Psoriasis and syphilis may of course coexist. There will be but little difficulty in differentiating the respective lesions.
Psoriasis may coexist with eczema, both presenting typical lesions, or we may have lesions of mixed character, in which it would be hard to say which disease predominated. Certain diseases of other organs appear to bear a close relationship to psoriasis. This is notably true of arthritic affections and also of asthma. As a rule, these do not coexist with the psoriasis, but manifest themselves during the time that the skin is free from eruption, alternating as it were with the cutaneous lesion.
Treatment.-It is but a few years since the chief reliance of the old school in the treatment of psoriasis was the internal use of arsenic and the external use of tar. Slow and tedious was the cure. Now, however, they possess an agent which they claim exhibits a remarkable energy in the control of the eruption. We allude to chrysarobin. This is employed in various ways, but the one seemingly most satisfactory, is a mixture of thirty grains of the drug with one ounce of traumaticin (liquor gutta- percha). This should be pained on the spots daily until a considerable degree of local irritation is produced. Sedative applications should then be applied for a few days, and the skin allowed to recover from the effects of the drug. A single course of this sort will cause most of the spots to disappear- that is, as regards scale formation and infiltration- and these spots will usually appear distinctly white and anaemic in comparison with the surrounding skin, which has been darkened by congestion produced by the chrysarobin. Unless the eruption was limited both as to size and extent of the lesions, we will find many patches in which complete recovery has not taken place. These will require additional applications. Chrysarobin possesses the inconvenience of staining the surrounding skin (temporarily) and permanently staining the clothing; and a number of substitutes- naphthol, resorcin, antarobin, hydroxylamin, etc.-have been proposed. Some of these are dangerous, while others are inefficient, and none of them are equal in efficacy to chrysarobin. This drug, however, should not be applied to the face or scalp, and we must instead use milder applications, such as tar or some of the essential oils, as the oleum pini sylvestris, oleum eucalypti, etc.
The following is an excellent aid:
Rx. Chrysarobin,
Acid Salicylici, aa gr. x.
Unquent Resinol, j.
Sig. Apply thoroughly at night and bathe thoroughly next morning, or, Rx. Tar,
Alcohol,
Soft soap, aa 3j. M.
Sig. Apply locally, with the flannel or a coarse piece of cloth, and is firmly rubbed into the part night and morning according to the effect.
The following is a very good application for an ordinary case of psoriasis which is passing on to the chronic stage.
Rx. Nitrate of mercury ointment, 3j to 3jj.
Powdered oxide of zinc, 3jj.
Solution of lead (liquor plumbi), 3 ss.
Carbolic acid, fl. drops, jj.
Olive oil, 3j or 3j ss.
M. Sig. Apply nightly.
Another excellent application is made as follows:
Rx. Red precipitate, finely powdered,
White precipitate, aa gr. vj.
Lard, 3j.
Mix. Sig. Apply night and morning.
Dr. Stern recommends for psoriasis capitis: Precipit alb., 10.0: Sapon. nigr., 40. 0; Lanoline anhydr., 50.0.
M. Ft. ung., S. Rub in every evening a portion the size of a filbert.
After four days all the scales are gone, and the affected parts become smooth and take on a natural appearance. It is usually advisable to continue the application of the lanoline alone for a time longer.
Dr. Patterson reports a case of psoriasis of fifteen years’ standing cured in one mouth by an ointment of vaseline, oxide of zinc and Sanitas oil. He fails to give the proportions.
The pomade of tar is classical in the treatment of psoriasis. Axunge or oil, with one-tenth part of tar. The pomade of oil of cedar has been employed in the same proportion. The immediate action of these pomades is a notable amelioration of this affection. But they never effect a cure.
In obstinate cases, unless the skin is very irritable, the oil of white birch may be used in the form of an ointment, one drachm to the ounce of vaseline.
The diet in psoriasis should be generous one, and in it meat ought always to play an important part. Cod liver oil is generally needed.
The indications for the internal remedies are as follows: It is better to commence the internal treatment with Sulphur. Afterwards one of the following remedies may be given:
Ammonium carb.-White pea-sized spots upon the cheek, which continually exfoliate; skin very sensitive to cold; aversion to being washed; nose-bleed when washing the face in the morning; in weak, nervous individuals.
Arsen. alb.-Eruption red or white and scaling; skin dry and scaly; great restlessness with weakness and prostration, worse about midnight; burning itching; oppression of breathing; aggravated by eating fruit, ice-cream, etc.
Arsen. iod.-Dry scaly burning itching eruption on various parts; persistent itching on the back; in obstinate cases.
Berber. vulg.-The eruption appears with itching, lymphatic swellings on the articulations, must scratch very hard.
Calcarea carb.-Scurfy spots on the leg; burning and itching; skin cracks; profuse sweat from the slightest exertion; large abdomen; blue eyes, blonde hair, fair skin.
Clematis.-The eruption is chronic and long lasting, and becomes redder and more humid with the increasing, paler and dryer with the decreasing moon.
Fluoric acid.-Roughness on the forehead like a rough line with its convexity upwards. Reddish spots above the eyebrows, desquamation on the eyebrows; nails, brittle, edges bent in.
Hydrocotyle-Circular spots with slightly raised scaly edges.
Iodine.-Rough, dry and dirty yellow color of the skin. Nervous irritation, and emaciation, with good appetite; psoriasis circinata.
Iris vers.-Irregular psoriatic patches on the knees and elbows, covered with shining scales; eruption becomes hard and dry; skin fissured and irritable; digestive derangement, with nausea, and debility; starting during sleep; psoriasis diffusa.
Manganum.-In inveterate cases.
Mercurius.-Psoriasis of the hands; psoriasis in spots all over the body; scaling off and exfoliation of the finger nails; the scalp is painful to the touch; easy perspiration without relief; recent cases.
Mezereum.-Scurf-like scales on the back, chest, scalp and thighs; roughness and scaling here and there; pruritus increased by scratching or when undressing.
Muriatic acid.-Psoriasis of the hands; great sensitiveness to damp weather.
Natrum ars.-Thin whitish scales, which when removed leave the skin slightly reddened.
Nitric acid.-Burning, itching or stabbing pains, worse at night, from change of weather, or during perspiration; strong smelling urine, like that of horses.
Petroleum.-Skin of the hands cracked and rough; unhealthy skin; aversion to the open air; extreme sensitiveness to slight touch; falling off of the hair.
Phosphorus.-Psoriasis of the arms and hands, and on the knees and elbows; arms and hands become numb; brownish or bluish- red blotches, with furfuraceous dry scaling; coldness of the knees at night in bed; falling out of the hair in large bunches; dry cough, with soreness in the chest; tall, fair children, with tuberculous tendency.
Phytolacca.-Surface of the skin shrunken and of a leaden color; squamous eruption; rheumatic pains in the extremities.
Psorinum.-Eruption dry and scaling, with itching, weakness, and debility; after acute diseases; profuse colliquative sweats.
Selenium.-Dry, scaly eruption on the palms of the hands, with slight itching.
Sepia.-Psoriasis on the face; red roughness of the skin; falling off of the hair; during pregnancy and nursing; dark complexioned individuals.
Silicea.-Elevated scurfy spots near the coccyx; small white scales on the face and neck; white spots on the cheeks; sensation of numbness in the extremities; brittleness of the nails; in scrofulous, large-bellied children.
Tellurium.-Psoriasis annulata, eruption over the whole body.
Teucrium.-Psoriasis on the index finger of the right hand.
