Chronic scaly diseases like ichthyosis or psoriasis call for the free use of water, plain or medicated. Warm or hot baths are frequently improved by the addition of an alkaline salt. For this purpose sodium bicarbonate (1 to 2 drams to the gallon), sodium borate, potassium carbonate or ammonium muriate (1 dram to the gallon) may be employed to lessen the irritability of the skin. When the natural sulphur baths are not available, some chronic dermatoses may be benefited by the addition of potassium sulphid or Vleminckx’s solution (1 dram to the gallon). For the formula of the latter, see page 484. Salt (3 ounces to the gallon) and marine baths are occasionally useful for their local effect, but more commonly for their general results on surfaces free from skin disease. Tar baths are seldom used at the present time. If it is desirable to employ them the skin is first anointed with a tarry substance and the body afterward immersed in warm water. Antiseptic baths are more often employed by the surgeon. However, cutaneous affections may call for local baths of boric acid in hot or cold water, or mercuric chlorid in the strength of 1 dram to 30 gallons. While the wet pack and the cold shower or plunge occupy a small sphere in dermatology, they may be often useful for their general effects.

Soaps are often contraindicated especially in such a disease as acute eczema but they are occasionally needed for cleansing purposes. They may be mild or strong. A representative of the former group is castile soap which is a soda combination useful for toilet purposes. It should be used with moderation in those possessing a thin or sensitive skin, especially on the parts exposed. Too violent and frequent washings contribute to many seborrheic diseases. It is a safe rule to advise the average person, possessing a susceptible skin, to apply soap only upon retiring. The stronger or potash soaps, of which sapo viridis (sapo mollis; green soap) is the most typical example, are useful in some cases of acne, seborrhea and psoriasis to remove adherent scales and crusts. The form commonly used is known as tincture of green soap and should not be employed as a toilet article. There are many soaps containing phenol, glycerin, tar, creolin, sulphur, betanaphthol and the various oils which are readily procurable and well advertised. The majority are practically worthless from a medical standpoint because they contain such a small proportion of the drug and it is best to prescribe these medicaments in other forms if needed.

Powders are applied to the surface of the skin for drying, protective, astringent and antipruritic effects. They have a limited sphere in cutaneous medicine but are useful in the erythemata, eczema, hyperidrosis and a few other affections. They should never be used when there is a free discharge of a purulent character. To be of any value they must be absolutely free from grittiness. All starchy substances form pasty rolls or cakes when they come in contact with serum or sweat, but lycopodium and zinc stearate with acetanilid are serviceable because they do not behave in this manner and form a dressing impervious to moisture. The commonly used powders are starch, talc, magnesium carbonate (most absorbent), lycopodium, calamine, bismuth, boric acid, the several stearates, camphor, tannin, iodoform, rice, kaolin, orris root, salicylic acid, aristol and europhen.

Lotions are medicinal solutions for external application. They are often more agreeable than ointments and very useful in many diseases but because of their drying qualities must often be used intermittently or conjointly with ointments. Acne, urticaria, erysipelas, pruritus and some cases of eczema and erythema are benefited by lotions. The addition of glycerin (5 to 10 minutes to the ounce) will often lessen the drying effect, while alcohol (5 to 10 minims to the ounce) may be added with advantage for the cooling sensation it produces. Lotions vary in their quality according to the purpose desired, being known as soothing, antiseptic, astringent, stimulating, antipruritic, etc. Many of these have been mentioned under the heading of water, and antipruritic lotions will be considered under the title of antipruritics. Among the extremely mild, soothing lotions are the well known calamin-zinc-oxid lotion (see formula on page 114), the lotion nigra and the boric acid lotion (also mildly antiseptic). Spraying the skin, especially with solutions of formalin for antiseptic purposes, may be of value in selected cases. Spraying for the purpose of freezing a part, preparatory to an operation, is most useful. Glass tubes or metal bulbs containing ethyl chlorid are used for this purpose.

Ointments or salves are fatty materials, generally containing a medicinal substance, employed for local application. These are by far the most valuable preparations employed in dermatology. Under the subject of treatment of the various diseases, mentioned in the text, will be found particulars concerning their use. It is only necessary here to briefly describe some common characteristics. Among the preparations commonly used for ointment bases are prepared lard which is the most penetrating but which should always be fresh; petrolatum or vaseline which, although not so penetrative, has little tendency to change; cold cream (unguentum aquae rosae), if properly and carefully made may be employed when lard and vaseline are not suitable; lanolin (wool fat) or a similar preparation, adeps lanae, is a valuable addition in the proportion of 10 to 20 per cent. to other bases but is most unsatisfactory if used alone; glycerite of starch is occasionally used; and spermaceti, wax, suet and other fatty substances are often added to an ointment base when it is necessary to make a stiffer consistency because of the addition of liquid substances such as lead water, adrenalin chlorid or liquor carbonis detergens. Depending upon the addition of some medicament, an ointment becomes soothing, stimulating, antiseptic, counter-irritative, caustic or actively destructive. Among the mild ointments may be mentioned cold cream, cucumber ointment and zinc-oxid ointment. Cocoa-butter may be added to any ointment in from 5 to 15 per cent. to give it greater rigidity. Mild salves containing such substances as calamin, boric acid and bismuth subnitrate or the diachylon ointment (see formula on page 114) may be applied by anointing or by spreading on some suitable cloth. Antiseptic and stimulating ointments containing sulphur, tar, one of the mercurials, resorcin, salicylic acid, etc., usually need to be well rubbed in.

Pastes are soft stickly substances, usually composed of starch and zinc oxid with a petroleum fat as the fatty constituent. They are in reality a form of ointment suggested by Lassar, Unna and others. Lassar’s paste (see formula on page 485) to which is commonly added salicylic acid (1 to 2 per cent.) or Duhring’s formula (boric acid 1 part, zinc oxid and starch 3 parts each, vaseline 12 parts) are of greater value in some eczemas than ordinary ointments owing to their porosity, consistency and adhesiveness. They rapidly dry on the surface, making a thin protective covering.

Oils, such as olive, linseed and sweat almond, liquid petrolatum and oil of cade, may be used in the place of ointments for the removal of crusts and scales or variously medicated for therapeutic action. Oily preparations, except when used as a general or local bath, should be applied with a medicine dropper and then rubbed in with a soft cloth.

Fixed dressings include plasters of all types, collodion, traumaticin, varnishes, glycogelatins, poultices and salve-pencils. They are principally used for chronic indurated psoriasis, eczema, lichen planus, the various keratoses, callositas, clavus and in a few instances the syphilids and lupus vulgaris. Plasters are necessarily consistent, exerting a continuous effect upon the skin. Resin-plasters are less useful than lead-plasters because they are more irritating. However, the irritating effects of the resin are entirely overcome in a good zinc-oxid adhesive plaster which serves admirably as a simple’s protection or to retain other dressings in place. Mercuric plasters are occasionally useful especially in syphilitic lesions.

Unna’s salve-muscles or salve-mulls are strips of muslin impregnated with medicated ointments. They may contain almost any desirable substance and if they are well made, they should remain fresh and efficacious for several weeks or even months. They are available in dermal conditions affecting the extremities and are usually agreeable to the patient. Unna’s plaster-mulls or plaster- muscles are thinly spread on gutta-percha cloth and may be variously medicated. They are less serviceable than the salve-mulls but are occasionally used for the protection of parts exposed to friction.

Collodion and traumaticin (10 per cent. gutta-percha in chloroform) are applied to protect or contact the surface or to apply a remedy to the skin. Their chief use lies in the application of such remedies as chrysarobin (chrysophanic acid), pyrogallol (pyrogallic acid), iodine, oil of cade, salicylic acid, bismuth, sulphur, etc., to limited areas of lupus erythematosus, ringworm, psoriasis, scleroderma, eczema, callositas, clavus and other keratoses.

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