Powders.-It is sometimes found that in the second stage of the disease ointments and lotions of every kind increase the irritation and add to the discomfort of the patient. Fortunately, these instances are rare; but when they are met with simple or medicated powders will sometimes prove of service. Starch, lycopodium, ordinary toilet powder, or talc, may be used alone, or the oxide of zinc or subnitrate of bismuth may be used with either of them.
Soaps.-Soft potash soap, equivalent to the sapo viridis of the Pharmacopoeia, contains an excess of alkali, and is used for the reduction of infiltration. It should be thoroughly rubbed in with the aid of flannel moistened in hot water until a lather has formed. This is left on, and the effect is similar to that of liquor potassae, already noticed. Hard soda soap, prepared for laundry use, also contains considerable free alkali, and may be used for the same purpose. Tar soap is of service in the third and scaly stage of the disease.
Certain mechanical means are sometimes employed in the treatment of eczema. The application of rubber, in the form of an elastic bandage, often proves of the greatest service in thickened eczemas of the lower extremities; then the object sought is steady pressure with a view to produce absorption of the infiltration. The silk elastic stocking may be used for the same purpose.
Sometimes localized patches of eczema of long standing fail to yield to any of the ordinary means for their relief, and necessitate more vigorous interference. In this connection scarification is extremely useful, and patches of thickened eczema will sometimes disappear almost as if by magic after the use of the knife. Treatment of th Special Forms and Varieties of Eczema.
Bearing in mind the general principles that underlie the treatment of all cases of eczema, we will consider the special varieties as influenced by age, degree of inflammatory action, locality, etc., commencing with eczema of young children.
In eczema intertrigo, so common in the groin and nates of infants, absorbent cotton dusted with finely triturated powder should be constantly applied, so as to come in contact with the inflamed surfaces and separate them. Boracic and salicylic acids, each one part of two of subnitrate of bismuth, and five of oxide of zinc, is a good power. Camphor mixed with ointments or washes relieves itching. A two per cent. solution of acetic acid, or a one percent. solution of aluminium acetate in water, frequently gives relief. Carbolic acid is very efficient for itching.
In eczema of the scalp in children we frequently, and perhaps generally, find the case acute as regards its character, though it may be chronic as regards the duration of time that it has existed. It is almost always presented to the physician in the second stage characterized by exudation and crusting, and complicated with enlarged glands at the back of the neck, small abscesses of the scalp, and may also be accompanied with pediculi. the vesicular and pustular forms are the most common, and the crusts, entangled in and retained by the hair, accumulate more thickly than elsewhere. The first thing to do is to cut the hair off as short as it is possible to do it with scissors. If pediculi are present, search through hair stumps for their ova, which should be removed. If many crusts adhere to the scalp after clipping the hair, saturate the parts with olive oil, and, after a few hours, give the scalp a good washing with soap and warm water. After thorough drying, apply zinc or diluted white precipitate ointment.
The ointment should be applied thickly, and renewed daily and even twice daily, and accumulations of old ointment be removed by gentle use of the comb as often as necessary. The scalp should not, however, be washed again for several days; in fact, the less frequently it is washed the better. If abscesses are present they must be opened, and perhaps poulticed for a day or two,. Eczema of the scalp, in many cases, seems to be called into existence as a consequence of parasitic irritation; and when the eczema itself is of but limited extent, but the parasites are numerous, they may be made the first point of attack and cutting of the hair be avoided. I know of nothing more effective than drowning them out with ordinary kerosene. If the hair be thoroughly saturated with this for two or three days in succession, soap and water, and a fine-tooth comb and patience will do the rest. The parasites destroyed, the eczema may recover spontaneously, or more quickly if aided with a few applications of ointment.
The enlarged glands at the back of the neck require no special attention. When the eczema gets well they will subside. Eczema of the scalp often extends to the forehead, face and ears. If fissures form behind the ears, it is well to add a little finely-powdered graphite to the ointment. As the case progresses toward recovery, and the exudation and crusting cease, and the third stage, characterized by dryness and scabs, is ushered in, the treatment requires a change.
A little tar, in some of its forms, should then be added to the ointment, and the proportion of tar gradually increased as improvement occurs. If progress toward recovery should halt, a little more active stimulation may be the thing needed. If, however, the eruption should revert to the second stage, as not infrequently happens, the latter treatment will have to be resumed.
Eczema of the scalp in adults presents itself more frequently in a subacute than an acute condition, and very commonly in the dry and scaly stage, the patient complaining of a certain amount of irritation and an excessive formation of dandruff. If the same condition should be present on the non- hairy parts, tar would be thought of as a remedy. This, however, is practically impossible on the scalp, except for those who are able to abandon social and business pursuits. As a substitute for tar Dr, Piffard recommends the following mixture as equally efficacious, and at the same time free from the objectionable features of the other. I can endorse his claim.
Rx. Acidi salicylici, gr. x to xx.
Ol. lavendulae, 3iij.
Ol. citronellae, 3j.
Ol. eucalypti, ij.
Ol. ricini, jj.
M.
In this preparation the salicylic acid is designed to restrict the formation of scale, the eucalyptus to act as a stimulant, and the castor oil to correct the drying effect of the latter. The best way to apply it is from a small oil can. The hairs having been separated, a few drops are applied directly to the scalp and gently rubbed in with the finger. All the affected portions are gone over in this way. To make the application in the most thorough manner the patient will, of course, need assistance. If care be taken, only so much oil as may be necessary is applied to the scalp, and the hairs, except near the surface of the scalp, do not become disagreeably impregnated with it. This application should at first be made daily; but at the expiration of a week the intervals may usually be lengthened. If any time the condition should revert to the second stage, with exudation and crusting, the oil must be discontinued, and white precipitate or zinc ointment substituted. Although I have devoted considerable space to the local treatment, I do not wish it understood that this is the most important; it is simply one of the means to effect a cure. The internal, constitutional treatment is, by far, the more important; they must go hand in hand to procure the best results.
Eczema barboe.-In eczema of the hairy portions of the face, the disease not infrequently descends into the hair follicles, and especially involves the root-sheaths, and may be accompanied with considerable infiltration of the tissues between the follicles. The most frequent form is the pustular, each pustule being pierced by a hair. When the hair is extracted, it is generally accompanied with the root-sheaths, which are swollen and loosened from the follicle. It is of the first importance that this affection be not mistaken for Trichophytosis.
If the eczema be purely superficial-that is, if the inflammation has not descended into the follicles-it may be treated very much as an eczema situated elsewhere. If, however, it is sycosiform in character, with infiltration and pustules, epilation must be performed. Every hair in the affected region must be plucked out with forceps. As a rule, they come out easily and without much pain, in consequence of the loosening of the root-sheaths. The necessity for epilation will be apparent when we consider the fact that the loosened bairs, while in the follicles, are, to all intents, acting as foreign bodies, and thus tend to keep up the inflammation. After epilation, white precipitate or zinc ointment should be applied two or three times a day.
Eczema of other hairy parts-axillae, pubes, etc.-does not usually take on the sycosiform character, and epilation may be unnecessary.
Eczema of the genital region frequently presents itself as a chronic affection of the scrotum; and most of the cases will have existed for years before consulting the physician. The parts will usually be found red, dry, and thickened, and the seat of more or less pruritus. In long-standing cases there are usually decided infiltration and thickening of the skin. Of all forms of eczema this is the one which is the most difficult to control. One writer disposes of the question of treatment in the following words:
