DERMATOLOGY 
BASIC THERAPEUTIC 
PRINCIPLES 
and 
MANAGEMENT 
361st STATION HOSPITAL 
TOKYO. JAPAN 
COLONEL J. T. R STRODE, M. C. 
Commanding Officer 
DERMATOLOGY SECTION 
CAPTAIN E. P. SCHOCH, JR. , M. C. 
Chief of Section CONTENTS 
I Introduction 1 
II Types of Dermatologic Agents 2 
III Pharmacology of Topical Drugs 10 
IV Special Preparations 14 
V Basic Management of the Ten 
Most Common Skin Diseases 17 
VI Summary 33 
REPRO BY THE 64TH ENGR BASE TORO BN This guide is intended to review a 
few of the basic dermatological principles 
and to give one workable example of the 
many methods of managing each of the ten 
most common skin diseases. 
Caution is to be stressed constantly 
to avoid over treatment which is the most 
common complication necessitating hospitali- 
zation of dermatological conditions. DERMATOLOGY 
Basic Therapeutic Principles and Management 
Introduction 
In no specialty is the range of possible 
remedies greater than in dermatology. The 
technique of external local treatment consti- 
tutes the most potent weapon in the management 
of most cutaneous diseases. 
Topical dermatologic therapy depends not 
only on the chemical action, but also the phy- 
sical properties of the agents applied. For 
this reason, the choice of the vehicle and the 
form of medication — even the mere manner of 
application and removal — are as important as 
the selection and quantity of active ingredients 
and will often decide the success or failure of 
topic therapy. 
In each individual case, the choice of 
both remedies and vehicles depends largely on 
the appearance and the course of the dermatoses. 
In this manual, we will attempt to discuss 
therapy that can be carried out with just the 
basic preparations available and with the stan- 
dard formulary. The medications will be 
discussed as to the types of dermatological 
agents, the pharmacology of topical drugs, 
special preparations and plans of treatment 
for the common skin diseases encountered in 
everyday practice. 
1 TYPES OF DERMATOLOGICAL AGENTS 
Cleansing Measures 
It is often necessary to cleanse the 
lesions which are to be treated. In cleansing 
irritable conditions such as oozing and crust- 
ing eczemas, impetigo contagiosa, and other 
pyodermas, and in removing the residues of 
local medication, mild nonirritating methods 
are to be used. 
Useful measures are gentle sopping or 
bathing with solution of hydrogen peroxide or 
boric acid, application of wet dressings, or 
the use of oil (mineral or olive) to remove 
pastes and ointments. 
Mechanical removal of crusts and scales 
may be necessary and is often more readily 
accomplished after the use of one of the afore- 
mentioned measures. 
After each cleansing procedure, the se- 
lected topical remedy is applied. 
Cleansing of torpid thickened and chronic 
lesions can be effected by more vigorous methods 
such as scrubbing with a brush, hot water and 
soap (tincture of green soap), soapless deter- 
gents, macerating and occlusive dressings, or 
direct painting with strong keratolytic agents. 
BATHS 
Baths affect even the normal skin. Many 
youthful individuals, whose skins tend to be 
greasy and to have a greater supply of natural 
oils than the skins of infants or of the aged, 
may benefit from frequent hot baths with plenty 
of soap and scrubbing; yet such baths may be 
2 harmful to individuals with dry skin, such as 
is common in infancy, early childhood, and in 
old age. There is no doubt that certain cases 
of excessive dryness of the skin and of itching 
are made worse by bathing and may sometimes be 
attributed to the excessive use of hot baths 
and soap. 
It is equally true that skin eruptions 
such as eczemas of the hand, monilia infec- 
tions, and other irritable or widespread der- 
matoses are often aggravated by alkalis and 
particularly by soap and water. Nevertheless, 
therapeutic baths often constitute the best 
methods for applying mild medication to the 
entire skin surface. 
A. Cleansing Baths 
This form is used to remove accumulated 
dirt, debris, crusts, scales, and the adherent 
remains of previous medications. 
If soap is not irritating, one can use 
plain white soap. Soaps that are made from 
tallow and corn oil are generally less irrita- 
ting than those of coconut oil, olive oil, 
whale oil, or sesame oil. Soap must be com- 
pletely rinsed off. The skin is dried by 
patting rather than rubbing. It is advantage- 
ous to apply topical remedies immediately after 
baths. 
B, Medicated Baths 
These baths achieve soothing effects, 
antipruritic action, decongestive and inflam- 
matory and specific effects of active medicinal 
3 ingredients including antiparasitic, anti- 
seborrheic, antieczematous and macerating and 
softening. As a rule, COOL baths are more 
serviceable. 
1, Corn starch and sodium bicarbonate 
baths are used for soothing action in general- 
ized and itching dermatoses. For corn starch 
baths, stir J to 1 lb. of refined corn starch 
into a tubful of water, (Starchs are made 
soluble through hydrolysis, for example, by 
boiling.) One-fourth to one-half lbs, of 
baking soda is adequate for each bath. 
2. Potassium permanganate baths are ef- 
fective in exudative, vesicular and bullous 
eruptions (pemphigus, generalized eczema), 
pyodermas and superficially infected dermatoses. 
This bath acts as a disinfectant and by its 
oxidizing effect, helps to dry exuding areas 
and acts as a deodorant in foul-smelling sur- 
face affections. Potassium permanganate in a 
dilution of 1-9,000 to 1-12,000 is used. 
3. Sulfur baths are an adjunct antipara- 
sitic treatment of pyodermas and of certain 
seborrheic conditions. Sulfur is a mild fun- 
gistatic, antiseborrheic, keratolytic parasi- 
ticide, Sulfur is also an irritant or stimu- 
lant to skin and a general disinfectant. 
Liquor calcis sulfuratae NF (Vleminckx’s solu- 
tion) 150 to 200 cc. per tub. 
4, Tar baths are antipruritic in cases of 
generalized itching dermatoses and in generalized 
eczemas and psoriasis. Liquor carbonis detergens 
120 cc, added to each tub. 
4 The individual response is the determin- 
ing factor both as to the measures used and 
as to the manner and frequency of use. The 
urban adult usually washes his hands too often. 
It is often advantageous to reduce exposure to 
soap and water whenever the hands are affected 
by irritated, eczematous or other dermatoses. 
In contrast to this excessive use of soap and 
water on the hands, many women never wash their 
faces. They are misled into avoiding soap and 
water by the advertising campaigns of those who 
have "creams," "skin food," "deep cleanser," 
etc., to sell and by the belief that their skins 
are too dry. However, in the majority of such 
cases of too dry skin in young women, the 
patients are suffering from a tallowy form of 
seborrheic scaling and not from actual dryness. 
The surface of the skin will be found to be 
greasy, not dry, and if the seborrheic scales 
are pressed between layers of cigarette paper, 
grease spots are produced. 
Daily soap and hot water scrubbing may at 
first irritate such skins but usually improve 
the underlying condition. 
It is rare to find an otherwise normal 
young person whose skin will not tolerate soap. 
In older persons, the tendency to dryness of 
the skin is not uncommon, and many middle aged 
and older men, and especially women, must 
actually dispense with the use of soap. In 
these cases, other methods must be adopted such 
as cleansing with oil (mineral or olive oil) or 
the use of soap substitutes such as lowila or 
dermolate. 
5 Wet Dressings 
Wet dressings are one of the most useful 
forms of dermatologic therapy. It is one of 
the best means of cleansing the skin of adher- 
ent crusts and debris. It helps maintain 
drainage of infected areas such as furuncles 
and superficial ulcerations. It is an effec- 
tive vehicle in local application of heat. A 
keratolytic action is manifested by macerating 
the skin surface. Wet dressings prevent rapid 
change of temperature at the skin surface — 
hence are often good analgesics and antipru- 
ritics. By relief of superficial inflammation, 
wet dressings have a soothing action. Wet 
dressings tend to open blisters and bring medi- 
cation to the base of ulcerating areas. 
1. Physiological saline solution 
2. Burow's solution (1:10 - 20) 
3. Potassium permanganate 1:9,000 
4. Boric acid (saturated solution) 
Powders 
Powders are most conveniently used in the 
treatment of intentrigenous areas (interspaces 
between the toes, in the groih or beneath pen- 
dulous breasts.) Powders protect from the irri- 
tation of maceration and friction and also exert 
a cooling effect. 
Powdering of the interdigital spaces and 
the liberal use of powder in the shoes, socks 
and stockings is one of the best measures in 
hyperhidroses and in the prophylaxis of certain 
superficial fungus infections including 
’’athlete's feet,*1 
6 Lotions 
Lotions are liquid or semiliquid prepara- 
tions usually having water or alcohol as a 
base and containing ingredients in solution 
or suspension or both. They are of greater 
use in subacute or chronic conditions, where 
there is not too much weeping (otherwise it 
acts as a cement.) Lotions are advantageous 
because of the ease of application, anti- 
inflammatory action and they allow passage 
of a certain amount of secretion. Lotions 
are disadvantageous because they are drying 
and not penetrating. 
It must be remembered that active ingre- 
dients which penetrate beyond the first few 
millimeters represent potential danger because 
of possible systemic and toxic effects. This 
must be kept in mind when treating large areas 
or when used for babies and children. 
Shake lotions do not penetrate as well as 
ointments, but this relatively superficial ac- 
tion is not always disadvantageous. Many der- 
matoses, e.g., eczema, seborrheic dermatitis, 
affect primarily the uppermost layers of the 
skin, and in these conditions, medication 
should be confined, if possible, to the super- 
ficial tissues. 
e.g., Basic Lotion 
Zinc Oxide 20.0 
Talc 20,0 
Bentonite 5.0 
Water qs. 
7 Emulsions or Liniments 
These preparations are oily or fatty sub- 
stances emulsified and suspended in an aqueous 
or other liquid or aqueous solution suspended 
in an oily medium. Emulsions or liniments are 
a transition between lotions and ointments. 
The principal use from these preparations lies 
in the treatment of patients confined to bed. 
Large areas can be treated with painting medi- 
cated emulsions. Usually these preparations 
are eventually quite drying — probably due to 
the alkaline effect (soap), 
e.g.. Calamine liniment. N. F. 
Ointments 
Ointments consist of various fats or oils 
into which oil soluble medicaments are dis- 
solved or suspended. Fatty substances which 
constitute bases of most salves and ointments 
may be divided into two groups: (l) animal 
and vegetable, (2) mineral greases and oils. 
Mineral greases are preferred because they do 
not become rancid and have a greater resistance 
to growth of bacteria. Animal fats hold more 
water so that water and most medicaments which 
can be dissolved in water can be incorporated. 
Ointments have many properties. They have the 
capacity of maceration. They bring medication 
into more intimate contact with the surface of 
a lesion. The eraolient and lubricant property 
serves to soften the surface of the skin as well 
as the crusts, scales and detritus on the skin 
surface so that medicaments reach tissues be- 
neath, Ointments, greases and oils enable the 
use of many therapeutic agents which are fat or 
oil soluble but which are not water soluble. 
8 Ointments are disadvantageous because of 
their general messiness and difficulty of 
proper application, especially in the case of 
extensive dermatoses and in ambulatory patients. 
Ointments are of great use in dry, scaly, 
thickened and deep conditions. When the scales 
and crusts are removed, penetration is achieved. 
Ointments are contra-indicated in oozing 
areas, infected lesions where drainage is re- 
quired, and in hairy areas, 
e.g.. Petrolatum 
Water Miscible Bases 
These preparations are water soluble and 
permit more rapid release of agents incorpora- 
ted. 
e.g., Ointment Base (emulsion base), USP 
9 PHARMACOLOGY OF TOPICAL AGENTS 
1. Antipruritics 
In general, pruritus is relieved by the 
following methods: 
a. Substitution of some other sen- 
sation for itching 
(1) Heat or cold 
(2) Phenol £ - 1 % 
(3) Menthol | - h % 
(4) Camphor ? - \ % 
(5) Thymol \ - 1 % 
b. Anesthesia of sensory nerves 
(1) Benzocaine 1 % 
(2) Nupercaine 1 % 
c. Protection of skin from external 
influences, 
(1) Wet compress 
2, Keratoplasties 
These are agents which tend to produce an 
increase in the keratinization of the horny 
layer. Agents which have a mild stimulating 
effect in general tend to stimulate horn for- 
mation if repeatedly applied to an area over a 
sufficient period, 
e.g,. Salicylic acid 1 - 3 % 
Tars 1 - 5 % 
10 3. Keratolytics 
Agents which tend to remove the horny 
layer or reduce its thickness are keratolytics. 
Removal of the horny layer can be achieved by 
any form of superficial damage severe enough 
to cause destruction or rapid exfoliation — 
thus caustics in macerating dressings act as 
keratolytics. Keratolysis produced by medi- 
caments is usually the result of withdrawal 
of fluid — leading to the subsequent throwing 
off of the loosened, dried-out horny mass; or 
of maceration of the horny lamellae and their 
imbibition of fluid and subsequent throwing 
off. 
e.g,. Resorcinol 1-5 % 
Salicylic acid 5-40 % 
4. Anti-eczematpus Agents 
Remedies used in treating eczematous, 
eczematoid processes and pruritic superficial 
inflammatory eruptions more or less resembling 
eczematoid dermatitis (eczematoid eruptions). 
Some of the agents relieve itching and thus 
prevent scratching, some act by keratolysis, 
some act by cleansing, some by antiphlogistic 
and cooling effect, some by simple protection, 
some by ultimate protection achieved through 
keratoplastic effect and increase in thickness 
and resistance of the horny layer. 
A. Acute Cases 
(1) Soothe with wet dressings first— 
a. Boric acid solution 
b. Burow’s solution (1:10-20) 
c. Physiologic saline 
d. Potassium permanganate solution 
1:9,000 
11 (2) Antipruritics—menthol and 
phenol in basic lotion when areas are 
not weeping excessively. 
B, Subacute to Chronic Cases 
(1) Lassar*s paste 
(2) Tars 
a. Liquor carbonis detergens 
(L.C.D.) 
b. Ichthyol 
c. Crude coal tar 
5. Antiseptics 
Agents which treat and guard against in- 
fection are antiseptics. 
A. Potassium permanganate 1:9,000 
B. Ammoniated mercury 2-10$ 
C. Quinolor 
D. Vioform 
E. Tyrothricin 
F. Furacin 
G. Penicillin and sulfonamides are not 
recommended for topical application because of 
the danger of sensitization of other tissues 
of the body. 
6, Antimycotics 
These preparations are used in the treat- 
ment of superficial fungus infections. 
A. Potassium permanganate 1:9,000 solution 
B. Castellan!1s paint 
C. Compound tar ointment (pragmatar) 
D. Undecenylenic acid ointment 
E. Gentian violet 1% solution 
12 7. Anti-seborrheics 
These preparations are used in the treat- 
ment of seborrhea and seborrheic dermatitis. 
A. Sulfur and salicylic acid 
(1) Sal - sulfur ointment 
(2) Compound tar ointment 
8. Antiparasitics 
A, Scabies 
(1) Sulfur (5-2$ ointment) 
(2) Benzyl benzoate (25% emulsion) 
B. Pediculosis 
(1) DDT (1$ powder or 2$ solution) 
13 SPECIAL PREPARATIONS 
These preparations are commonly used in 
the practice of dermatology: 
1. Vleminckx* solution (liquor calcis 
sulfuratae), (for acne) 
2. 1-2-3 ointment: 
gm or cc 
Burow1 s solution 10 
Lanolin 20 
Lassar1s 30 
3. Lotio alba: 
Zinc sulfate 4$ 
Potassium sulfuratae 4$ 
Water qs. 
4. Scalp lotion #1 (for dark hair) 
Resorcinol 4.0 
Salicylic acid 4.0 
Mercury bichloride 0.2 
Glycerin 2,0 
Water 
Alcohol (95$) aa, to make 240.0 
5. Scalp lotion #2 (for blond hair) 
Chloral hydrate 4.0 
Salicylic acid 4.0 
Mercury bichloride 0.2 
Glycerin 2.0 
Alcohol (95$) 
Water aa, to make 240.0 
14 If hair is too dry, you can replace 
the glycerin with 0,5 to L$ castor oil in 
both scalp lotions. 
6. 3% vioform cream 
7. Compound tar ointment 
8. Sal sulfur ointment; 
gm or cc. 
Salicylic acid 3% 
Sulfur 6% 
Emulsion base qs 
9* Sulfur resorcin lotion: 
Resorcinol 2$ 
Sulfur k% 
Basic lotion qs 
10. Burowfs solution: 
Lead acetate 150 
Aluminum sulfate 87 
Water qs to 1000 
11. Carron oils 
Olive oil 
Lime water aa 
12. Boric acid ointment 
15 13. Silver nitrate; 1-BOO as a wet dress- 
ing; 5-10g, granulation tissue and pyodermia; 
50g, strong cautery treatment of warts. 
14* Trichloracetic acid (cautery) 
15• Phenol (cautery) 
16. Scabies ointment: 
Balsam Peru % 
Sulfur 10g 
Castor oil lOg 
Lanolin 
Petrolatum aa qs 
17. 20$ olive oil in emulsion base (for 
asteatosis)• 
18, Chrysarobin 1-5$ ointment (for 
psoriasis) 
19. Psoriasis ointment: 
Crude coal tar 3g 
Ammoniated mercury 3% 
Salicylic acid 3% 
Emulsion base qs 
20, 20$ podophyllin in alcohol (for 
verruca acuminata). 
21. Whitfields Solution 
Acid salicylic 3% 
Acid Benzoic 6g 
Alcohol (70%) q.s. 
16 BASIC MANAGEMENT OF THE TEA MOST COMMON SKIN 
DISEASES 
I. acne VULGARIS 
1. Instruction of patient regarding diet 
and skin hygiene (printed directions), 
2. Lotio Alba nightly, to be washed off 
in morning. 
3. Alcohol wiping after soap and water 
washing 2-3 times daily, 
4. Anti-seborrheic scalp lotion (#1 for 
brunettes; #2 for blonds) nightly. 
5. Brewer1s yeast—9 to 12 tablets daily 
For more severe cases: 
6, Crushed solid C02 - acetone slush with 
10$ sulfur applied in clinic weekly. 
7. Complicated cases—hospitalize. 
17 (Instructions for patient) 
ACNE 
ACNE is a very common skin disease espe- 
cially in young men. 
In the face, neck, chest, and back, are 
many small glands which keep the skin oily, 
in ACNE these become overactive, fill up and 
get plugged. This causes large pores, oily 
nose, blackheads, whiteheads and pimples. 
ACNE is not catching and is not dangerous. 
ACNE is not due to sexual continence, master- 
bation, or sexual excess. It is made worse by 
infection, dirt and grease. 
YOUR SKIN WILL GET BETTER 
You must follow all the suggestions given 
and take care of your skin EVERY DAY, y0u can- 
not miss one day in this care. Some ACNE needs 
more treatment. Some of these are helped by 
X-ray. Nc X-ray is given until ordinary treat- 
ment has been tried. No X-ray treatment is 
given overseas. Penicillin will not cure ACNE, 
1. Take a warm shower every day. 
2. Wash face gently with warm water and 
white soap FIVE times every day. Take your 
time. Use your hands and do not use rough 
cloth or brush. Rinse with cold water. 
3. Put rubbing Alcohol on face after 
washing each time. 
4. Put lotion on face every night. The 
skin will get rough and dry but this causes a 
peeling which opens the plugged glands. 
18 5, Do not use any cream or grease on face. 
6, Shampoo hair every morning, 
7, Rub scalp lotion into the hair every 
night, 
8, Do not use any vaseline or oil on the 
hair, 
9, Eat a low fat diet. Avoid CHOCOLATE, 
NUTS, PORK, CHEESE, ICE CREAM, BUTTER, MILK, 
SAUSAGE, FRIED FOODS, COD LIVER OIL, PASTRIES,* 
CAKES. Limit SUGAR, POTATOES, BREAD, RICE, 
MACARONI, SPAGHETTI. 
10, KEEP HANDS OFF FACE, Do not squeeze 
pimples or try to get out blackheads, 
11, Do not wear oily or greasy clothes 
next to the skin, 
12, Get eight hours sleep. Exercise, 
Have regular bowel habits. Drink six glasses 
of water each day. 
This treatment outlined by skin special- 
ists has helped many who have had ACNE, it 
can help you, but only if you believe your 
face will get better and only if you believe 
your Medical Officer can help you. You must 
follow all the suggestions EVERY DAY, 
19 II A, DERMATITIS VENENATA 
1. Acute (weepy, erythematous, vesicular, 
exudative, ’’hot”.) 
a. Wet Dressings (compresses or soaks) 
(1) Burow's solution (1:20) 
(2) Physiological saline 
(3) Boric acid solution (sat’d) 
(4) KMN04 1:9000 (pyoderraic) 
2, Subacute (Less erythematous, vesicula- 
tion subsiding, no exudation, "warm".) 
a. Lotions 
(1) Basic lotion 
b. Liniments 
(1) Calamine Liniment 
c. Pastes 
(1) Lassar's paste 
3* Chronic (no erythema, scaling, no exu- 
dation, thickening, ’’cold"). 
a. Ointments 
(1) Petrolatum 
(2) Boric acid ointment 
Persistent chronic dermatitis should 
be treated as an eczema. 
4, Antihistamics if markedly pruritic or 
evidence of ”id” reaction: 
a, PBZ 50 mg q.i.d. 
5. No soap to involved areas (see methods 
of cleansing.) 
20 II B ECZEMA 
1. Acute, subacute, early chronic stages 
treated like dermatitis venenata, 
2. Chronic (or persistent subacute) 
a. Ichthyol 3% 
Lassar*s paste qs, 
or 
b. Vioform cream 3% (if pustular) 
then 
c. Crude coal tar 1-5% 
Lassar* s paste 
(or emulsion base) qs, 
3. Vesicular eczema of hands and feet. 
a. Burow*s 1:20 or saline soaks t.i.d, 
b, 3% LCD (liquor carbonis detergens) 
in emulsion base (EM3) t.i.d., daytime 
c, Lassar*s paste hs (remove with 
mineral oil in a.m.) 
d. PBZ 50 mg q.i.d. 
21 DIRECTIONS FOR WET DRESSINGS 
Dilute with 
of water in enamelware, 
porcelain or glass dish or pan. (Not in copper 
or aluminum.) The water should have been pre- 
viously boiled and allowed to cool. (May use 
distilled water.) The mixture should be at a 
comfortable temperature - if it is too cold, 
warm it up by heating; or if too warm, add a 
few pieces of ice. 
The pack is made of 8 to 12 layers of 
cheesecloth and larger than the area you are 
treating. Soak the pack in the mixture and 
wring out to a point of being soppy, but not 
running. 
Evaporation is desirable, you may place 
waterproof material (oil cloth or rubberized 
sheet) under the pack to protect the bedding 
or furniture, but do not enclose the entire 
pack in the material. 
Every hour completely remove the pack, 
rewet it by immersion and replace it, (Pouring 
solution over or under the pack is not satis- 
factory.) If the pack becomes dry before an 
hour is up, rewet it earlier. 
Use the mixed solution until it shows 
sediment or becomes cloudy, then make a fresh 
batch again. 
Fix the pack preferably by overlapping 
and fastening with large safety pins or tie 
straps. Do not wrap it with bandage. 
22 HI DERMATQPHYTOSIS 
1. Acute 
a, KMN04 1:9000 (compresses or soaks) 
2. Subacute 
a, KWN04 1:9000 soaks t.i.d. or 
normal saline soaks t.i.d, 
b. 5 strength sal sulfur ointment hs, 
3. Chronic 
a. Painting with Whitfield’s solu- 
tion b.i.d, 
b. Abundant foot powder t.i.d, 
c. Saline soaks hs, 
d. Full strength sal sulfur ointment 
or compound tar ointment hs. 
e. Fungicidal ointment is helpful in 
mild cases and in prophylaxis. 
23 IV PYODERMA 
1. Acute 
a, KMN04 1:9000 (compresses or soaks) 
2. Subacute to chronic 
a. Vioform cream 3% or ammoniated mer- 
cury 3% q.i.d. 
3. If extensive: 
a. Penicillin aqueous 300,000 units 
daily or b.i.d. x 5-7 days. 
4- Special types 
a. Sycosis Vulgaris 
(1) General measures as for all 
pyodermas 
(2) Mild: sulfur-resorcin lotion 
t.i.d, 
(3) Severe or resistent: quinolor 
ointment (watch for sensiti- 
vity-may use J strength.) 
(4) Shave daily with new blades 
($) Sterilize razor blades with 
alcohol 
(6) Wipe skin with alcohol after 
shaving 
(7) Manual epilation 
b. Impetigo Contagiosa 
(1) Same general measures 
(2) Careful removal of crusts 
before each application of 
ointment 
(3) Prevent community use of 
clothing, towels, etc. 
24 c. Folliculitis Simplex 
(1) Sulfur-resorcin lotion t.i.d, 
(2) Avoid oils and grease to skin 
25 V SEBORRHEIC DERMATITIS 
1. Acute 
a, Burow»s solution 1:20 or normal 
saline (compresses or soaks.) 
2. Subacute to chronic 
a. Scalp: 
(1) Sal sulfur ointment b.i.d. or 
compound tar ointment 
(2) Shampoo every 2 days when 
subsiding 
(3) Scalp lotions (#1 brunettes; 
#2 blondes) to scalp daily; 
plus sal sulfur ointment 
weekly 
b. Glabrous skin: 
(1) J strength sal sulfur ointment 
b.i.d, or 
(2) Sulfur resorcin lotion b.i.d, 
3. Restrict fat and carbohydrates in diet 
4. Vitamin B complex orally 
26 VI PSORIASIS 
1. Acute 
a. Basic lotion 
b. Calamine liniment 
c. Boric acid ointment 
2. Subacute to chronic 
a. 2$ crude coal tar in petrolatum 
b.i.d. 
b. Daily suberythema ultraviolet 
irradiation (after removal of salve.) 
c. Calcium gluconate 10.0 cc IV 
three times a week. 
d. Autohemotherapy 10,0 cc three 
times a week. 
e. Restrict fat in diet, 
3. Chronic resistant cases 
a. Psoriasis ointment: 
(1) Ammoniated mercury 3% 
* (2) Acid salicylic 3% 
(3) Crude coal tar 3% 
(4) EM3 qs. 
b. Ultraviolet, as above. 
27 VII SCABIES 
1. Preparation: 
a. Benzyl benzoate emulsion 25% 
120.00 cc bottle. 
2, Directions: 
a. Shower, scrub off all crusts and 
pay special attention to areas of skin with 
maximal involvement, 
b. After shower, while still wet, 
apply first coat of Benzyl Benzoate, cover- 
ing every area of body from neck down, pay- 
ing special attention to areas where lesions 
are most numerous. Allow lotion to dry on 
skin for 10 minutes. USE NO TOWEL and 
reapply medicine in same manner from neck 
down, allowing medicine to dry and remain 
on. 
c. Wait 24 hours - no bathing or 
showering. 
d. Reapply lotion from neck down - 
1 coat, 
e. Allow lotion to remain on for 
24 hours. 
f. Shower, change all clothing, bed 
clothing, sheets and blankets. Treatment 
finished. Have all worn clothing cleaned 
or washed. Itching may continue for sev- 
eral days to several weeks, but as long as 
no new sores or bumps appear, you may con- 
28 sider yourself cured. If you think you 
are not cured, see your medical officer 
before repeating treatment. 
3. Caution against repeated applications 
because of danger of contact dermatitis from 
kenayl benzoate* 
29 VIII PITYRIASIS ROSEA 
1. Avoid hot soapy baths. 
2. Sulfur-resorcin lotion t.i.d. 
3. Suberythema ultraviolet irradiation 
two or three times a week. 
30 IX HYPERHIDRQSIS 
1. Wash feet at least twice daily. 
2. Change socks twice daily. 
3. Abundant use of foot powder three or 
four times daily, 
4. Soak feet inBurow's solution 1:10 
(Domeboro tablets—U to quart of water) daily, 
5. Tannic acid % 
Glycerine % 
Alcohol (9550 
Water aa qs. 
Sig. Painted on feet b.i.d, 
6. Occasionally sedation and neuropsy- 
chiatric evaluation. 
31 X PEDICULOSIS PUBIS 
1, Spray once with DDT aerosol bomb, or 
2, DDT 2% in 12benzyl benzoate emul- 
sion (one application*) May repeat in one or 
two days if necessary. May also be used in 
the scalp, or 
3, 10$ DDT powder daily x 5 days. 
32 SUMMARY 
1, Make a diagnosis or have the diagnosis made 
as early as possible. Diagnosis may be necessary 
for proper treatment. 
2, Properly selected topical measures are often 
the best forms of treatment in cases of uncer- 
tain or unknown etiology or diagnosis, as well as 
in the period before determination of the exact 
diagnosis and in many cases, with established 
diagnosis and etiology. 
3. The choice of topical measures is often 
largely determined by the presenting morpholo- 
gic characteristics, by the stage, and by the 
site of the eruption. The physician must, 
therefore, be able to recognize whether a der- 
matosis is acute or chronic, dry or exudative, 
papular or vesicular, infected or not infected, 
irritable or torpid, superficial or deep, hyper- 
keratotic or not, spreading or remaining fixed, 
growing or regressing, improving or not, of 
exogenous or of endogenous origin, destructive 
or non-destructive (atrophy or scarring), malig- 
nant or benign. 
4. Topical remedies are then chosen to produce 
specific effects according to the characteris- 
tics of the lesions (e.g,, soothing, protective, 
absorbent drying, macerating, keratolytic, 
penetrating, reducing or destructive effects.) 
The following hints should prove useful: 
a. Use few remedies and know everything 
that is to be known about them. Adopt a few— 
say eight—standard eternal medicaments; for 
example, two forms of wet dressings (one sooth- 
ing and one soothing and parasiticidal); two 
33 shake lotions (one soothing and antipruritic 
and one antiparasitic and keratolytic); two 
pastes (one soothing and one antiparasiticidal); 
two ointments (one soothing and softening and 
antiecaeraatous and one penetrating, keratolytic 
and antiparasitic.) Master these eight and you 
will have greater prospects of success and for 
less chance of making costly mistakes than if 
you use 80 different remedies without complete 
knowledge of their properties, incompatibilities 
and contraindications. 
b. Bear in mind the possibility that a 
remedy may harm rather than help. When in 
doubt, and in all acute and irritable dermatosis 
begin with the mildest and most indifferent 
agents. When in doubt and using a new medica- 
ment, observe the effects on a small site before 
proceeding to the treatment of larger areas. 
c. Frequent observations on the effects 
of medicaments may be necessary not only to 
prevent ill effects but to select, adjust and 
modify the treatment. 
d. Do not change to a new remedy as long 
as the dermatosis is improving satisfactorily 
under the old one. Do not complicate the 
therapy by useless modification of, or additions 
to the remedies prescribed. 
5. When a remedy disagrees with a patient, 
stop its use at once and try to find the cause 
of the disagreement. In many patients, allergic 
eczematous hypersensitivity is the basis of the 
irritation. When this is the case, consider 
each of the ingredients and their combinations, 
as well as the measures and substances used in 
34 the application and removal of the prescribed 
medication. Gritty salves, pastes, or emul- 
sions, improperly homogenized or unevenly dis- 
solved or dispersed chemicals may be sources 
of irritation. Therefore, the practitioner of 
external therapy must have some knowledge of 
the art of dispensing and of the appearance 
feel, odor, and other characteristics of every 
remedy he prescribes. 
6. The action of topical remedies will often 
depend on the mode of application and removal. 
The physician must, therefore, give adequate 
instructions to each patient and must often 
also demonstrate exactly the correct manner of 
use, application and removal of each prepara- 
tion. 
In addition to following these 6 rules, 
other practical difficulties must be considered 
and overcome. For example, social or occupa- 
tional duties, lack of funds, and facilities 
or still more commonly, lack of time, may 
prevent the patient*s proper use of an agent 
which, on purely medical grounds, would be the 
remedy of first choice. In such cases, it will 
be necessary to substitute a more easily used 
remedy. 
Moreover, the physician must repeatedly 
check upon the manner in which the remedies 
are being used. He should at each successive 
visit carefully examine the treated areas and 
closely question the patient as to the manner 
of use and removal of the remedies. With some 
patients, no amount of painstaking instruction 
will achieve the correct and conscientious use 
of topical remedies. In such instances, hos- 
pitalize the patient. 
35 Despite the difficulties which topical 
treatment may present, no effort can be spared 
in the endeavor to accomplish its proper selec- 
tion and execution. For the abandonment of 
correct topical treatment means the surrender 
of what is often the most powerful weapon of 
present dermatologic management. 
36