SUNBURN Treatment

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Burning of the skin as a result of excessive exposure to the sun is best treated with calamine lotion, lead and zinc lotion or a local corticosteroid preparation. Local use of antihistamines is not recommended because of the risk of sensitization. It should be noted that cosmetic lotions, designed to imitate the colour of sunburn, offer little or no protection.

Adverse reactions to an apparently small dose of sunlight suggest that the skin has become photosensitive. This may be a drug reaction (antibiotics, pheno-thiazines, sulphonamides), contact with certain plants (such as hogweed), with a cosmetic (such as lipstick), with a local application (such as tar or oil of bergamot) or with soap. Alternatively there may be an inherent state of photosensitivity; this is often idiopathic but is sometimes associated with abnormalities of por-phyrin metabolism. Apart from the removal of any causative stimulus and avoidance of the sun, the application ofa" light screen " such as Uvistat, corticosteroids locally and chloroquine by mouth may be helpful.

SCABIES Treatment

Scabies is due to a mite, Acorns scabies. The female burrows superficially in the skin to lay her eggs. The infestation is derived from close contact with another person suffering from the disease, and in families it spreads readily. Animal scabies causes only a transient eruption in humans. The prominent part of the eruption, which is very itchy, is an ide resulting from the development of hypersensitivity to the products of infestation but it is necessary to treat the whole body surface—excluding the head—to be certain of a cure. All affected members of the family must be treated simultaneously. Benzyl benzoate application B.P. is applied to the whole surface of the body below the chin on three occasions at 12-hour intervals. Twelve hours after the last application the patients should have a bath, put on clean underclothes and change their sheets.

They should now be cured of the infestation but will probably continue to itch for some weeks. They should be treated with calamine liniment or some similar bland application, and mild silver proteinate B.P.C. can be added in ¼ per cent. strength if secondary infection is present. Children should be treated with the half-strength application, that is I 2½ per cent. benzyl benzoate, and babies (whose heads must also be treated) with quarter-strength sulphur ointment B.P. (2½ per cent. of sulphur). Any accompanying sepsis of the skin must wait until the anti-scabetic treatment has been applied. Crotamiton N.F. will also cure scabies, although the drug is designed for the relief of irritation.

PSORIASIS Treatment

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The fundamental lesion in psoriasis is probably biochemical since the disease is often present in forebears, siblings or collaterals, but its exact pathogenesis is not understood. It is a reversible change; and, if the lesions disappear, the skin is unblemished. People who are subject to the disease often develop it for no obvious reason but at other times attacks clearly follow infections (tonsillitis provokes guttate psoriasis), physical trauma to the skin (operation scars, etc.), climatic changes, endocrine disturbances (pregnancy and the menopause) and emotional upsets. It is associated with an arthritis more commonly than can be accounted for by chance ; the disorder affecting the joints is often rheumatoid in type, but some patients develop a specific psoriatic arthropathy which can be distinguished by clinical and serological methods.

Corticosteroid drugs taken systemically suppress psoriasis as a rule but the dose required to maintain the improvement is too great to make this a practicable form of treatment; and there is an impression that systemic corticosteroids may precipitate the serious pustular form of the disease. The newer corticosteroid local applications, betamethasone valerate and fluocinolone acetonide, are effective particularly when their penetration is assisted by occlusion of the area with polythene film. This method, however, carries the risk of significant systemic absorption and it is advisable to limit the periods of occlusion to not more than 12 out of the 24 hours applied to no more than one-third of the total body surface at one time. Corticosteroid applications seldom produce a permanent effect on their own and the best results are obtained by alternating them with tar or dithranol.

Psoriasis which is extensive and waxing should always be treated with respect —for fear of aggravating it or even converting it into an exfoliative dermatitis. In such cases the patient should be put to bed and given salicylates as though he had rheumatic fever, and soft yellow paraffin should be used locally.

The usual problem is to deal with localized scaly patches involving the scalp, limbs and trunk. It is unfortunate that the most effective remedies are the most messy, for example crude coal tar and dithranol. These active agents should be applied after the worst of the scales have been removed with an ointment con­taining from 2 to 4 per cent. salicylic acid in emulsifying ointment, combined with soaking in a bath and washing off the scales gently where this is tolerated. Tar is started as 2 per cent. crude coal tar in zinc paste and worked up to 10 per cent. Its effect is improved by giving ultra-violet light treatment con­currently. Dithranol is a more powerful substance and should be started at a strength of o-i per cent. in zinc paste and worked up to 2 per cent., although some patients need—and wall tolerate—greater strengths. Dithranol is unsuitable for application to the face and scalp because it irritates the eyes. For the. scalp 12 per cent. oil of cade is useful, combined with 4 per cent. of camphor and 4 per cent. of yellow oxide of mercury in emulsifying ointment. The oil of cade has a strong smell which many patients dislike ; but purified tars—which are cosmetically more acceptable—are less effective. The hair needs washing twice a week during this regimen, and soap spirit B.P.C. or any ordinary shampoo can be used. The obsessive patient will overtreat his psoriasis, and for him sedatives are indicated : externally Lassar's paste should be applied; and phenobar-bitone, 30 mg. twice daily, is often useful. The efficacy of inorganic arsenic taken bv mouth is bevond doubt. Arsenic, however, is a cumulative poison with unpleasant delayed effects, and it is doubtful whether its use is ever justified even in short courses. Recently antimitotic drugs have been used with some success but the treatment needs very careful supervision and it is too early to define its indications and limitations. It is regrettable that in many cases the psoriatic spots remain obstinately present. The physician must train himself and his patient to the view that perfectionism is not without its dangers, and that the virtues of the immaculate state can be exaggerated.

Dry Itchy Scalp & Dandruff Causes & Remedies.!