Diuretics may be needed in any stage if the kidneys fail to act properly. Renal insufficiency might demand an alkaline mineral water or to to 20 grain doses of potassium acetate, citrate or bicarbonate, given a half hour before meals but ordinarily the free use of water between meals will sufficiently flush the kidneys.
If constipation can be relieved by diet, it is the ideal method, but it is not always possible to do so. It may be necessary to urge the eating of an extra amount of fruit, such as prunes and gigs, or to resort to the regular application of massage or gymnastics aimed at the stimulation of the abdominal functions. Laxatives are to be preferred to cathartics in all cases, mild agents such as olive oil and liquid albolene rather than harsher methods. Cascara, aloin and a host of other well to be torpidity of the liver, pancreas or spleen. Saline waters such as Rubinat, Hunyadi, Apenta or Carabana are often efficient, or a natural effervescent salt such as one of the Carlsbad products may be employed with or seems due to muscular atony, high enemas are preferable, or if due to rectal atony, simple suppositories or dilation of the sphincter may be advisable.
Physiological treatment further demands that the patient have a sufficient amount to bodily exercise, especially if it can be pleasurable, to further the elimination of poisonous accumulations within the system because retention of these is supposed to be a fundamental cause of eczema. Often passive exercise, if not applied to the surface involved, is the easiest means of accomplishing the object. Bathing, like many useful habits, must be regulated to the needs of each individual but the ordinary soaps should never be employed. Hot water is best employed both for its cleansing and therapeutic effects, especially if only used for a few minutes, as it will often relieve irritation and cause a beneficial reaction. The drying of the skin should be more in the nature of a patting than a rubbing, as irritation of all description should be avoided. It is seldom that the addition of alcohol, salt, bran, starch, borax or soda will benefit chronic papular eczema. Occasionally the subject of fresh air and ventilation, especially of sleeping rooms, should be radically changed to improve his general hygiene. Clothing should be selected with care so as not to be too warm, too thin or too irritating. Flannel or wool invariably irritates an eczematous surface, although they may be worn over linen or cotton.
External Treatment. The local treatment of eczema has in view cleanliness, protection, relief of itching, burning or other sensations, and stimulation or counter irritation of indurated patches. Ordinarily mechanical protection may be given by applications of non-medicated powder, oils, ointments, pastes, varnishes, bandaging, etc. When advisable, a weak, non-irritating antiseptic or antiparasitic, such as ammoniated mercury, can be incorporated in the protective prescription. It is most important that a patient be made comfortable, not only because the itching will cause scratching and consequent aggravation, but because the mentonervous state of the patient contributes largely to the course of the attack. Carbolic acid, calamin acid, calamin, tar, mercury, menthol and camphor may be mentioned as antipruritics. Masks, gloves, bandages and even immobilization of various parts may aid to prevent scratching.
When local treatment is not specifically employed for protection or for the relief of itching, it aims to improve the local circulation by stimulation or by counterirritation if necessary. The stage of acute inflammation having passed, the external treatment must be more stimulating, and for this purpose the antipruritics already mentioned may be employed in greater strength. When the skin becomes thick and infiltrated, the stimulating remedy must promote absorption of the exudate and restore the skin to its normal condition, and hence may be classed as a counterirritant. Keratolytic substances may be needed to remove a hard horny epidermic; tar, salicylic acid, itchtyol, soft soap, iodin, chrysarobin or pyrogallol are commonly used for these purposes. Whatever local application may be used in treating eczema, it should be for a definite purpose, and when that is attained a recourse to simple protective methods will usually bring about the best results.
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:
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