\ THE USE 
—op— 
CHRYSOPHANIC ACID 
—IN THE— 
V 
TREATMENT OF 
Diseases of the Skin. 
V ■ 
By R. W. TAYLOR, A. M., M. D., 
Professor of Diseases of tlie Skin in the University of Vermont, 
Surgeon to Charity Hospital, New York. 
[Reprinted, from the St. Louis Courier of Medicine, October, 1880.] 
ST. LOUrS: 
McCORMICK, NIXON & CO., Printers. 
1880. THE USE OF CHRYSOPHANIC ACID IN THE 
TREATMENT OF DISEASES OF THE SKIN. 
By It. W. Taylor, A. M., M. D., Professor of Diseases of the Skin in the Univer- 
sity of Vermont, Surgeon to Charity Hospital, New York. 
IT may "be truly said of chrysophanic acid, that unlike 
the majority of new remedies, it has a greater range of 
usefulness than has yet been claimed for it. Indeed it is, 
in the treatment of certain skin diseases, what quinine is 
to malarial fever, almost a specific. This acid, as is well 
known, is in the form of a yellowish-brown powder, and is 
derived from an Eastern remedy called goa powder, in 
which it exists to the extent of 85 per cent. It is also said 
to be derived from rhubarb. Originally this goa powder 
was used for ring-worm in Eastern countries, and it is only 
within a few years that its use has been extended to the 
treatment of other cutaneous affections. 
To Dr. Balmanno Squire, of London, certainly belongs 
the credit of our more extended knowledge of the useful- 
ness of this valuable agent and its derivative acid. Having 
myself used it in a number of skin affections, including 
many cases, I desire now to present my views as to its gen- 
eral sphere of usefulness, and to consider certain draw- 
backs which we must admit there are in its application. I 
hope thus to draw out the experience of other physicians 
who have used the agent. First, let us consider the form 
and strength of the ointment to be used, since this is the 
most convenient mode of application. Some of the physi- 
cians who first used it, recommended a strength of two 
drachms of the acid to the ounce of lard or cerate. But I 
am convinced by experience, that in this country this 4 
Chrysophanic Acid in Shin Diseases. 
strength is far too great. Such an ointment is rarely ne- 
cessary, and should always he used with the greatest 
caution, as I will point out later. I may here remark that I 
have found no necessity for the use of hot lard in the for- 
mation of the chrysophanic acid ointment, nor for its solu- 
tion in benzol before mixing it with the cerate or lard. My 
preference is that the acid should be thoroughly triturated 
with a few drops of alcohol before mixing it with equal 
parts of vaseline and simple cerate or cold cream. This 
makes a smooth ointment, which readily penetrates the 
skin. As to the strength of the ointment preferred by me, 
I would say that I constantly use it in the proportion of ten 
grains to the ounce of cerate, and rarely higher than one 
drachm to the same quantity. In speaking of the various 
diseases, I will state the proportion usually found beneficial 
by me for each. In general, brisk inunction, once or twice a 
day, leaving a coating of the ointment on the parts, is all 
that is necessary, but in some instances it is essential to 
apply the salve spread on lint as a plaster. Care should 
always be taken that only the morbid tissue is thus covered. 
To state briefly its general applicability, I may say tliat 
chrysophanic acid ointment is useful for chronic subacute 
skin affections attended with superficial infiltration or with 
much epidermal proliferation. In cases of very deep in 
filtration, it is not, I find, as beneficial as other agents are, 
for the reason that the strength of the ointment is neces 
sarily so great that it of itself causes inflammation around 
(the part, and even then it does not afford especially good 
results. Then again, it is not to be used upon excoriated 
surfaces, yet in cases such as psoriasis, lichen planus, in 
some of the early papular and some superficial tubercular 
syphilitic eruptions, its action is marvellous. My general 
rule is to employ it only in cases in which the epidermis 
is intact or not shed, or again when this layer is much 
thickened. The disadvantages of the ointment are its 
staining qualities, its tendency to produce erythema, se- 
vere edema, and sometimes furuncles. While we cannot 
prevent the pigmentation of the skin, we can use measures Chrysoplianic Acid in Skin Diseases. 
5 
for its removal, such as brisk friction with powdered pumice 
stone on a pad of flannel. As regards the inflammatory 
sequelae I think that, as the observer becomes more familiar 
and skilled in the use of the agent, he will be less liable to 
see them. When I first used the ointment in the proportion 
of two drachms of the acid to the ounce of fat, I several times 
incases of psoriasis saw much edema around the patches, 
following the application, but still the disease yielded so 
quickly and the inflammatory symptoms were so speedily 
relieved by cold water dressing, that in some urgent cases I 
did not regret its occurrence. However, I could from 
further experience, counsel caution, and advise a moder- 
ately strong ointment, although the cure will not be quite 
so rapid. In some rare instances little boils and large om>s, 
even, will appear after the application of a mild ointment; 
and sometimes it will be necessary to stop the remedy in 
consequence, but such instances are quite rare. One point 
has struck me very forcibly in using this agent, namely, 
that it has not very pronounced anti-pruritic properties, 
so that in some affections attended with severe itching, 
we are compelled to combine with it one of the tarry 
oils or camphor or carbolic acid. 
Let us consider briefly the value of chrysoplianic arid in 
various skin diseases, for, as I have said, its range of appli- 
cation is very wide, greater than is generally conceded, and 
is not by any means limited to the treatment of psoriasis 
and ringworms. In acne much good can be obtained from 
the use of a mild ointment, ten to twenty grains to the 
ounce. But here its staining properties are almost insu- 
perable objections to its use. Yet my experience in dis- 
pensary practice has convinced me, that many cases of 
simple and of the indurated form of acne will be bene- 
fitted by this, more than by any other single remedy. I have 
directed patients to first bathe the face with hot water, and 
then to rub over each papule or tubercle a little of the oint- 
ment, leaving a film of it to be absorbed. • The result is 
that the next day the whole face is stained to the copper 
color of an Indian, to remove which it is necessary to scour 6 
Chrysophanic Acid in Skin Diseases. 
the parts well with powdered pumice stone, which operation 
however is not always followed by complete success. Great 
as is the drawback, there are persons who will undergo the 
annoyance in hope of ridding themselves of their chronic 
disfigurement. In cases ©f acne complicated with rosacea 
and in rosacea I have seen excellent effects from a tolerably 
strong ointment, twenty, thirty or forty grains to the ounce. 
I have seen the dilated superficial capillaries wither under 
its use several times in-very severe cases. Let me here 
say that great caution must be exercised in using a toler- 
ably strong ointment on the face, since in this situation it 
is liable to cause severe inflammation, sometimes resem- 
bling erysipelas. The best mode of procedure is to use at 
first a mild ointment and simply rub a little in, carefully 
watching the result. Then we may go a step further and 
apply it spread on linen lint constantly. Should at any 
time inflammatory symptoms show themselves, the appli- 
cation must be suspended and water dressing applied. But 
care and observation will make the prescriber skillful in 
avoiding such accidents. In eczema the use of chryso- 
phanic acid is limited, I think, to chronic localized spots 
not attended with great infiltration. To these it can be ap- 
plied in moderate strength continuously, but in general it 
will be necessary to combine with the ointment a sufficient 
quantity of the oil of cade, birch oil, and tar oil to relieve 
pruritus. In chronic eczema of the palms of the hands I 
have used with great benefit an ointment made of fifteen 
grains of the acid to diachylon ointment one ounce. The 
same ointment I have used with equally good results in 
chronic cases of scaling eczema of the scrotum, in which 
there was considerable thickening. When used upon the 
hands or scrotum the ointment should be spread on lint 
and kept continuously applied. It may be/necessary, of 
course, to envelop the former in india-rubber gloves, and 
perhaps to envelop the scrotum over the dressing with 
gutta-percha tissue. In any case in which the itching is 
severe, I think a sufficient quantity of a tarry oil should 
be added. In two instances of sycosiform eczema of the Chrysoplianic Acid in Skin Diseases. 
7 
beard in tlie chronic and somewhat infiltrated stage, I pro- 
duced a cure by ten grains of the acid to the ounce of 
diachylon ointment, the dressing being kept on continu- 
ously. This, indeed, was after the usual remedies had 
failed. 
In ringworm of the scalp, chrysoplianic acid is often 
very useful, but it is necessary to use it with considerable 
care, as it has and may produce severe inflammation. Ten 
grains to the ounce of cerate and vaseline is generally suf- 
ficiently strong. Of course it is necessary to use epilation 
in bad cases. One drawback to its use on the scalp is 
the staining of the hairs to a purplish brown color. I 
think it well to mention this fact to patients when stating 
to them the advantage of rapid cure which we are war- 
ranted in promising from the use of this acid. Ringworm 
of the body is readily cored by an ointment of moderate 
strength rubbed in several times daily. When used upon 
the trunk or extremities, chrysoplianic acid will inevitably 
stain the underclothes. To get over this trouble as well 
as we can, I state the fact to patients, and advise them to 
wear such clothes as are well-worn, and to continue their 
use while under treatment, as the time is usually not 
very long. In lichen planus, I have seen some of the 
most rapid cures produced by this agent, but the itching 
which usually accompanies this afiection, often necessitates 
the addition of some anti-pruritic agent. In other chronic 
forms of lichen this acid may often be used with great ben- 
efit. I have now under treatment a case of lupus erythe- 
matosus, which I am sanguine of curing by an ointment of 
the strength of twenty grains of the acid, to the ounce of 
ointment. 
In a number of cases of papular and scaling syphilides, 
I have seen excellent results from the use of a mild oint- 
ment. Particularly valuable is this agent combined with 
diachylon ointment in the scaling syphilides of the palms 
and the soles. Its application here must be continuous, and 
a previous removal of the scales may be necessary, while 
in severe cases the bands should be enveloped in india-rub- 8 
Chrysophanic Acid in Skin Diseases. 
ber gloves. It is, however, in the cure, perhaps I may 
more properly say the removal of psoriasis, that the acid 
owes its great and well-deserved reputation ; and here I may 
add that my experience in its use convinces me that the 
high praise which has been accorded to it by others, is well 
deserved. Indeed it is rare to see any agent act as promptly 
and uniformly as this one does. One feels assured in pre- 
scribing it that a good result will surely follow its use. In 
psoriasis it is generally necessary to use mild ointments 
from ten to sixty grains, rarely any stronger. Care and cau- 
tion should be exercised in treating children, particularly if 
very young, since severe inflammatory reaction may follow 
the use of a strong ointment. For such patients I have rarely 
had to exceed fifteen grains ; I usually employ only ten 
to the ounce. Of course, the scales must be carefully re- 
moved by scraping or by baths, and the ointment should 
be well rubbed into the patches. If inflammation follows, 
the parts must be treated by the water dressing. In some 
very chronic cases I have used the two-drachm ointment, 
and in order to avoid inflammatory reaction I have ordered 
the parts to be enveloped in linen and kept continually wet 
with cold water. In this way I hurried the cure and 
avoided bad results. In general, however, a mild oint- 
ment is sufficient, and the strong one should never be used 
unless the patient is fully under control. Though chryso- 
phanic acid has been recommended in the treatment of 
tinea versicolor, I am able to say from considerable experi- 
ence that it is less efficacious than the remedies usually 
employed. 
1$ West Twenty-first street, June 1st, 1880.