ECZEMA



In this place it is wise to note that powders are principally used for acute erythematous and papular forms and between opposing surfaces, that lotions are especially useful in moist eczema of the acute or subacute stage and that ointments are more useful in the subacute and chronic forms and in the dry fissured and leathery types. However there is no fast rule as to the form of the appropriate vehicle, and no one can affirm that any given formula will be the correct one in every case of similar eczema. The following therapeutic hints are conveniently grouped as they are typically used for acute, subacute or chronic eczema, without regard to the location of lesions.

In acute or actively inflammatory cases of any type without infiltration or thickening, mild applications are absolutely necessary. Among the useful powders may be mentioned talcum, lycopodium, starch, rice flour, bismuth subnitrate, magnesium carbonate (most absorbent), zinc oxid, clamin, boric acid and kaolin. The following combinations are useful:

R Acid. boric., 3ij; 8

Talc., 3vj; 24

Ol.ros., mij; 12 M.

R Talci venet.,

Zinci oxidi, aa 3iv; 15

Amyli, 3j; 30 M

R Bismuth. subnitrat.,

Acidi, borici, aa 3ij; 8

Amyli, 3iv; 15 M

R Acid boric., 3ij; 8

Zincum met. stearat., 3ij; 8

Talc., 3ss; 15

M. Fiat posta molis q.s.

Lotions may be sedative, antipruritic, astringent and stimulating and usually embrace carbonic acid, calamin, resorcin, hydrocynic acid and glycerin in some combination like the following:

R Calamin., 3ij; 8

Glycerini, 3ss; 2

Aq. rosae, 3ss; 15

Lac. magnesia q.s.ad 3iv; 120

M. Sig. Apply after bathing parts with hot water

R Liniment, calcis., 3iv; 120

Acid. hydrocyanic, dil 3j; 4

Liq. plumbi subacet.dil, 3ij; 8

Glycerini, 3ij; 8

Aq. rosae, q.s.ad 3viij; 240

M. Sg. Cream, and apply on strips of soft linen.

R Calamin.,

Zinci odixi, aa 3ij; 8

Liquor, calcis, 3ij; 60

Aquae, vel solut, ac.

boric.satur., q.s.ad.Oss; 240 M

R Acid. borici, 3ij; 8

Phenolis, 3ss; 2

Glycerini, 3ss; 2

Aquaem q.s.ad Oss; 240 M

R Resorcini,

Acidi borici, aa 3j; 4

Glycerini, 3j; 4

Zinci oxidi, 3ij; 8

Aquae q.s.ad 3vj; 180 M

R Zinci oxidi, 3ij; 8

Phenolis, 3ss; 2

Mucilag. acaciae, 3ij; 8

Emlus, amygdalae 3ij; 60

Aquae, q.s.ad 3viij; 240 M.

Liquor carbonis detergents one to five per cent. in water, black wash (lotio nigra) pure or diluted with equal parts of lime water and an aqueous saturated solution of boric acid may also be recommended.

Soothing ointments are sometimes well borne; such as Lassar’s paste:

R Zinci oxidi,

Amyli, aa 3ij; 8

Petrolati, 3iv; 16 M

or Hebra’s diachylon:

R Ol. olivae, 3xc; 450

Lithergyri, 3v; 150

Aquae, q.s.

Sig. Coq. et ft. ung.

Salicylic acid, carbolic acid, resorcin or thymol may be added to the above in one to three per cent. strengths if desired. The following are also recommended:

R Calamin.,

Zinci oxidi, aa gr.xl; 2 6

Amyli, 3j; 4

Ac. salicylici, gr. x; 6

Petrolati, q.s.ad 3j; 30 M

R Gelatin. alb.,

Zincum met. oxid., aa 3j; 30

Glycerin., 3jss; 45

aq. distill., 3iijl 90 M.

In the subacute or moderately inflammatory eczemas the methods suggested for acute eczema are the best to start with although stronger formulas are often eventually needed, such as the following:

R Tinct, picis liquidae 3iv; 15

Glycerini, 3jss; 6

Zinci odixi, 3ij; 8

Ext. hamamelidis 3j; 30

Aquae, q.a.ad 3vj; 180 M.

E Menthol., gr.xv; 1

Phenol., gr.xxx; 2

Tinct. picis mineralis 3j; 30

Ext. hamamelidis, 3j; 30

Glycerini, 3jss; 2

Aquae, q.s.ad 3vjl 180 M.

R Potassii sozoiodol., gr.v; 3

Potassii hyposulphiti, gr.v; 3

Gallanol., gr.v; 3

Ac.salicylici, gr.xv; 1

Ichthyol., gr.ij; 12

Ol.Rusci, gr.x; 6

Ol.Cadini, gr.x; 6

Zinci oxdini, 3jl 4

Hydrarg. naphtholat., gr.v; 3

Lanolin; 3jl 8

Zinci oxidi, 3ss; 15

Petrolati, q.s.ad 3ij; 60 M.

R Phenolis, gr.x; 6

Hydrargyri chloridi mitis gr.xv; 1

Pulv.amyli,

Pulv.zinci oxidi, aa 3ij; 8

Vaseline, 3iv; 15 M.

R Acidi salicylici, gr. xc; 1

Emplastri plumbi, 3ijss 10

Emplastri saponis, 3ijss 10

Petrolati, 3iij; 12

M. (Klotz).

R Liquor. carbonis deterg., 3ij; 8

Ungt. zinci oxidi, q.s.ad 3j; 30 M.

R Ungt. picis liquidae, 3j; 4

Ungt. zinci oxidi, q.s.ad 3j; 30 M.

In the treatment of chronic sluggish eczema, more than stimulation is needed. Often counterirritation and the actual removal of hardened tissue are desired. Tar, ichthyol, salicylic acid, resorcin, tincture of iodin, guaiacol, soft soap and hot water, and liquor potassae are useful. For small patches of chronic infiltration on covered parts, five to ten per cent. of chrysarobin or pyrogallol in traumaticine may be found a convenient and serviceable agent painted every there days. Salicylic acid is especially useful in the form of ointments, pastes and plasters. Resorcin may be substitute for salicylic acid in the following:

R Emplast. saponis, 3iij; 90

Olei olivae opt., 3ij; 8

Acid. salicylici, 3ss; 2 M

For a 5 per cent. plaster (Hyde):

R Emplast, sasponis, 3j; 30

Olei olivae mxxiv; 1 6

Acid, salicylici, gr. xxic; 1 6 M.

For a 10 per cent. plaster:

R Emplast, saponis, 3j; 30

Acid. salicylici, gr.xlc; 3 M.

For a 20 per cent. Plaster:

R Emplast. plumbi, 3j; 30

Cerae flavae, gr.xlv; 3

Acid. salicylici, gr.xc; 6 M.

Tar in some form is a valuable remedy but the weaker preparations should always be employed at first, or a mild ointment alternated. The following will illustrate:

R Pricis liquidae, 3j; 30

Sapon, virid., 3jss; 45

Glycerin., 3j; 30

Spt.vin.rectif., 3viij; 240

Ol. rosmarin., 3ss; 2

M. Sig. To be rubbed gently into the skin with a flannel rag.

R Ol rusci(vel cadini), 3iij; 12

Potass bicarbonat., 3ss; 2

Unguent.aq.ros., 3jl 30

M. Ft. ungt.

Bulkley’s “liquor picis alkalinus is as follows:

R Picis liquidae, 3ij; 60

Potassae causticase, 3j; 60

Aq. distillat., 3v; 150

M. Sig. Dissolve the potash in the water, and add slowly to the tar in a mortar with friction.

If used as a lotion, dissolve one dram of this solution in a pint of water, or if an ointment is desired, the same amount is added to an ounce of cold cream or other fatty base.

Special External Treatment of Regional Eczema

Eczema of the scalp in children may demand that the hair be cut short, but this is not necessary if the lesions are small or few in number. The scales or crusts must be softened with applications of fresh lard or oil, and a close-fiting cap or handkerchied tied about the head for several hours. The, after the crust has been removed with a coarse comb, the whole head may be cleansed with a mild, warm solution of borax. After drying of the surface, some simple oil or fat, such as one part of lanolin to four of sweet almond oil may be applied, and this application should be repeated once or twice daily. If pediculi complicate the local disorder, they should be destroyed first. Occasionally lathering the scalp with a mild antiseptic soap (boric acid 5 per cent.( and washing it off in hot water may suffice. the object, however, is not so much the removal of the oily application as it is the removal of the accumulated exudations of the disease. Even wiping of the old application with gauze and renewing with fresh oil will often suffice for days after the first dressing. In sqamous eczema, oxid of zinc ointment, which may be diluted with a fourth part of sweet almond oil makes a good protective dressing. Disastrous effects have followed the indiscriminate use of medicinal applications on the scalp of children. Hence, I prefer simple, non-medicated on the scalp of children. Hence, I prefer simple, non-medicated applications, except in some few cases of adult eczema of the scalp. The latter is seldom acute or exudative. When needed, the hair over the patches may be separated, the crust or scales loosened by friction with any bland oil or fat, and, after being washed or wiped off, the following application may be used:

R Boroglycerini (50 Percent), 3ij; 8

Cera. alb.,

Lanolin., aa 3j; 4

Adipis, 3jss; 45 M.

This may be repeated one or twice daily, as required, the preliminary frictions with oil being omitted. Another excellent application, recommended by Piffard, is as follows:

R Ol. ricini, 3ss; 60

Spts. vin.rect., 3ijss; 10

Ol. eucalypti, 3jss; 6 M.

A small oil-can may be employed to deposit a drop in the parting of the hair over the patch, which is well rubbed in with the finger; then another parting of the hair made and treated as before, until the whole patch has been covered. In this way only so much oil as is needed is used, and the hair away from the patch is not impregnated with it. Either of the foregoing can be used less and less frequently, as improvement goes on. If much fluid exudation is present or intervenes, the application should be discontinued and protection given to the part in the manner suggested for similar cases in children.

Eczema of the face. In children, the protection of the surface by a simple ointment or Lassar’s paste is demanded. When severe or extensive, the wearing of a linen or cotton mask may be necessary. If the ears are affected, the mask should cover them, and it is well to sterilize the surface of the ears with a solution of peroxid of hydrogen before applying an oleaginous protection. When the auditory canal is involved, applying an oleaginous protection. When the auditory canal is involved, applying an oleaginous protection. When the auditory canal is involved, small tampons smeared with the necessary ointment can be left in the canal. When the eyelids are affected care in removing and softening the crusts with bland oil, followed by a light application of benzoated lard with or without one per cent of resorcin or the yellow oxid of mercury, five grains to an ounce of vaseline, will often prove beneficial. If the nostrils are affected a boric acid or weak citrin ointment may be employed as well as the remedies just mentioned. The treatment of the conjunctiva, or of the eye proper, or of the inner portion of the lips are affected, a tendency to crack may be averted by frequent applications of bland oil, cold cream or equal parts of benzoin, alcohol and glycerin and the same applications may be made to the outer borders.

In adults, acute moist eczema of the face is treated in the same general way as with children. Erythematous eczema of the face and neck may call for the use of alcohol 5 to 20 per cent. instead of water in the bathing of the face, and the application at night of a simple ointment with the addition of an antipruritic, such as carbolic acid, 1 to 5 per cent. Eczema of the bearded part of the face must be treated as a true folliculitis. The pustules should be opened, the hairs extracted, shaving insisted upon, and hydrogen peroxid, hot borax solution or dilute electrozone used as a cleanser. During the day the patient may apply a boric acid, starch or compound stearate of sinc powder to the surface, but upon retiring a 5 to 10 per cent. ammoniated mercury ointment should be applied. It may even be necessary to X-ray the affected area. The methods mentioned for the treatment of eczema of the eyelids, nostrils, ears and lips in children may be used in the case of adults, although the relative strength of the medicaments are usually increased.

Eczema of the male genitals is most often seen in the chronic form, with much induration of the scrotum. Warmth, moisture, and the dependent position of the parts serve to perpetuate it. Careful cleansing, the application of a hygroscopic powder and the use of a suspensory bandage are to be employed. Later, a protecting ointment, covered with a few layers of antiseptic gauze, all within the supporting bandage, may be serviceable. For local pathogenetic use, iodin, soft soap, diachylon, carbolic or mercurial ointments, a 1 per cent. solution of formulin, or the high-frequency currents, may be used until the counterirritation is developed, when the soothing application is applied but the patient should always be advised of this proposed course, and his assent obtained. If the penis is involved, the inflammation is usually milder than on the scrotum, often seborrheic in character; hence, resorcin may be used in a simple basic ointment. Shaving is often necessary if the pubic region is affected before lotion or ointments can be applied. In acute forms, rest in bed is often essential, and the application of hot boric acid water, as hot as it can be borne, for a minute or two at a time, followed by boric ointment, may give relief. If the itching is severe, 3 to 6 per cent. of carbolic acid in glycerin and water, calamin, hydrocynic acid or other agents mentioned in the treatment of acute and subacute eczema may be needed.

Eczema of the female genitals is rarer and less severe than in males and ordinarily ointments should not be used. Equal parts of alcohol and rose water, or weak solutions of hydrogen peroxid, electrozone or potassium permanganate will be found effective and more convenient. If necessary any of the formulas mentioned in the previous paragraphs may be used. A T-bandage or simple napkin may be useful in some cases. The X-rays and radium have effected brilliant cures and in my opinion are more apt to relieve itching and promote healing in the female suffers than in the male cases.

Persistent eczema of the genitals in either sex should lead to examination of the urine to determine the presence of glycosuria or other irritating qualities of the secretion. Dribbling of urine from the bladder, or discharges from any of the mucous outlets may prove causative. Many genital eczemas in both sexes follow pruritus and are due to repeated and too vigorous scratching.

Eczema of the nipples and breasts occurs usually in nursing women, and the reddened, thickened, fissured and weeping surface makes nursing very painful; in fact, impossible in extreme cases. If nursing is continued, poisonous applications must not be employed even between the periods of active use. Any mild soothing lotion or ointment may be applied, such as zinc oxid, bismuth, ichthyol (one dram to the ounce of water) or a weak solution of liquor carbonic detergens, but these should be carefully removed before nursing with sweet or by a lotion of boric acid and glycerin.

Eczema of the anus will often show marked induration of the parts affected, with fissures and pronounced itching. For the pruritus, the carbolic, calamin or hydrocyanic solutions may be used. The X-rays and radium have likewise diminished the itching, while the high-frequency currents are best used to stimulate the induration. For the thick puckered eczemas with concealed fissures, no local measures have proved so beneficial in my practice as, immediately after the application of peroxid, snipping the edge of the fissures of folds with fine pointed scissors, and then packing the same with aristol or orthoform on absorbent cotton, held in place with a T-bandage. This procedure is not painful, although cocain may be used before the cutting. It should be repeated every four or five days, if necessary. Dilation of the sphincter has been urged.

Eczema of the palms and soles presents features different from other parts due to thickness of the skin on these surfaces and their constant exposure to pressure and friction, hence, induration and fissures are often seen. The fissures may be treated in the same manner as fissures of the rectum, and a 25 per cent. salicylic acid plaster may be applied to the horny thickened skin, or carbolic acid, resorcin, salicylic acid (5 to 10 per cent.), diachylon and other similar ointments may suffice. Picric acid, 1 per cent. solution, and adrenalin chlorid (1:1000) may be used for the itching. It may be necessary to use rubber gloves on the palms, although cotton gloves should be worn at night. The highfrequency currents are best indicated for stimulation and the X-rays are often curative in cases of vesicular eczema of the hands and feet if used in conjunction with the proper ointment. Chapping of the hands is really a form of dermatitis, and can usually be relieved by the application of vaseline, cold cream, or equal parts of tincture of benzoin, glycerin and alcohol. The latter may be also used as a preventive.

Eczema of the nails needs only a protective application, but oleate of tin, 10 per cent. in a simple ointment may improve the appearance of the nail. A weak salicylic acid ointment may be applied several times a day, as convenient, and I have often seen mild X-raying restore the integrity of the nails after three to five treatments.

Eczema of the extremities may differ in no way from the same disease elsewhere but there are a few details of treatment that are distinctive. Papular eczema requires the ordinary antipruritics: Acute moist forms require rest, applications of a dilute solution of hydrogen peroxid followed by simple ointment and covering with loose absorbent gauze or bandage which may be renewed as demanded by the patient’s comfort. Chronic types of eczema of he arms may be occasionally treated with stronger solutions of hydrogen perioxide, subsequent protection with boric acid or calendula ointment and as many turns of a gauze bandage as needed to completely protect and support the parts. The bandage should be constantly worn as a rule, but renewed with the whole method of dressing as often as may be required. Many cases of eczema of the legs can be managed in the same way as indicated for the arms. On the lower legs, eczema may be kept up by varicosis, and rest in the horizontal rest cannot be carried out, and support as well as protection may be given by a firm ordinary or woven elastic bandage after applications of peroxid and simple ointment. Several layers of sheet lint or gauze can be placed under the bandage if there is much exudation. Liquor carbonis detergents 1 to 3 per cent. solution, is a safe and useful lotion for eczemas involving large areas, especially of the extremities. The treatment of varicose ulceration is a separate subject and will not be touched upon beyond saying that any internal medication of an associated eczema should always take cognizance of the varicose condition.

Eczema of the umbilicus is usually seborrheic in origin and is more properly considered under seborrheic dermatitis.

While galvanism and static electricity have served a minor part in the stimulatory treatment of eczema, the high-frequency currents applied through the vacuum electrodes at a distance of 1/8 to 1/4 of an inch from the eczematous surface, from one to five minutes, twice weekly, have given a much more practical and efficient mode of stimulation. Their action is not only stimulatory but antipruritic and germicidal. In the treatment of three hundred and thirty-two cases of subacute, recurrent or chronic eczema with currents of high tension and frequency I have often seen cures result with no additional local treatment. Acute eczema dose not call for electrotherapeutic treatment. Cautious use of the X-ray has given relief from itching when all other methods have failed and a resolvent in the sclerotic and verrucose types of eczema has accomplished more than the strongest ointment. The unipolar X-ray, solidified carbon dioxid and mild fulgruation are particularly well suited to some small persistent areas of eczema, especially on the hands and face. Phototherapy and radium, with the exception of the relief of pruritus accomplished by the latter, do not offer anything superior to the physical methods mentioned above.

Internal pathogenetic treatment is considered last in conformity with the general plan of this book, but, if any one particular item of treatment is important in eczema, it is the application of a single remedy corresponding as closely as possible to the totality of symptoms presented by the individual. In many cases where the acute causative factors is not present or is unimportant, the indicated remedy is all that is necessary. The condensed repertory for eczema which follows is largely based upon personal verification and is added as a guide from which to select a possible remedy although I thoroughly appreciate the fact that any remedy may be indicated and may not be included in the following list because symptoms other than those of the skin, are often so important as to totally change the symptom-picture.

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