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ACNE & ACNE ROSACEA
The word acne, which is thought to be simply a variation of acme, a point, appears to have reference to the sharp-pointed papules, or pimples, found in the skin disease known acne vulgaris, or common acne. In this disease a small pustule or blister filled with matter, commonly forms on the top of the papule.
Common acne usually begins at the age of puberty or shortly thereafter, and the explanation of this is that at this time there is a great increase in the activity of various glands about the body. Amongst these are the fat glands of the skin, and in some people the greasy secretion of these glands pours out on the skin or it accumulates as plugs in the ducts or little tubes through which the glands open on the skin. Sebum is the name commonly given to the secretion of these glands and an excessive flow of sebum constitutes seborrhea. When a considerable quantity of sebum is being poured out on the skin this assumes a sallow and greasy appearance, and this condition may be the precursor of acne and of other skin diseases. Should the sebum in the gland ducts become too thick to flow freely it forms plugs, and these plugs appear to provide nutriment for a microbe known as the acne bacillus, which therefore invades the gland ducts in large numbers. Through its activities the substance of the plug becomes changed, and usually, also, the outer end of the plug becomes dark in colour forming the familiar blackhead. The plug is termed a comedo (plural, comedones). Should come dones be allowed to persist, inflammation tends to take place round them, and thus arises the acne papule. If, as commonly happens, the papule is invaded by a matter forming microbe it becomes topped by a pustule. Sometimes matter forms deep in the substance of the papule, and the adjacent skin becomes hard, hot and painful, and perhaps purple in colour.
 
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A general state of ill-health will increase the likelihood of inflammation occurring round blackheads, and apparently so do anemia, indigestion, constipation and lack of exercise in the open air.
In common acne, therefore, treatment must be directed not only to the local condition, but also to any other condition which tends to produce it. The diet should be plain, starchy food and sugar in any form being restricted, and very greasy food and pastries being avoided altogether. Alcoholic beverages should not be taken. Vegetables and fruit should be taken freely.
 
Common acne usually affects the face, the front of the chest, and the back. The first thing to remember about local treatment is to get rid of all blackheads. Each day the face should be washed with hot water and a soap which forms a good lather, and the washing must be very thorough. Thereafter an attempt must be made to press out as many blackheads as possible. This may be done by the pressure of the fingernails through a fine silk handkerchief, or what is known as a comedo extractor may be obtained from a chemist and used for the purpose. The success of treatment will largely depend upon whether or not this part of it is thoroughly performed.
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Twice daily the face will be gone over with the following lotion:

Precipitated sulphur 60 grains
Spirit of camphor 1 drachm
Rose water and lime water of each make 6 ounces
This can be painted on with a clean brush or mopped on with cotton wool, and it is left to dry on. Should the lotion cause much irritation of the skin, as occasionally happens when the skin is unduly sensitive cold cream or zinc ointment should be applied till the irritation has been subdued. Then for a few days the following ointment should be used:
Salicylic acid powder 10 grains
Precipitated sulphur 10 , ,
Zinc oxide 60 , ,
Soft paraffin 1 ounce
The lotion should then be resumed, and carried on, if possible, because a lotion is generally much more effectual than an ointment. A lotion which is often successful, and which may be tried alternatively with the above, is the following:
Sulphate of zinc and sulphurated
potash .. .. of each 60 grains
Water .. .. 4 ounces
If the patient suffers also from dandruff, he must endeavour to get rid of it. A sulphur soap, made by a reliable maker, should be procured from a chemist, and with this a man may wash his head three times a week.
A woman would wash with the soap once a week and in the intervals use some such preparation as the collosol mercury and sulphur hair lotion. The treatment of dandruff is very important as it seems to have much to do with the persistence of acne on the chest and back; and it sometimes causes crops of boils on the back of the neck. If the treatment described is carried out conscientiously for a month or two, a great improvement will usually be made; but, even when the papule and pustules have disappeared, care should be taken to clean out blackheads, and sulphur soap should be used fairly frequently. In severe or prolonged acne when marked improvement does not take place, with consequent disfiguring scars, a doctor should be consulted.
ACNE ROSACEA: Rosacea is a skin disease which affects the nose and the adjacent parts of the forehead and face. It begins with redness of these parts, but sometimes acne-like papules are superadded. It is, however, quite different from acne; there at no blackheads, the redness appears before the pimples, and it affects people about middle life, a large majority of these being women.
Indigestion, constipation, flushings at the monthly periods and at the change of life, the abuse of alcohol, coffee or tea, and exposure to cold are amongst the possible causes underlying the condition. For a long time-months; or even years-the patient suffers from hot flushes which come and go. They may be provoked by a meal or by exposure to heat or cold. Eventually the redness does not disappear at any time, and it becomes darker in colour. It will now be found that in the skin of the affected parts there are numerous small blood vessels which are dilated and tortuous. Pimples or papules, resembling those of common acne, may also make their appearance. Occasionally the skin over the nose becomes much thickened, so that the organ is bulbous and deformed. In this condition the term rhinophyma is applied.
In the treatment of rosacea indigestion and constipation must be corrected. The adoption of a full vegetarian diet is said to give excellent results in some cases.
Preventive and Curative Treatment
It is important that those who exhibit signs of rosacea should avoid exposure to cold as far as possible. They should avoid sitting in front of a hot fire, particularly after exposure to cold. Tepid water should be used for washing the face. One of the lotions mentioned in the treatment of common acne may be used during the day, and at night the following ointment: Ichthyol, 15 grains; sweet almond oil to an ounce. A dressing should be worn over the parts to which the ointment is applied, in order to prevent soiling the bed linen. When the face is hot and uncomfortable relief may be obtained by sopping on a calamine lotion. If the patient suffers from dandruff it is necessary to treat this also, and this may be done on the lines described for the treatment of common acne.
When the disease has persisted for a long time and the redness is permanent, with, perhaps, thickening of the skin or the presence of papules, the same treatment appropriate to the earlier stages should still be adopted, but more will require to be done. This may be the use of the electrocautery to obliterate some of the enlarged blood vessels; but in the case of rhinophyma the excrescent pieces of skin must be cut off, and the cosmetic effect of this operation will be good.
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