Treatment

Time alone, without special medical treatment, is sufficient in many cases of acne simplex in young persons to bring about a cure. Acne simplex is in a certain sense a self-limited affection, but this limitation is not a matter of weeks or months but of years, and the patient who leaves the affection entirely alone may usually count on six or eight years of annoyance. The majority prefer a quicker cure, and to that end consult the physician. Now, the "cure" of an acne involves two quite different questions. The first relates to the speedy removal of the existing eruption, and the second to the prevention of the ever-recurring tendency to relapse.

Baehr says that acne patients are very hard to treat, as they generally feel so well that a restriction in their diet is hardly ever taken with good grace, or strictly followed out.

Hebra says: "I must confess that, in spite of many efforts, I have not yet succeeded in finding a remedy by which acne can be prevented from developing itself, or quickly got rid of when established.

In acne simplex the measures best calculated to promote disappearance of the eruption are: Puncture of the papules and pustules; hot fomentations, in cases characterized by marked inflammatory action; stimulant and discutient applications in those of a more sluggish nature. It is good practice in every case to puncture the papules with a lancet-point, and at the earliest possible moment. If pus has already formed, this should be squeezed out. Hot fomentations for several minutes should then follow, and the fomentations with water, as hot as it can be borne, repeated night and morning.


In subacute cases an artificial irritation should be set up by nightly rubbing with green soap. Usually in a week, or in less time, the skin will be inflamed to as great an extent as the patient's endurance will permit. Soothing applications should now be employed, and in a few days the irritation will subside, accompanied with desquamation of the outer layers of the cuticle. This will be followed by a greater or less disappearance of the eruption. If necessary, the applications may be repeated. In like manner, sulphur, either pure or diluted with some violet powder, may be applied with a ladies' puff. Ghrysarobin, in the strength of four or ten grains to the ounce of traumaticin, effects similar results. In the use of chrysarobin, however, it will be wise to commence with rather mild applications confined to the papules themselves, and not permitted to spread to the adjacent healthy skin, as this drug when too freely applied to the face may set up a considerable degree of inflammation almost simulating erysipelas.

Dr. Hutchinson advises the passage of the cold urethral sound every third day in cases that are attended with or caused by hyperaemia or irritability of the genital organs. In females, he orders hot water vaginal injections every other night, and claims in both instances successful results.

Dr. Piffard says: "The effect of internal medication in acne simplex sometimes appears to be very striking, and at other times absolutely nil. The drugs which we have found most useful are, in ordinary cases, calc. sulphurate, arsenic, and ergot. The first of these is decidedly the most useful, and may be given in doses of one-tenth to one-half a grain two, three, or four times daily, bearing in mind that the more acute the process the smaller the dose should be, while in sluggish and indolent lesions it should be pushed to the maximum.

The dosage of arsenic should be governed by the same principles. Ergot was introduced into the treatment of acne by Dr. Denslow. It has appeared to me to be specially useful in the treatment of pustular acne in females. Whether it directly affects the local circulation, as believed by Dr. D., or whether its primary effect on those cases is on the pelvic organs, I do not know. It has also been followed by good results in males.


In patients who are suffering from anaemia, struma, etc., iron and cod-liver oil should form an important part of the treatment.

In acne tuberculata and indurata the same general principles of treatment are to be followed; except that in these forms arsenic has appeared to me to be of very little use. On the other hand, iodide of potassium, in doses of five to ten grains, has in some instances been followed by favourable results.

The foregoing applies to the removal of the existing eruption. The prevention of relapses, or frequent outbreaks of eruption, is quite another matter; and success in this regard will be due to the accuracy with which the practitioner unravels the etiological factors, and is successful in bringing about their removal or amelioration."

Our first object should be to get at the cause of the disease, if possible, and remove that. The dyspeptic should avoid pastry, highly-seasoned food, beer and spirits of all kinds. The poorly nourished patient should be fed on good food, and should have plenty of it. Buckwheat cakes, hot bread, nuts, cheese, fried substances, exhilarating drinks, and all sweet and rich articles of food should be avoided. In dyspeptic patients, a cup of. hot water taken a half hour before meals, will often prove beneficial.

The soaps that have been found most useful are, notably, sulphur and iodide of sulphur soaps, and the Juniper tar soap. I have seen excellent results from the use of a soap made from the waters of the "Shookum Chuck Lake", and prepared by Boericke and Tafel.