The Local Treatment of Atopic Dermatitis part 2

Filed under: 4 - Atopic Dermatitis

The general character of the skin means a good deal so far as prognosis goes-if it is soft and smooth where there is no dermatitis, the prognosis is much better than if it is of the dead, dry, “asteotic” type. In some children with atopic dermatitis there is seen an exaggeration of the small crisscross lines, with or without thick­ening, that run across the palm of the hand. (See Fig. 32.) This indicates chronicity, and means, as a rule, that you are dealing with a stubborn and a difficult case.

(7) Swartz’s ointment:

Salicylic acid gr. xxx Mercurochrome  crystals gr. xx Aquae q.s. Anhydrous lanolin Petroleum jelly aa 3 i

Fig. 33.-Subacute atopic dermatitis.    Local treatment:     Swartz’s ointment.    It almost always does remarkably well for this type.     (Prom Brennemann’s  Practice  of  Pediatrics.)

This was originated by Dr. Jacob Swartz of Boston over thirty years ago for the. treatment of fungus in fection, for which it is still good. I happened to use it once on a child who had no fungus infection, but subacute atopic dermatitis in front of the elbows and back of the knees. It worked so well that I have used it constantly ever since for such pa­tients. I have never seen it irritate, and it almost always does good, for what reason I have no idea. It should be well rubbed into the skin and not simply spread on. If the dermatitis is thick and lichenified, a strong tar paste or ointment is better. (See Fig. 34.)

(8)  Vioform.

This is used as a 2 per cent oint­ment either in petroleum jelly or in hydrophilic ointment (U.S.P.), or as a paste in the same strength with paste zinc oxide (U.S.P.) as the base. It is a fairly good antiseptic and fungicidal agent, is usually well tolerated, and is not likely to sensi­tize. I have used it especially on the arms and legs of infants with atopic erythroderma, and sometimes for moniliasis of the abdomen and pubic region. It is a good preparation, but I think its value has been somewhat exaggerated.

(9)  Burow’s solution 3 i ss

Hydrophilic  ointment   (U.S.P.)   3  vi Paste zine oxide (U.S.P.)  I i

This is a soothing, slightly drying, excellent preparation for acute derma­titis if it is not too wet.

(10)  Lassar’s   paste    (paste   zinc   oxide, U.S.P.)

This is an old and tried preparation of value. It has the virtue that the large amount of starch it contains enables it to absorb a little fluid, and it is so thick that it is protective. I use it for acute angry eruptions in order to get them calmed down a bit before using tar, and as a protection, applied thickly with a throat stick, for ammonia dermatitis.

Fig. 34.-Lichenifled atopic dermatitis.    Local treatment:     a strong tar paste. (From Brennemann’s Practice of Pediatrics.)

(11)  Crude coal tar.

This is the most valuable local remedy there is for most infants and children with atopic dermatitis. It can be used as it comes, undiluted, or in pastes or ointments made up in various bases, and of various strengths.

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