
q.s. ad z3iv;
@5
Ointments may be needed if lotions are not tolerated, either because they seem to have lost their efficacy or because the skin is naturally dry. I invariably apply them at night and even in cases that seem to thrive under their use, a lotion is dabbed on two or three times during the day. Among the ointments that may be used for decided pathogenic effects are the following:
Rx Betanaphthol.,
Resorcin.,
Acid salicylic.,
Sulphur precip.,
Amyli.,
Petrolat.,
gr. v;
gr. x;
gr. v;
gr. x;
3iij;
q.s.ad z3j;
@3
@6
@3
@6
Rx Sulphuris precipitati,
Lassar’s paste: Amyli,
Zinci oxidi,
Petrolati,
3j;
aa 3ij;
3iv;
@
Rx Hydrarg. ammoniat.,
Ung. zinci oxidi.
gr. xxx;
q.s. ad 3j;
Rx Sulphuris precipitati,
Ichthyol,
Petrolati,
3j;
3ij;
q.s.ad z3j;
Rx Hydrarg. bichlorid.,
Emuls. amygdal. amar.
Tinct. benzoin. comp.,
gr. ij;
z3iv;
3j;
@12
Acne of the back or trunk is treated with the same preparations, especially the stronger ones, applied more energetically. My custom is to thoroughly wash the part affected with tincture of green soap and hot water, immediately followed by the application of dilute ether, which in turn is followed by a dusting powder of boric acid, with or without salicylic acid. A strong solution of resorcin, 1 dram to the ounce of equal parts of water and alcohol, or better yet, formalin, pure or diluted, may be used in place of the other applications.
Rather than use the stronger ointments or lotions, recourse may be had to physical therapy. In this repeat I believe the routine application of the high- frequency currents is most beneficial in all mild cases, if applied once or twice a week for about five minutes. The particular variety of these currents must depend upon the exact nature of the case, but the resonant form (Oudin) with a glass electrode is usually indicated. High-frequency sparking or mild fulguration may benefit individual cases and these varieties, together with the other forms of high-frequency currents, have entirely supplanted faradic and galvanic energy. While the X-rays are not as generally successful as formerly thought, because they do not prevent recurrence, they are a valuable asset in chronic, persistent, indurated, deep-seated and pustular acne. It is not necessary to carry the treatment beyond a point where a mild erythema develops, and the eyes, eyebrows and scalp should be carefully protected. Exposures are from three to ten minutes’ duration, at a distance of from eight to fifteen inches, using a soft to medium tube and repeating the treatment every three to five days. The disadvantage of this treatment is that it must be vigorous to insure a cure and hence may leave pigmentation, wrinkling and telangiectasis. In any case, I believe it should only be used for obstinate cases, or as an auxiliary to other measures. Even the massive dose X-raying which presents many advantages over the fractional method just described, offers no better prognosis. In a few instances I have applied solidified carbon dioxide for from five to fifteen seconds, using very slight pressure, to persistent acnoid lesions with the best results possible.
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