The treatment of diseases of the skin differs in no particular from that of other diseases and all that pertains to general medical science properly belongs to dermal therapy. Dermatology is a branch of general medicine and in fact more closely approaches it than any other specialty. The successful treatment of skin diseases necessitates a sound knowledge of general medicine and a ripe experience in the treatment of general cases as well as in the diagnostic methods employed, in ordinary practice. It should be the aim of the physician to treat the individual rather than the particular skin condition. In doing this, relief will be afforded the local symptoms or, if relief is impossible, their severity mitigated and the patient made more comfortable. Prophylaxis is no doubt a more scientific achievement than the treatment of present conditions but necessarily it is with the latter that we are most concerned. However, any advice that may be given which enables the patient to protect himself from the extremes of heat and cold, trauma, toxic and contagious elements will naturally enable him to resist many of the minor invitations to disease. The danger of “driving in” certain diseases of the skin and the importance of “driving out” others has been much overestimated. There are few if any diseases that do not call for relief as promptly as safety will permit. Placing the skin, which is one of the important emunctories of the body. in a healthy condition not only relieves the patient of annoying local symptoms and produces a more healthy systemic condition but also assists the other eliminative organs of the body in their effort to accomplish an abnormal amount of work.
Skin diseases, like other morbid conditions of the body, may be divided into three classes. The first group includes all diseases which run a natural course ending in a favorable termination. These call for protective treatment and it is often exceedingly difficult to refrain from active measures. Such a judicious course is really scientific but not spectacular. The second class includes those skin affections which are hopeless from a remedial standpoint or must be expected to end fatally. The relief from pain and the correction of deformity, together with the hope that the physician can inspire, are all that can be accomplished. These cases call for an abundance of patience and usually invoke a like amount of censure. All affections not included in the first two groups may be included in the third class. Here it is that the most pronounced successes and deplorable failures of the dermatologist are seen. The treatment suggested will prolong or shorten the course of a disease, make it more or less endurable, make it run an acute or chronic course, or allow it to become inveterate. The treatment of all cutaneous conditions naturally divides itself into internal methods, whether they be medical or dietetic, and external which includes all varieties of local therapeutics. However, it is possible that a combination of these methods is usually employed. For many years the German authorities have held to the opinion that skin diseases were purely local conditions and therefore controllable by external measures and naturally their opinions have spread to our country. However, at the present time most of the English, French and American writers take a conservative view believing that, while external remedies are essential in almost all cases, constitutional or internal treatment is likewise important in many diseases.
Physiological methods embrace all those items which, when properly, used and regulated, contribute to the health. As has been remarked before, the skin plays a most important part in the physiology of the system along with the lungs, kidneys and intestinal tract. However, the last two chiefly concern us because functional deficiency on the part of the skin is compensated to a certain degree by these organs, and the opposite holds true as well. Thus when inflammation of the skin is present, treatment, which increases the action of the kidneys and intestinal tract by causing a free urinary flow and fecal discharge, will lessen the cutaneous disturbance. In this connection all etiological factors must be considered and the examination of the excreta as well as a study of the family history and personal tendencies will often disclose an underlying disease or diathesis. Many people want all the passive enjoyments of life and very few of the active. It is to regulate this desire that proper food, hygienic living, well-ventilated sleeping quarters, an out-of-door life, exercise, especially in those of sedimentary habits, rest in some cases and diseases and often change of scene and climate may be considered as important.
Diet. Gastrointestinal influences. The regulation of food is often most important although it is true that purely local diseases, such as verruca, many of the benign new-growths and parasitic affections such as scabies, do not call for dietary regulation. It is as emphatically true that many of the generalized skin conditions, in which a diathesis is causative, must have proper regulation of food. Many skin eruptions are simply surface manifestations of abnormal systemic conditions due to errors in diet or to toxemias, the result of the absorption of abnormal products in the digestive tract. Thus the regulation of the intake is quite as important as the observation of the output. There are few conditions, except purely local processes, which are not to some extent the result of faulty nutrition or delayed excretion of waste products. The by- products of digestion should not be allowed to remain in the system long enough to change the color or condition of the skin. This is well shown in the pasty or muddy complexions of those who possess hepatic derangements. Gastrointestinal influences are directly responsible for many of the acute dermatoses such as urticaria, miliaria and erythema multiforme. Many subacute, recurrent or chronic diseases such as eczema, psoriasis, lichen ruber and acne are expressions of the so-called rheumatic or gouty diathesis which is but another way to express a want of balance between the intake and the output. This latter may be in the shape of faulty assimilation or delayed excretion but the skin manifestations are not necessarily different. Doubtless many diseases, due to the invasion of microorganisms, could not thrive if it were not for systemic poisoning from fecal or other abnormal absorption.
The patient should be consulted as regards his diet because appetites, idiosyncrasies and real wants are not entirely imaginary and the psychic and nervous facts that contribute to a good digestion must not be overlooked. The diet need not always be a rigid one but rather should be selected for the individual case. Thus many patients with eczema, psoriasis or acne need a change from a nitrogenous to a vegetarian diet or possibly meat once daily may suffice. In others a pure milk diet or a rice and water regimen may be demanded. Alcohol is directly damaging to many inflammatory conditions especially the erythemata, eczema and acute psoriasis. It cannot always be eliminated but may be limited, depending upon the age and habits of the patient. In the old and feeble it is often necessary. Tobacco, tea, coffee and cocoa produce external flushing of the superficial vessels and increase the congestion of the skin much in the same way as alcohol so that the same warning may be given concerning these. The question of water-drinking is most important. Many people drink too little or it is not of the correct temperature or they drink it at the wrong time. Water should be drunk freely, apart from the meals at a natural temperature, cooled but not iced. The action of water is to flush the gastrointestinal tract thus relieving constipation and to stimulate the kidneys thus affording a diuretic action. There are many foods which might be deleterious in individual cases but in general the following show the greatest possibility of detrimental influence. All fried or greasy foods, pork in all forms, veal, shell fish, hot and fresh breads, buckwheat and other similar cakes, waffles, pastry, candy, cake, sweets in general, rich cheese, dressed salads, acid fruits, seeded berries, condiments, nuts, cereal foods, potatoes, beans, peas and corn in excess, and cauliflower, cabbage, sprouts and onions in a few instances. It will be noted from what has been said that the mucous membranes rather than the skin demand attention in many diseases of cutaneous interest. Sedatives or bland applications can contribute to the patient’s external comfort but the gastrointestinal tract calls for the real treatment. Thus an alveolar pyorrhea may poison the system because its products lodging in the stomach set up a gastric catarrh; a chronic gastritis due to errors in diet may produce a catarrhal condition which will affect the liver as well as the small intestines and the stomach; or fecal accumulations in the colon may produce systemic poisoning by gradual absorption. The fact that a patient has a daily bowel movement, occasionally more than one does not signify that the evacuation is sufficient. It is the quantity rather than the frequency of the movements that indicates the proper result. Thus it will be seen that the treatment of many skin diseases is often the scientific relief of chronic constipation.