Part 43

#Is it usually necessary to change from one external remedy to another in the course of treatment?#

Yes. After a certain time one remedy, as a rule, loses its effect, and a change from lotion to ointment or the reverse, and from one lotion or ointment to another, will often be found necessary in order to bring about continuous improvement.

#Name the various important remedies and combinations employed in the external treatment of acne.#

Sulphur is the most valuable. It may often be applied with benefit as a simple ointment:--

Sulphur, præcip., .................... ss-j Adipis benz. Lanolin, ............ [=a][=a] ....... ij.

Or it may be used as a lotion, as in the annexed formula:--

Sulphur, præcip., .................... iss Pulv. tragacanthæ, ................... gr. x1 Pulv. camphoræ, ...................... gr. xx Liq. calcis, ........ q.s. ad ........ fiv. M.

Another lotion, especially useful in those cases in which an oily condition of the skin is present, is the following:--

Sulphur, præcip., .................... iss Etheris, ............................. fiv Alcoholis, ........................... fiijss. M.

A compound lotion containing sulphur in one of its combinations is also valuable in many cases:--

Zinci sulphatis, Potassii sulphureti, .... [=a][=a] ... ss-iv Aquæ, ................................ iv. M.

(The salts should be dissolved separately and then mixed; reaction takes place and the resulting lotion, when shaken, is milky in appearance, and free from odor; allowed to stand the particles settle, the sediment constituting about one-fourth to three-fourths of the whole bulk).

At times the addition to this formula of several drachms of alcohol and of five to ten minims of glycerin is of advantage.

An external remedy, often valuable, is ichthyol. It is thus prescribed:--

Ichthyol, ............................ ss-j Cerat. simp., ........................ iv. M.

The various mercurial ointments, especially one of white precipitate, five to fifteen per cent. strength, are sometimes beneficial.

A compound lotion, containing mercury, which frequently proves serviceable, is:--

Hydrarg. chlorid. corros., ........... gr. ii-viij Zinci sulphatis, ..................... gr. x-xx Tinct. benzoini, ..................... fij Aquæ, ............ q.s. ad ........... fiv.

In extremely sluggish cases the following, used cautiously, is of value:--

Ichthyol, Saponis viridis, Sulphur, præcip., Lanolin, ............. [=a][=a] ...... j.

In such instances the application of a strong alcoholic resorcin lotion, ten to twenty-five per cent. strength, repeated several times daily till marked irritation and exfoliation occur (a matter usually of one to three days), will sometimes be followed by marked improvement. Acne of the back is treated with the same applications, but usually stronger; in this region applications of Vleminckx's solution and formaldehyde solution, weakened considerably, at first at least, prove of value.

Obstinate and indurated lesions may be incised, the contents pressed out, and the interior touched with carbolic acid by means of a pointed stick. The x-ray has proved a most valuable addition to our resources in the treatment of acne, and is especially serviceable in extensive and obstinate cases. An exposure should be made about twice weekly, at a distance of five to ten inches and for from three to ten minutes, and a tube of medium vacuum used. It must be used with great caution and never beyond the production of the mildest erythema. The hair, eyes, and lips should be protected. The x-ray treatment is best reserved for obstinate cases, and then used mildly, and rather as an adjuvant to the ordinary methods than as the sole measure.

#What precaution is to be taken in advising a change from a sulphur to a mercurial preparation or the reverse?#

Several days should be allowed to intervene, otherwise a disagreeable, although temporary, staining or darkening of the skin results--from the formation of the black sulphuret of mercury.

#Acne Rosacea.#

#Give a descriptive definition of acne rosacea.#

Acne rosacea is a chronic, hyperæmic or inflammatory disease, limited to the face, especially to the nose and cheeks, characterized by redness, dilatation and enlargement of the bloodvessels, more or less acne and hypertrophy.

#Describe the symptoms of acne rosacea.#