Arsen. alb.-Black pustules, filled with black blood and fetid pus; painful sensation on scalp and face, as from cutaneous ulceration; worse from cold and touch; better from warmth.
Baryta carb.-Especially old people; thick crusts behind the ears; fat dumpy children, with swollen lymphatics,; sore throat, with swelling of tonsils after the least cold; worse at night and when thinking of it; better in open air.
Calcarea carb.-During dentition; dry crusts; sweat of forehead, particularly in the evening; sensitiveness of the root of the hair.
Cicuta vir.-Impetigo sparsa; eruption on chin and lower part of face, forming thick yellow crusts; honey-comb-like crusts, which fall off and leave a bright-red smooth surface; painful eruption on scalp.
Clematis.-Psoric constitution; pimples on forehead, root and sides of nose; pustules about lips, tender to touch; large pustules about loins; eruption changes character during the changes of the moon; worse in bed, washing, and towards morning; feels exhausted on waking.
Conium.-Sero-purulent eruption in aged people, old hypochondriac maids; vertigo when turning over in bed, looking up; old weak, and feeble men; scrofulosis, with engorgement of lymphatics; eruption around mons veneris.
Croton tigl.-Pustular eruption upon an inflamed base, with itching and stinging pain upon septum nasi, plugging the nostril; eruption on abdomen; sore nipples of nursing women.
Euphorbium is indicated when there is an irritable skin, with swelling of the face and pea-sized yellow vesicles.
Graphites.-Scabby eruption, with excessive oozing;eruption around mouth and nose or the whiskers; hair falls out; corrosive blisters about extremities, toes, and fingers; dry skin; very sensitive to cold; cold hands and feet, with scanty menses; rhagades.
Hepar.-Eruption after mercurialism; sensitive to touch; tendency to ulceration; humid scabs and pustules upon the head, oozing a fetid substance; swollen cervical glands; cracks behind ears; hands cracked dry.
Iris vers.-Impetigo capitis, with gastric complaints, nausea, and vomiting.
Kali bichrom.-Dry eruption; pustules disappear without bursting. Stands next to Antim cr. as a remedy.
Kreasotum.-Painless pustular eruption all over body, especially on chin and cheeks; sticking pain, especially on points; sad and weeping; worse in open air.
Lycopodium.-After abuse of mercury; itching and suppurating eruption on head and face; full of deep cracks; abundant and fetid discharge; fetid and moist scabs behind ears; humid tinea capitis.
Mercurius.-Swelling and suppuration of glands; gastric derangement; moist scabs, with excoriation of the scalp and destruction of the hair; yellowish scabs on face, with fetid discharge; yellowish scabs, especially around mouth.
Mezereum.-Deep inflammatory redness of face; eruption fat and moist; ichor from scratched places excoriates other parts.
Nitric acid.-Eruption on head, pricking on being touched; pustular eruption on face, with large red margin and heavy scabs; mercurio-syphilis.
Rhus tox.-Small pustules on back base; greenish pus, with violent itching at night; humid eruption, with thick scabs on face and head, destroying the hair, with fetid smell; eruption on nose, extending to face.
Silicea.-Eruption resembling varicella; violent itching of scalp; moist scald head; growing pains; better warmth, worse from cold.
Sulphur.-Dry, thick, yellow scabs on scalp, with profuse discharge; great itching relieved by scratching; purulent eruption on elbows.
Tartar emet.-The remedy when the disease is exceedingly pustular.
Thuja.-Eruption all over the body; itching and shooting, especially at night; pustular eruption about the knee; better from gentle rubbing.
Viola tricolor.-Pustules and scabs upon face, with burning and itching, and discharging fetid pus; sensation as of tension of the integument of face; urine smells like cat’s urine worse at night. Recent cases.
Ecthyma.
This disease is described as consisting of isolated phlyzacious pustules-namely, those which are “large, raised on a hard base, of a vivid red color, and succeeded by thick, hard, dark-colored scabs, beneath which there is ulceration.” The pustules are generally distinct round, and isolated; they are mostly general, but may be partial, and leave cicatrices behind. The shoulders, buttocks, and limbs are the parts usually attacked. There are two chief forms described-acute and chronic.
Acute general ecthyma is rare. The ordinary scattered ecthyma is practically always the result of the action of some irritant upon the skin, in an unhealthy or badly nourished subject; and so ecthymatous pustules frequently occur in connection with scabies and phthiriasis, and more rarely in pruri, or eczema, and other diseases.
Acute ecthyma commences with slight febrile disturbances, and occasionally sore throat; locally, there is first a sense of heat and burning, followed by the appearance of reddish raised points, with hard, indurated bases, and distinct vivid areolae; these points, which very size from that of pea to that of a shilling, quickly pustulate, and are often accompanied by acute, sharp pain. In two or three days the pustules give exit to discharge, which dries into hard, adherent, dirty, discolored scabs, covering over circular ulcerations; the crusts fall off in a week or so, leaving behind dark stains. The ecthymatous spots may be few or many; in the latter case a good deal of irritation is set up; the patient may be unable to sleep from pain and the glands and lymphatic vessels may become inflamed, small abscesses forming subsequently. The disease is generally protracted by successive crops of pustules or it may relapse into a chronic state. The limbs, shoulders, and trunk are chief seats of the disease.
Chronic ecthyma generally results from the action of some irritation, as in scabies, in connection with pediculi, and from scratching and badly nourished subjects. The ecthymatous pustules in the chronic disease are of similar character to those of acute ecthyma. They are painful, with hard, inflammatory bases and a small central collection of pus. When they occur on the limbs, especially the legs, in old people they are followed sometimes by troublesome ulcers.
In ecthyma the seat of disease appears to be the uppermost layer of the derma, not unlikely about the glands of the skin, the depth of surface involved being less than in furunculus, and there is no “core”, otherwise ecthyma would be well classed with boils. The tendency to ulceration and sloughing, the lividity of the inflammatory areola, the disturbance of the general system, all point to a cachectic condition.
Causes.-The predisposing causes are always such as lead to debility and an impoverished state of blood. They are, in infants, bad nursing, suckling by mothers much out of health, scabies, bad clothing, damp dwellings; in adults and others, over-work, fatigue, convalescence from acute diseases, bad food, privations, various occupations that induce irritation of the skin, as bricklaying, excesses of all kinds, debauchery, uncleanliness, night-watching, overcrowding in public institutions-work houses, jails, and such like. The immediate exciting causes are scabies, phthiriasis, the use of acrid medicinal applications, and scratching.
Prognosis is to be made according to the general condition of the patient. The ecthyma, per se, is of little gravity, save when it is accompanied by sloughing, as in old people; then it is grave. Diagnosis.-The distinct, large isolated pustules, with an inflamed areola and hard base, disturbed over the body, are very distinctive of the disease. It may be confounded with impetigo sparsa, but in this disease there are rather sero-pustules, which are very superficial; the discharge is viscid, yellowish; these are as dark scabs, no indurated, inflamed, and painful bases. Furunculus is deeper, it runs a slower course, and contains a central “slough” or “core”, as it is called. It is more circumscribed, and there is little scabbing.
Treatment.-Locally a good application is an ointment made by rubbing together an ounce of lard, and half a drachm or so of Friar`s balsam. The crusts may be removed after soakings with oil, and affected parts dressed with an ointment made by adding five to ten grains of white precipitate to the ounce of cosmoline. After the pustules burst, if the ulcers show but little tendency to heal, a weak carbolized wash may be used.
The patient should be well hygiened and given a good generous diet.
The appropriate internal remedy may be selected from the following:
Anacardium.-Hard, red pustules, itching worse after scratching; crossness and irritability with weakness of mind; sensation of a hoop around the affected part.
Antimon crud.-Pustules on the face in fat people; yellowish or brownish scabs on the face; desire for acids.
Arsen, alb.-Red or white pustules, with intense burning; painful black pustules, gnawing, burning, and itching; eruption on the scalp, forehead, around the eyes, cheeks, arms shoulders, and upper part of the chest, terminating in thick crusts, and leaving well-marked scars.
