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.
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