Part 37

Scabies differs from eczema in its peculiar distribution, the presence of the burrows, the absence of any tendency to patch formation, and usually by a clear history of contagion.

#How would you exclude ringworm in a suspected case of eczema?#

Ringworm is to be distinguished by its circular form, its fading in the centre, and in doubtful cases by microscopic examination of the scrapings.

#How does eczema differ from sycosis?#

Sycosis is limited to the hairy region of the face, is distinctly a follicular inflammation, and is rarely very itchy; eczema is diffused, usually involves other parts of the face, and itching is an annoying symptom.

#State the general prognosis of eczema.#

The disease is, under favorable circumstances, curable, some cases yielding more or less readily, others proving exceedingly rebellious. The length of time to bring about a result is always uncertain, and an opinion on this point should be guarded.

#Upon what would you base your prognosis in the individual case?#

The extent of disease, its duration and previous behavior, the removability of the exciting and predisposing causes, and the attention the patient can give to the treatment.

In eczema involving the lips, face, scrotum, and leg, and especially when this last-named exhibits a varicose condition of the veins, a cure is effected, as a rule, only through persistent and prolonged treatment.

#Does eczema ever leave scars?#

No. Upon the legs, in long-continued cases, more or less pigmentation usually remains.

#How is eczema treated?#

As a rule, eczema requires for its removal both constitutional and external treatment.

Certain cases, however, seem to be entirely local in their nature, and in these cases external treatment alone will have satisfactory results.

#What general measures as to hygiene and diet are commonly advisable?#

Fresh air, exercise, moderate indulgence in calisthenics, regular habits, a plain, nutritious diet; abstention from such articles of food as pork, salted meat, acid fruits, pastry, gravies, sauces, cheese, pickles, condiments, excessive coffee or tea drinking, etc. As a rule, also, beer, wine, and other stimulants are to be interdicted.

#Upon what grounds is the line or plan of constitutional treatment to be based?#

Upon indications in the individual case. A careful examination into the patient's general health will usually give the cue to the line of treatment to be adopted.

#Mention the important remedies variously employed in the constitutional treatment.#

Tonics--such as cod-liver oil, quinine, nux vomica, the vegetable bitters, iron, arsenic, malt, etc.

Alkalies--sodium salicylate, potassium bicarbonate, liquor potassæ, and lithium carbonate.

Alteratives--calomel, colchicum, arsenic, and potassium iodide.

Diuretics--potassium acetate, potassium citrate, and oil of copaiba.

Laxatives--the various salines, aperient spring waters, castor oil, cascara sagrada, aloes and other vegetable cathartics.

Digestives--pepsin, pancreatin, muriatic acid and the various bitter tonics.

#Are there any remedies which have a specific influence?#

No; although arsenic, in exceptional instances, seems to exert a special action. Cod-liver oil is also of great value in some cases.