The disease is self-limited, requiring no special treatment other than sedative applications to the affected parts.
In erythema multiforme the allopaths claim that “Unless the cause of the affection be discovered, little need or can be done in the way of treatment, and the affection may be left to run its course, which it will usually do in two or three weeks, and may not return until the following season, for in some persons this disease appears to affect a predilection for the spring and autumn months, returning annually at one or the other of these seasons.”
TREATMENT- When there is much itching and burning either a carbolic acid or veratrum viride lotion may be used. When the opposing surfaces are much inflamed they may be protected by dusting with buckwheat powder, or equal parts of starch and zinc oxide. Especial attention should be paid to cleanliness, and all irritants should be removed. Poultices are apt to do more harm than good, and better be avoided. Particular attention must be paid to the diet; such food as corn-flour, maizena, and the like must be forbidden, and proper nutritive substitutes be given to children in conjunction with suitable quantity of milk.
In the erythemata dependent upon general causes you must always remember the effect of ingesta; that a gouty or rheumatic habit, disordered menstrual function, dentition, delicacy of skin, or lymphatic temperament, are present in greater of less degree. It is important to allow the patient the use of an unstimulating diet only, to forbid him spirits, wine, and beer, to clear out the bowels, and in the early stage to adopt a soothing regime, with tepid sponging and emollient baths.
Bed-sores are best treated by attempting to “harden” the skin in the early stage by spirit applications, removing pressure as much as possible at later stages by pads, cushions, and water- beds, and by using charcoal poultices or soap plaster spread on soft leather to the sores. For chilblains, equal parts of turpentine and tincture of Aconite, and soap liniment, together with the indicated remedy, constitute the best treatment.
The internal remedies for erythema are;
Aconite-Erythema excited by the action of the sun’s rays.
Aethusa-Appearance and disappearance of reddish-blue spots on the trunk and left leg. General malaise.
Ailanthus-Irregular spots of capillary congestion. Dark almost livid eruption on the forehead.
Arsenicum iodide-Erythema, especially of the face.
Belladonna-Inflamed red patches. Irregularly-shaped scarlet spots over the body. More on face and upper part of body.
Berberis-Mottled spots as after bruise on the right shoulder, left humerus, back of the hand and wrist.
Bryonia-Red round hot spots on the malar bone, as large as peas.
Cadmium sulph-Red spots on the extremities.
Chelidonium maj-Round red spots, size of a half dollar, accompanied with burning pain, on anterior surface of the forearms and face, disappearing in a few hours.
Chloral hydrate-Bright red or bluish erythema over the whole body, permanent under pressure, mottled with livid patches and deep red spots. Pruritus of the whole skin.
Crocus sat-Circumscribed red spots on the face, which burn.
Condurango-Erythematous blotches on the face and arms.
Gelsemium-Papulous eruption on the face resembling measles.
Gossypium-Round little spots with pale red circles around the knee caps and over the shin bones, which itch very much.
Lactic acid-Several bright red blotches on the anterior surface of the leg, with slight burning and no itching. Relieved by cold. Eruption brightest at 8 A.M.
Laurocerasus-Erythematous patches, terminating in dark red purple spots.
Mercurius sol-Light red patches on the forearm and inner side of the thighs. Itching changed to burning by scratching.
Mezereum-Erythema on the legs in old people.
Nux vomica-Pimples on the face with itching, burning after drinking wine or alcoholic liquors.
Phytolacca-Painful erythematous blotches of a pale red color.
Pulsatilla nut-Erythema of the scalp. Dark blue or red eruption on the legs and ankles.
Rhus tox.-Ridges on the lower limbs.
Sabadilla-Red streaks on the arms. Worse from cold.
Ustilago-Fine eruption of a deep red colour, about the size of a pin’s head, appearing on any part of the body after scratching. On the neck it takes a circular form.
Mr. M., a very large and fleshy man of exceedingly good habits and with no history of specific trouble, presented himself for a long standing and obstinate erythema. The case had been prescribed for under nearly every conceivable diagnosis, the majority of physicians claiming it was due to syphilis. During a fishing expedition, some years ago, he thought he had been poisoned while in bathing, and since that time he has been exceedingly troubled with this persistent local inflammation. His unusual flesh had been a constant irritant, and being obliged too work for his living he had almost despaired of recovery.
In the folds of his right groin and extending back between the nates an immense phlegmonous surface was visible. So long had it existed that fissures and ulcerations, and excessive secretions of sweat and pus had complicated what might have been a short enduring, and simple sore. A rash, like measles, extended over the surrounding healthy skin. Extreme local itching and general aching pains made him exceedingly restless. These symptoms were always worse after midnight and during wet or cold weather.
With these indications he was given Rhus tox. 30 four times daily for a week. He was directed to use a local wash of warm water and lanoline soap, being careful to wipe the parts to perfect dryness. He was then to use a dusting powder to aristol and wear an abdominal supporter to relieve any chafing. In four weeks he was entirely well.
Roseola
It is important to know this disease-not so much because it gives rise to any anxiety or trouble, as that it is likely to be confounded with measles and scarlet fever. Roseola is not generally considered to be a contagious disease, but rather occurs in an epidemic form. The eruption is preceded by some febrile symptoms; the rash is not much raised above the level of the surrounding part, and is of a rose color. It is in fact an erythema of a rosy hue. The eruption is patchy, and its color deepens somewhat as the disease advances. It is accompanied by slight itching and sensation of heat. Before the eruption makes its appearance and during the slight febrile symptoms, a slight redness of the mucous surfaces of the palate and fauces will be noticed on inspection of these parts. When not epidemic, roseola seems to depend chiefly upon derangements of the digestive apparatus as a producing cause, though it may likewise be due to sudden changes of temperature, violent exercise, taking cold drinks while the body is warm and perspiring, etc.
The eruption may appear suddenly during the night, and cover the entire body with its rose-colored patches, situated closely together, yet distinct.
Roseola is divided into two groups, Idiopathic and Symptomatic. In the latter group the roseola occurs as an accidental phenomenon in the course of acute diseases, and hence is called symptomatic; in the other group it exists as the sole and primary disease.
Idiopathic Group-Roseola infantilis is the name given to roseola when it is seen in infants. It roughly resembles measles minus the catarrh; it runs an irregular course as regards precursory symptoms, which vary in degree, and in the extent, degree, and seat of eruption. It may be quite general but patchy, or it may be limited to the arm, or the neck, or trunk; the rose blushes often come and go for several days capriciously, and are accompanied by local heat and itching, which are often marked at night. No catarrhal symptoms, as in measles, are present. The redness generally lasts a dozen or more hours.
When the disease assumes the form of rings (and this is generally observed about the buttocks, thighs, and abdomen), developed from little rose spots, and enclosing presently a healthy circle of skin an inch or so in diameter, the variety R. annulata is present. The concomitant symptoms are the same as those of the common form. It is not necessary to make all the varieties of roseola that are made by some authors.
The Symptomatic Group contains roseolas which are merely rosy erythmata developed in the course of acute diseases, generally appearing about the arms, breast, and face, thence spreading over the body. R. vaccinia coexists with the formation of the vaccine vesicle, and is accompanied by slight fever. It commences around and about the seat of the vaccination. In cases of fevers, about the tenth day or so, and indeed whenever the weather is very warm, the perspiration is apt to distend the sweat glands, which become more or less hyperaemic, so that little vesicles form, for example, miliaria and sudamina. Sometimes red blushes accompany this particular kind of vesicular eruption, and to these rosy blushes the name R. miliaris has been given.
After surgical operations a rash like scarlet fever very frequently occurs; its color varies somewhat; it is not contagious, and is without the general symptoms, the throat complication, hot skin, quick pulse, and tongue of scarlet fever. It is due, doubtless, to some volatile poison free in the blood. It has no gravity.
