The following ointment is highly recommended:
Rx Resorcin, 2 to 5 parts. Zinci oxid.
Pulv. amyli., aa 5 parts.
Vaseline, 10 parts.
Fiat unguentum. Sig.: Apply to parts as often as occupation of patient will permit.
Dr. Piffard says: “The effect of internal medication in acne simplex sometimes appears to be very striking, and at other times absolutely nil. The drugs which we have found most useful are, in ordinary cases, calc. sulphurate, arsenic, and ergot. The first of these is decidedly the most useful, and may be given in doses of one-tenth to one-half a grain two, three, or four times daily, bearing in mind that the more acute the process the smaller the dose should be, while in sluggish and indolent lesions it should be pushed to the maximum”.
The dosage of arsenic should be governed by the same principles. Ergot was introduced into the treatment of acne by Dr.. Denslow. It has appeared to me to be specially useful in the treatment of pustular acne in females. Whether it directly affects the local circulation, as believed by Dr. D., or whether its primary effect on those cases is on the pelvic organs, I do not know. It has also been followed by good results in males.
In patients who are suffering from anaemia, struma, etc., iron and cod-liver oil should form an important parl of the treatment.
In acne tuberculata and indurata the same general principles of treatment are to be followed; except that in these forms arsenic has appeared to me to be of very little use. On the other hand, iodide of potassium, in doses of five to ten grains, has in some instances been followed by favorable results.
The foregoing applies to the removal of the existing eruption. The prevention of relapses, or frequent outbreaks of eruption, is quite another matter; and success in this regard will be due to the accuracy with which the practitioner unravels the etiological factors, and is successful in bringing about their removal or amelioration.”
Our first object should be to get at the cause of the disease, if possible, and remove that. The dyspeptic should avoid pastry, highly-seasoned food, beer and spirits of all kinds. The poorly nourished patient should be fed on good food, and should have plenty of it. Buck-wheat cakes, hot bread, nuts, cheese, fried substances, exhilarating drinks, and all sweet and rich articles of food should be avoided. In dyspeptic patients, a cup of hot water taken a half hour before meals, will often prove beneficial.
The soaps that have been found most useful are, notably, sulphur and iodide of sulphur soaps, and the Juniper tar soap. I have seen excellent results from the use of a soap made from the waters of the “Skookum Chuck Lake,” and prepared by Boericke and Tafel.
As for remedies, we should choose that one that meets all the symptoms of the case, and not some one that has been suggested for acne, for cases differ widely in their causes and symptoms.
One of the following will likely be indicated :
Antimonium crud.-Small, red pimples about the face and on the right shoulder, stinging when touched; acne in drunkards, with gastric derangements, severe thirst, and white-coated tongue.
Antimon. tart.-In obstinate cases, with longing for acids, and when there is a decided tendency to pustulation; the pustules are thickest on the neck and shoulders, and after discharging leave bluish-red cicatrices. May be used internally and locally.
Arctium lappa.-Aggravated cases, with numerous small boils all over the body.
Arsenicum.-In chronic cases where the skin is dry, rough, and dirty-looking, and when the eruption is most marked on the face and extremities; cachectic acne.
Asimina.-Itching red pimples, appearing first on the left, then on the right side; pustular acne, with itching in the evening when undressing.
Aurum.-Red pimples on the face; disposition to melancholy; disgust for life, with suicidal tendency; in onanists and syphilitics; after over-dosing with the iodide of potash.
Baryta carb.-In obstinate cases, especially when the papules or pustules are interspersed with comedones; persons who take cold easily; wine drinkers; hysterical or scrofulous persons.
Berberis vulg.-Red, burning, gnawing pimples, sensitive to pressure, surrounded by red areolae, and leaving brown stains; adapted to indurated acne, associated with urinary or hemorrhoidal troubles; in women with scanty or suppressed menstruation; the patient complains of a good deal of chilliness.
Belladonna.-Large, bright, red pimples on the face, back, and scapulae, especially in young, full-blooded people; fine stinging in the tips of the pimples; frequent congestion of the face and epistaxis; aggravation during profuse menses, pregnancy and confinement.
Bovista.-Large, scattered pimples on the forehead; hard, red pimples, large as peas, on the chest, worse from scratching; in delicate women, with thick acrid or corrosive, greenish-yellow leucorrhoea, after the menses; ill-humor.
Bromine.-Indurated acne in scrofulous individuals; aggravated by smoking; swelling and induration of the glands of the neck; prone to erysipelatous inflammation.
Bryonia.-In dyspeptic cases, aggravated by eating cabbage, or warm food; or occasioned by suppressed perspiration; constipation as a rule.
Calcarea carb.-Acne on the face and neck; when due to sexual excesses; redness of the nose in consequence of dysmenorrhoea or amenorrhoea; people who work much in water; scrofulous persons; always worse before the menses.
Calcarea phos.-Has been used successfully for similar indications after the failure of the carbonate; chronic enlargement of the tonsils; red pimples full of yellow pus. In young people during puberty.
Cannabis.-Meets acne rosacea better than simplex when there is morning aggravation with burning like fire; syphilitic patients with much headache on top of the head.
Carbo veg.-Pimples on the nape of the neck; red pimples on the face and chin; young people, with aggravation from eating butter or pork; lymphatic swellings with suppuration and burning pains; dyspeptics, when the most innocent food disagrees.
Causticum.-Eruption on the face, more felt than seen; yellow color of the face; papulous eruption between the eyebrows above the nose; dark-haired persons; in cases which have not been improved by Arsenicum, Hepar, or Sulphur; aggravation from cold, with sensitiveness to cold air.
Chelidonium.-Pimples and pustules in groups of three of four on the face, except the chin; chiefly on the left side; acne dependent upon liver derangement.
Actea rac.-Acne in women, dependent upon gastric, ovarian, or uterine derangement; melancholy persons.
Conium.-In obstinate, indurated acne occurring on the face; aggravation from suppressed menses; swelling of the parotid or submaxillary glands; fetid, smarting perspiration; adapted to scrofulous persons and old maids.
Eugenia.-Pimples on the face which are painful for some distance around; at times useful in the indurated form.
Granatum.-Pimples on the forehead and left temple with sore pain; they suppurate, and on drying leave nodules; itching in different parts of the body as if pimples would break out.
Graphites.-Pimples in persons inclined to obesity; particularly females with disposition to delayed menstruation; aggravation during, after, and from suppressed menstruation; the skin is very dry, inclined to crack, and easily tends to ulceration.
Hepar.-Painless pimples on the nape of the neck, forehead, and chin; crusty pimples on the face in young people; swelling and suppuration of glands; skin yellow and unhealthy, every small injury suppurates; cough with rattling in the chest but no expectoration.
Iodine.-Indurated acne in scrofulous subjects with ulcers in the throat; adapted to young persons with dark hair and eyes; and rough, dry skin; skin insensible and of a dirty yellow color.
Kali bich.-Face covered with a profuse eruption resembling acne; when pustules form they resemble small-pox pustules; in persons with loud rattling cough and stringy expectoration; especially suitable for fat, light-haired persons.
Kali carb.-Small pimples on the face, chest, and back, with redness and swelling; deficient perspiration; cases aggravated by suppressed menses; rough, chapped skin of the hands; dry, parched skin of the face; persons inclined to pulmonary difficulties.
Kali mur.-Pimples on the face with thick white contents, caused by a disturbed action of the follicular glands.
Kreasote.-Acne worse after menstruation, or from getting heated; dry pimples on the forehead; greasy pimples on the right cheek and chin; sad and irritable individuals, always worse after the menses, or from getting heated.
Ledum.-Red pimply eruption on the face; small pimples on the root of the nose; in rheumatic persons or drunkards, also when greatly aggravated by heat.
Lycopodium.-Red pimples in clusters, between the scapulae and on the nape of the neck; after the failure of Sulph., Rhus, or Hepar; dyspeptic ailments; red sand in the urine; cold feet; constipation.
Mercurius sol.-Indolent bluish-red papules, especially on the lower extremities; dirty yellow color of the skin, with glandular swellings; in syphilitic and scrofulous persons.
