PSORIASIS



Ringworm may be distinguished by a history of contagion, asymmetrical location, elevated and at first papular margin, and when on the scalp by the short, stubby hairs. The microscope will show the presence of the fungi of ringworm.

Lupus erythematosus is usually situated on the face, an uncommon site for psoriasis. It occurs generally in middle life instead of before, as is common in psoriasis. It scales are scanty, adherent and, when removed, often show the patulous opening of the sebaceous follicle. On the scalp, lupus destroys the hair and in any location leaves scars.

Lichen planus begins as flat smooth, shining, angular papules which become closely aggregated, thus forming an infiltrated patch over which there may be a scant scaliness. Moreover, it selects the flexor surfaces especially at the wrists and sides of the knees.

Lichen ruber shows acuminate papules beginning on the trunk, and the infiltration are formed in the same way as lichen planus. When generalized, the infiltration is much greater than in like cases of psoriasis, while the scaling is much less.

Pityriasis rosea is an acute disease, and rapidly spreads all over the surface of the skin. Its scales are thin, papery, easily detached, do not fully cover the reddened skin, and never pile up.

Squamous syphilids may be mistaken for psoriasis in the absence of a history of syphilitic infection because syphilis is a polymorphous affection, but it seldom occurs on the elbows or knees, and many often be seen on the mucous surfaces, where psoriasis is never seen. In secondary syphilis, the lesions are rarely large and do not spread peripherally. The scales are scanty, dirty gray in color and not freely shed, while the brownish red color of the active lesions and the fawn colored pigmentation left after the eruption subsides, with the constitutional symptoms of the disease, should aid the diagnosis. The scaly lesions of tertiary syphilis are usually few in number and not symmetrically distributed; the edge of a patch is often elevated, while the center appears depressed, and scarring and deep stains commonly follow.

Prognosis. The historically bad prognosis of psoriasis is not longer justified. Rather it may be said to be good as far as temporary relief is concerned, and to be hopeful as to a permanent cure. It is wise, however, to inaugurate treatment when the disease is still in its infancy. The younger the patient, the less chronic the disease, and the more recurrent the type, the better the prognosis.

Treatment. As underlying systemic causes seem to be the only constant factors, it is necessary that every item f personal hygiene should be investigated. If radical changes are necessary, they may be made gradually by adding in one instance or cutting off in another. Perhaps the diet may need in one instance or cutting off in another. Perhaps the diet may need to be regulated, and it is usually to improve gouty or rheumatic tendencies. Often an increase of vegetable food and a lessening of animal food is all that is necessary, but the usual tendency in early adult life, and even after, is to indulge in the too much food and too little water. Hyperacid states result especially in those leading sedentary lives, hence exercise must often be recommended as well as an improved dietary. Again, its is well to urge that exercise of all kinds should be that which a person most enjoys. Bathing has a much more beneficial effect upon psoriasis than upon eczema. The cold spray and the needle bath for a few moments at the end of an ordinary bath, or the cold pack occasionally, may be very beneficial by their action on the nervous system, while a Russian or Turkish bath once a week may be of considerable local value. For those who can afford it, a change of scene or climate is often value. For those who can afford it, a change of scene or climate is often desirable, because many cases improve in a warm climate during the winter months, especially if a course of bathing in some hot, natural spring may be taken. Outside of the numerous thermal establishments on the European continent, the Virginia and Arkansas Hot Springs, Mount Clemens and Crockett Springs (Virginia) have all given marked benefit to cases of psoriasis within my observation. Pure water, however, is to be preferred to the mineral waters for internal consumption. General tonic effects may be produced by galvanic, faradic and static currents but I prefer the high- frequency currents.

External Treatment. The first essential of local care is the removal of the scales, not only for the patient’s comfort, but also to aid in the eradication of the disease. When it is desirable to apply any medicaments to the surface, it is essential that the scales be first removed. This may be accomplished by ordinary soap and water, by the means of friction with-soft soap, or by prolonged alkaline or simple soap baths. In this connection, it is my custom to apply a saturated solution of sodium hyposulphite after the bath and if this be done upon retiring, a simple fat can thoroughly applied the following morning with such good effect that the more active local applications need not be used. The external remedies that are generally used are chrysarobin, used. The external remedies that are generally used are chrysarobin, tar, pyrogallic acid, salicylic acid, mercury, resorcin, and betanaphthol. Chrysarobin, which is the most rapidly efficient remedy, is a yellowish powder derived from the East Indies or Brazil. It can only be used in certain cases, however, because it stains the skin temporarily and the underclothing permanently, causes a severe dermatitis or if used upon the face, a conjunctivitis, and may even set up nephritis. Hence it is ideally employed upon the face, a conjunctivitis. It may be applied in ointment (40 to 60 grains to the ounce, or preferably as a paint. The addition of salicylic acid enhances its value but may not be well borne by sensitive skins. The following formulas may be employed:

R Chrysarobini, gr. xxx; 2

Pulv. amyli,

Pulv. zinci odidi, aa 3ij; 8

Petrolati, 3iv; 15 M.

R Acidi salicylici, 3ujss; 10

Chrysaroibini,

Ol. rusci, aa 3v; 20

Sapo. virid.,

Petrolati, aa 3vjss; 26 M.

R Chrysarobini, 3j; 4

Acidi salicylici, gr.xv; 1

Liquor gutta-perchae 3j; 30 M.

R Chrysarobini, 3j; 4

Acidi salicylici gr. xv; 1

Etheris, 3j; 4

Olei ricini, mv; 3

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

These should be applied regularly over a limited surface, starting with a weak solution. Solutions may be applied every three days and ointments once or twice daily. When a dermatitis develops, a dusting powder, or soothing lotion may be used.

Tar is better borne than chrysarobin and may be applied in the form of ointment, paint, lotion or bath. Its odor and color are objectionable but is toxic properties are much less than chrysarobin. The agents employed are liquor carbonis detergens (2 drams to an ounce of simple cerate or as a lotion diluted with water or full strength), oil of cade, oil of birch or unguentum picis. The following will illustrate:

R Liq. carb. detergens, ung. picis, Ol. cadini,

or Ol. rusci, 3j-ij; 4-8

Adipis or Collodii flex., q.a.ad 3j; 30

M. Sig. Apply once or twice daily.

R Acid. salicylici,

Olei cadini, aa 3j; 4

Balsami Peruviani, 3ij; 8

Ung. aqua rosae, 3j; 30

M. Sig. Apply locally twice daily

Some authorities have urged the tar bath as a convenient method for using this remedy in extensive cases. Anthrasol, a purified tar oil, which is colorless and almost devoid of tar, and which may be used in ointment form one to two drams to the ounce in alcoholic solution, is well thought of for young subjects and often used when the skin is tender.

Pyrogallic acid in 3 to 10 per cent. ointment, acts less efficiently, although in the same manner as chrysarobin. Fatal poisoning may be produced through its absorption, and it also stains the clothing, hence has no particular advantages.

Ammoniated mercury is the most useful and elegant preparation for the treatment of patches of psoriasis on the face, scalp and hands, because it is odorless, does not stain the skin and is non-irritating. The following prescription, with salicylic acid, may be used:

R Acidi salicylic. gr.x-xxx; 0.6-2

Hydrarg. ammoniat., gr.x-xxx; 0.6-2

Ung.aq.rosae, or

Ung.zinci oxid., q.s.ad 3j; 30 M.

Or a milder suggestion (ravogli):

R Hydrarg. ammoniat. gr.v-x; 0.3-0.6

Bismuth. subcarb.,

Zinci oxid., aa 3ss; 2

Phenol., m.vj; 36

Petrolat.alb., q.s.ad 3j; 30 M.

Other preparations of mercury, such as the yellow odix, nitrate, and bichlorid have been used, but present no advantage over the white precipitate.

Resorcin is useful when seborrhea complicates the psoriasis in the strength of 10 to 40 grains to the ounce of vaseline, lanolin, or cold cream. Salicylic acid, thymol and betanapthol have been used in the strength of 15 to 60 grains to the ounce in the same manner as ammoniated mercury.

Actinotherapy and radiotherapy. While light baths, especially exposure to the rays of the sun or to one of the forms of arc lamps, may be of value in psoriasis, the X-ray is more rapid and convenient. The most satisfactory results are in cases of inveterate psoriasis, in which the lesions are few, circumscribed or localized. The advantages of this treatment are that it is cleanly, simple and without danger if the rays are applied twice weekly for three weeks for short periods of five to ten minutes’ duration with a medium low tube six to ten inches distant from the skin. Usually results will be noted by the fifth or sixth treatment. Recently I have accomplished more satisfactory results from the single massive or full X-ray dosage. Just as much caution should be used to prevent severe dermatitis as in any other disease and the X- rays do not insure against relapse more than my other local agent. The Finsen light and radium present no advantage over the X-rays.

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