Wednesday, 11 January 2012

13 January, 1900 - 'The Face and Its Blemishes' by the New Doctor - Acne (Part Two: Treatment)

For Part One, click the appropriate tag below.

Since acne is a local disease dependent upon local affection, it is by local means that it should be treated. It is our belief that constitutional treatment of any kind and dieting and internal medication are alike without any effect upon true acne.

The proper treatment is acne is really very satisfactory if properly carried out for a sufficiently long period. The condition is one which lasts off and on for seven to ten years, and it is impossible to put a stop to it in a day or two. The treatment must be carried out for two or three weeks at first, and then for shorter periods at intervals, should the affection return.

It is a great point to prevent the formation of pustules, if possible, for each acne pustule leaves a permanent scar.

Since the affection starts by blocking of the sebaceous glands, absolute cleanliness of the face is essential. Persons liable to acne should wash their faces frequently in warm water, and only use the best toilet soap. It is exceedingly important only to use soap that is absolutely reliable. Good soaps are antiseptic and therefore do good to acne, but bad soaps are either caustic or made from putrid fat, and are irritating and not antiseptic.

Since sulphur is par excellence the remedy for acne, a good sulphur soap is far preferable to any other. It is, however, almost impossible to get a good sulphur soap. Most of the samples that we have seen have either been like balls of sand, or else contained such a minute trace of sulphur that their value from this ingredient is not increased one atom. There is an excellent opening for a really nice sulphur soap containing a fair proportion of fine sulphur, and a good toilet soap as the basis. Why some of our enterprising soap manufacturers have not put such a soap on the market we cannot understand, for the demand for it is considerable.

Rubbing the face with a fairly rough towel after washing is an excellent way of removing the dried secretion which is plugging the sebaceous glands. You must rub the face with caution. There is no need to rub hard, or with a very rough towel, else you may do more harm than good. Moreover, you must be exceedingly careful, if you have any pustules upon your face, not to diffuse their contents and rub them into the face elsewhere, for if you do, other pustules will for certain be formed there.
Face massage is used for the same purpose as rubbing the face with a rough towel. We must say that massage has certainly no advantage over the towel. Face massage is exceedingly expensive to have done, and it is not easily performed by oneself. It is not a form of treatment that is often of service.
One of the most effectual ways of getting rid of miliums and comedones is squeezing them out. This treatment is the most radical of all, and is certainly most valuable. You should not squeeze out too many at a time, not more than four or five of the most prominent ones. There are numerous wonderful instruments and contrivances used for removing blackheads, but none is half as good as clean fingernails. It is an open question whether it is advisable to squeeze out the pustules, which are so frequently met with in acne. Personally we think that it is right to do so, if you are careful and clean. You will fequently find it stated that, when you have once squeezed out a comedone, the gland will not again become plugged. Such a statement is absolutely opposed to fact. The sebaceous glands which have become blocked are particularly liable to go wrong again.

We have already stated that we do not believe that internal treatment nor constitutional measures have the slightest effect upon acne; but one form of general treatment is of great value, not because it improves the general health - because acne occurs mainly in those who are absolutely healthy - but because it has a distinct local action. The measure we refer to is fresh country or sea air. Fresh air and sunlight are valuable in the treatment of acne, because they kill the various microbes which lurk about the face, and so minimise the risk of the spots becoming pustules.

The local applications which are used for acne are numerous. Some of them are excellent, some worthless, and most are injurious. The local application which is by far the most valuable is sulphur. Sulphur is not only an antiseptic but it acts directly upon the outer skin causing it to become soft and readily removed. It therefore tends to destroy the plugs which fill up the sebaceous glands. The sulphur is best used as an ointment. The sulphur ointment of the pharmacopeia is too strong and coarse for most girls' faces, and it is best to use it diluted with an equal quantity of lanoline or cold cream.

The sulphur ointment should be applied every night to the places where the spots are most numerous. It may be washed off in the morning with hot soap and water. Sulphur occasionally causes the skin to become rough and scaly for a short time.

Many other preparations are used, but sulphur is so much the best of all that it is unnecessary to mention any others.

For the roughness left after acne or for the scaliness due to the sulphur, or for the natural greasiness which is invariably present on the faces of those subject to acne, glycerine and rosewater or glycerine and lime juice may be used. With these exceptions, cosmetics altogether should be strictly avoided.

Steaming the face has lately come into fashion for the cure of acne. The face is exposed to hot steam for several minutes and is then rubbed with a dry towel. The treatment certainly does good, but whether as a result of the steam or the rubbing or both we cannot say at present.

Acne is not the only common complaint due to the affection of the sebaceous glands. Dandruff or seborrhoea is another common sebaceous disease. It is an annoying and intractable complaint dependent upon some alteration in the sebaceous glands which causes them to secrete a thin albuminous fluid instead of the normal thick sebum. The thin secretion dries in scales and does not nourish nor oil the hair, which consequently becomes dry, brittle and lustreless. As it is an affection of the head and not of the face, we need not further discuss it here.

But persons who are subject to dandruff are frequently troubled by patches of scurfy skin on their faces, especially on the cheeks and round the mouth. These patches are disfiguring and sometimes itch intolerably. They are seborrhic eczema, a form of eczema which occurs as a remote result of seborrhoea. These patches are readily inoculated from place to place. We have seen the body almost completely covered by this form of eczema, all due to inoculations by the fingers from a small patch upon the face. Besides this, patches of this eczema tend to spread all round without external help. Seborrhic eczema readily yields to treatment with sulphur or calamine ointment.

There is a complaint of the complexion known familiarly as "grog blossom" and scientifically as "acne rosacea" which really is secondary to dietetic indiscretions, and is therefore the first affection we have noticed which is not a purely local trouble. This complaint embraces a wide selection of troubles from a slight redness of the nose after meals to complete purple discolouration of the whole of the face. Pustules are frequently present and constitute the "grog blossom" proper, but they are no essential part of the disease and are secondary local inoculations.

Although its household name would suggest that the disease is dependent upon alcoholism, it is certainly not always due to over indulgence in alcohol, nor is it the typical complexion of the hard drinker. The condition is secondary to chronic catarrh of the stomach and throat. The congestion spreads from the stomach up the gullet to the throat, thence to the nose and then on to the face.

Alcohol causes acne rosacea because it causes chronic congestion of the stomach. In women the abuse of tea is the commonest cause of red noses and even of the more advanced form of acne rosacea. This complaint yields to proper dietetic and local treatment, sometimes readily, sometimes with great reluctance. The dietetic treatment is that of the indigestion which has caused it: the local treatment is the application of mild antiseptic ointments.

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