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Dry Tetter - Psoriasis.This disease is marked by the appearance of scaly white patches, usually circular or oval in shape, and often surrounding a patch of healthy skin. These patches appear most frequently upon the outer surfaces of the elbows and upon the front surfaces of the knees ; in fact, they are to be found here if anywhere on the patient's body. Yet they are by no means limited to these localities, since they may spread over the trunk and limbs and even cover the entire person from head to foot with a thick layer of silvery-white scales. When these patches occur on the head they cause annoying dandruff. These patches may vary in size extremely, but can usually be recognized by the fact that when gently scraped with the finger nails so as to remove the white scales, a few bleeding points appear underneath. Psoriasis rarely causes any itching or scratching ; its surface is not moist unless greatly irritated, and it occurs on the outer sides of the limbs. By these three characteristics it can readily be distinguished from the disease just described - eczema. Psoriasis is rarely developed in very young children, nor does it usually appear for the first time after the individual has attained the age of 35 or 40 years. It is usually developed between 10 and 25 years of age. The disease appears to be, to some extent, hereditary. Several members of the same family will often suffer from it at the same time ; yet it is not in the least contagious, nor does it seem to be dependent upon any depraved condition of the system, since those who suffer from it are frequently perfectly well in every other respect. It often appears in an individual only at certain seasons of the year, especially in winter; after lasting for some months, it disappears spontaneously, but returns again at the same season in the following year. Treatment,-In many cases it becomes necessary to use con stitutional remedies in the treatment of psoriasis. This is especially true in the treatment of children, whenever the scales are very plentiful and silvery. In all cases, attention should be directed to the bowels, regular daily evacuations being insured. Internally we may administer arsenic in some form, preferably as " Fowler's Solution. " This may be given in the following prescription : Fowler's solution, - Fifty drops. Wine of iron, - - - - Two drachms. Syrup of orange peel, - - One ounce. Water, - Five ounces. Mix, and take a tablespoonful after meals. If the patient prefer to take pills, the following form of arsenic may be administered : Arsenious acid, - One-third grain. Carbonate of iron, - ' - Half a drachm. Sulphate of quinine, - - Haifa drachm. Extract of nux vomica, - - Six grains. Mix, and make twenty-four pills. Take one half an hour before meals. In cases of scrofulous, pallid children, it will be advisable to administer cod liver oil also. A teaspoonful of this may be given morning and night, and the dose gradually increased to a tablespoonful, if the stomach can bear it. Yet, in most cases, it is quite possible cure to psoriasis by the use of remedies to be applied directly to the skin. For this purpose various substances have been used, but within the last few years it has become evident that reliance can always be placed upon some of the derivatives of tar. It is, therefore, a waste of time to employ other and less trustworthy remedies. The preparations of tar, which rarely fail to cure the disease and cause a disappearance of the rash within two or three weeks at most, are chrysoph"nic acid and pyrogallic acid. If the former is to be used, the patient should take a warm bath and rub the skin vigorously with soap and with a flesh brush, though not so roughly as to cause bleeding ; the object is simply to remove the scales. The following ointment may then be applied : Chrysophanic acid, - Two drachms and a half. Simple ointment; - Ten drachms. These should be rubbed together very carefully by the apothecary ; there may then be added ten drops of the oil of bergamot. This salve is to be applied immediately after the patient leaves the bath and has dried his skin. It should be rubbed only upon the diseased patches, and not promiscuously upon the diseased and the healthy skin alike ; for this agent irritates the skin considerably, and if used carelessly it may cause considerable swelling and heat of the skin. Indeed, the only objection to the use of this remedy is the fact that it sometimes causes considerable irritation of the skin and of the kidneys as well. In most cases it will be sufficient to apply this salve once a day for three consecutive days. At the end of this time the patient may take a warm bath and thoroughly cleanse the skin. For several (five or six) days thereafter, the skin will probably exhibit a certain amount of scaliness ; but this passes off entirely in eight or ten days, and the eruption will be found to have disappeared. In marly cases the spots, where the salve has been rubbed in, exhibit a dark red color, due to the chrysophanic acid ; this disappears spontaneously in a week, and it can be removed in a few minutes by washing the spots with benzine if necessary. The hair, also, is apt to exhibit this color, especially the gray hairs. In this case the color cannot be so readily removed, yet it is only in exceptional instances that this coloring of the hair can be objectionable. The chrysophanic acid stains the linen as well as the skin ; the clothing is not thereby injured, yet it will be desirable that the patient wear some old undergarments next to the skin so long as the salve is used. If we have to treat a particularly obstinate case, it will be advisable to take especial pains in removing the scales before we apply the salve. For this purpose we may not only use a handbrush while the patient is taking the preparatory warm bath, but we may gently rub the diseased patches with benzole or with green soap (sapo viridis), or we may prepare a solution as follows : Bicarbonate of soda, - - Two drachms. Water, - - Four ounces. A piece of flannel may then be dipped in this solution and the scaly patches of skin gently rubbed with it until all the scales are removed. In obstinate cases - that is, those which have often recurred in the same individual and have resisted other modes of treatment - the salve may be applied for five or six consecutive days, instead of three or four, as above directed. In fact, unless the diseased surface be very extensive, the salve may be used for six to ten days without danger. If, however, there be a great many patches, extreme caution must be employed ; and at the first appearance of swelling in the face or in the healthy skin around the diseased patches, or at the first complaint of indisposition on the part of the patient, the salve should be discontinued and the patient should cleanse the skin by means of a warm bath. If the psoriasis affect the face also, this salve may be applied to the skin of the face by means of soft cloths, upon which the ointment may be smeared. The pyrogallic acid can be used for the same purpose. It has the advantage over chrysophanic acid that it does not stain the skin to the same extent, and does not cause the same amount of 'irritation. It may be used essentially as has been directea for the chrysophanic acid. It may be employed in the following prescription : Pyrogallic acid, - Two drachms. Vaseline, - Two ounces. Mix well together and apply to the diseased patches after the patient has taken a warm bath. While these two remedies are extremely valuable, in fact the best and quickest in their action that we possess, yet they hav¾ the disadvantage that they sometimes cause unpleasant and even serious irritation of the skin and of the kidneys. It is therefore advised that if the treatment of psoriasis by means of either of these acids be undertaken without the professional supervision of a physician, extreme care be employed. Under these circumstances it will be advisable to treat the patient by sections, as it were; that is, both arms may be treated, and subsequently both legs, and ultimately the trunk, if this also be affected. In every case of extensive psoriasis involving trunk and extremities, it will be better to place the patient in the hands of a physician for the reasons named ; but if there be only a few scattered patches, especially at the elbows and the knees, the treatment above detailed may be employed without professional assistance. 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