Eczema is really a catarrhal inflammation of the skin, with the exudate (fluid that escapes) concealed beneath the surface, or appearing on the surface after irritation has occurred. The many varieties are best classified as follows:
(1) Eczema of internal origin, including cases due to morbid agencies produced within the body, cases due to drugs, and possibly reflex cases.
(2) Eczema of external origin, including cases caused by occupation, by climate, or by seborrhea.
Eczema of internal origin almost invariably appears on both sides of the body at once, as on both cheeks, or both arms, or both thighs. Its border shades into the surrounding skin, it is dotted with papules (or heads) filled with fluid, and its surface is clean and not greasy. As it spreads, the symmetry of distribution is lost. Among the morbid agencies producing this variety of eczema are the products of indigestion. Among the drugs producing it is cod liver oil.
Occupation eczema occurs first on exposed parts, as the hands, arms, face, and neck, in those who handle irritant dyes, sugar, formalin, etc.
Climatic eczema includes the “winter itch,” common in this latitude, appearing on wrists and ankles in the form of clean, scaly patches, often ringed.
The seborrheic variety spreads from the scalp to the folds of the skin. Its borders are sharply defined, and its crusts and scales yellowish and greasy. It spreads from a center in all directions at once.
Treatment. The treatment of eczema puzzles a physician, and only specialists in skin diseases are able easily to diagnose the subacute or chronic forms. It may appear different, and need different treatment almost from day to day, and consequently only general suggestions can be made for home management of a case of this disease.
The outlook is always good; and even in the case of weak and debilitated patients, there is excellent chance of cure.
The diet must be regulated at once. Meat should be eaten in small quantities once a day only, and none but very digestible meats should be eaten, as fowl, beef, and lamb. Sugar and sweet food need be cut down only when there is indigestion with a production of gas. Fresh air and exercise are imperative. Five grains of calomel, at night, followed by one heaped tablespoonful of Rochelle salts dissolved in a full tumbler of water the next morning before breakfast, should be repeated twice a week till marked improvement is seen. Meanwhile, external treatment must be pushed.
Generally speaking, ointments must not be used on weeping or exuding surfaces; all scales and crusts must be removed from the surface; and acute patches must be soothed, chronic patches stimulated. Water is harmful and increases the trouble; but it is necessary to use it once, in cleansing the affected area, in the form of soap and water. If there are thick, adherent crusts, a poultice of boiled starch, covered with a muslin cloth, will loosen them in a night. Thickened or horny layers on the palms and soles may be covered with salicylic plaster (ten per cent strength), which is removed after two days, and the whole part soaked in warm water, when the horny layer is to be peeled off. Thickened surfaces are best treated with wood tar, in the form of oil of cade ointment, or the “pix liquida” of the drug shops mixed with twice its amount of olive oil. This should be well rubbed into the affected part.
Seborrheic eczema of the scalp and neighboring areas is best treated with a four per cent ointment of ammoniated mercury, rubbed in once a day for five days, followed by the application of a solution of resorcin in water, four grains to the ounce. Weeping and exuding patches should be treated with powdered stearate of zinc, or oleate of bismuth, or aristol, either one dusted on till the area is fairly covered. When the surface begins to dry up, the following paste may be applied:
Salicylic acid 5 to 15 grains Zinc oxide 2 drams Powdered starch 2 drams Vaseline 1 ounce
If weeping returns, stop the ointment and resume the powder treatment, or use the following lotion:
Zinc oleate 1 dram Magnesium carbonate 1 dram Ichthyol 1/2 ounce Lime water 4 ounces
When the skin after scaling off becomes thin, all swelling having disappeared, lead plaster is of service, or diachylon ointment twenty five per cent, made with olive oil.
An eczema of moderate extent should recover after four to six weeks’ treatment, unless the soles or palms be attacked, when six or more months of treatment may be necessary.
If itching is pronounced, remove crusts and scabs after soaking with olive oil, dust borax, finely powdered on the surface. If the itching is not controlled in twenty minutes, wipe off the borax with a very oily cloth (using olive oil), and then apply a little solution of carbolic acid (made by adding a half teaspoonful of carbolic acid to a pint of hot water). If this does not allay the itching, wipe it off thoroughly with the oiled cloth, and rub in the tar ointment made of equal parts of “pix liquida” and olive oil. After the itching ceases, treat as directed according to the variety existing. Itching often disappears after a good saline cathartic has acted Rochelle salts, solution of magnesia citrate, or phosphate of soda. Scratching must be avoided. In the case of children it is prevented by putting mittens of muslin on the hands.
The best cathartic for young children is a teaspoonful of castor oil. Carbolic acid solution must not be used on them. The folds and creases of their skin must be kept dry and powdered with borated talcum. A great point in the treatment of all eczema is to avoid the use of water, and to substitute oiling with olive oil and wiping off for the usual washing of the affected area.