Reprinted <•< ::t the “Journal oj Cutanea * and Genito-Urinary Lite*. 
for January, -7S9. 
SYCOSIS: 
A CLINICAL STUDY.* 
BY 
GEORGE THOMAS JACKSON, M. D., 
Assistant Physician, Now York t <rin und Cancer Hospital. 
GENTLEMEN : It is a good thing to go over one’s cases from time 
to time and to find out how 1 inch or how little one has accom- 
plished in the treatment of the various diseases that have come 
under one’s observation. Sometimes hr may be surprised to find that he 
has accomplished so much, and sometimes he may be humbled by discov- 
ering that his most conscientious endeavors have been futile. I ask your 
indulgence to-night while I relate im experience in the treatment of 
sycosis. 
* Read before the Now York Dermatol, cal Society, November 27, 1888. 14 
Original Communications. 
All of you will probably agree in the opinion that sycosis is one of the 
most obstinate of skin diseases. It has proved itself, in my hands, a most 
difficult disease to manage. What I offer you to-night is no story of brill- 
iant cures, but a candid statement of difficulties struggled against; and is 
brought before you in the hope that it may serve to bring out in the dis- 
cussion some suggestions as to treatment from some of you who are older 
or wiser than I. 
My cases number twenty-two. Ten of the patients were between 
twenty and thirty years of age, nine between thirty and forty, two be- 
tween forty and fifty, and one between fifty and sixty. The earliest age 
was twenty-three—three cases. The oldest patient was fifty-four. 
As to nationality, twelve were from the United States, four were Ger- 
man, one Austrian, one Russian, one Pole, and two Irish. 
As to occupation, five of them were tailors; four, clerks; one was a 
car-starter; one, an engineer; one, an upholsterer; one, a boiler-maker; 
one, an elevator boy; one, a salesman ; one, a cigar-maker ; one, a hatter; 
one, carpets; one, a druggist; and three had no occupation. 
The duration of the disease before coming under treatment was as fol- 
lows : In one case, fifteen years; in one, twelve; in one, ten; in one, 
seven; in two, six; in two, four; in one, three; in three, two; in one, 
one year and three months ; in one, eleven months; in one, nine months; 
in one, six; in one, five; in one, four; in two, three; in two, two. 
The location of the disease was as follows : Upper lip alone, six cases; 
upper lip and chin, two; upper lip and cheeks, one; upper lip, cheeks, and 
chin, five; cheeks alone, three; cheeks and lower lip, one; chin alone, 
two; one cheek alone, one; whole bearded face, eyebrows, and scalp, 
one. 
Digestive disturbances were noted in seven cases; nasal catarrh in four 
cases in which the upper lip was involved. 
In only fourteen of the cases was I able to observe the effect of treat- 
ment long enough to be of any value in a study of this sort. As most of 
the cases were dispensary patients, the results are, perhaps, not so good as 
they might have been in those of a better class. Allow me here to give a 
short account of the treatment in the fourteen cases: 
1. Sept. 27, 1882. Began treatment by epilation and the use during the 
day of a solution of hydrarg. bichlor., gr. j to § j; while at night the patient 
was directed to wear upon the affected parts an ointment of ungt. hydrarg. 
ammon., 3 j; ungt. zinci oxid., § j. M. Fowler’s solution was given by the 
mouth. Local treatment for rhinitis. 
Oct. 2. No better. The patient was directed to use soap frictions once a 
day. The other treatment was continued, excepting that diachylon ointment 
was substituted for the ammoniate of mercury and zinc oxide. 
Oct. 15. Much better. Stopjfiehloride wash. 
Nov. 4. Stop frictions with soap. Substitute Bronson’s ointment (hg. Sycosis: A Clinical Study. 
15 
ammon., 3j; calomel, 3ij; vaseline, fj; M.) for the diachylon. Apply so- 
lution of caustic potash (gr. xx ad § j) to a few spots. 
Nov. 8. Spots touched with caustic decidedly better. Repeat. 
Nov. 15. As before. Paint all with caustic. 
Dec. 10. All well but small patch on each cheek. 
Dec. 24. Slight relapse. 
Feb. 12, 1883. Disease still continues. Paint with iodine. 
Feb. 20. No better. Curetted right side, after which applied Lassar’s 
paste. 
Feb. 27. Right side improved. Curetted the other side. 
March 6. Decided improvement. Repeat. 
March 21. Relapse. 
May 6. Better. Some places nearly well. 
2. March 10, 1883. Epilate and curette right cheek and use protective 
ointment. 
May 14. Have continued curetting on both sides, and latterly have used 
Bronson’s ointment. Very much better than at first, but not well. 
3. Feb. 8, 1884. Epilate. Direct to shave. Ungt. diachyli. Local treat- 
ment for nose. 
Feb. 12. Calx sulphurata, gr. TV, every two hours. 
Feb. 16. Less red and swollen. Stop calx. 
Feb. 23. Worse. Spreading. Stop diachylon and give white precipitate 
ointment. Renew calx. 
March 3. Great improvement. Stop calx. 
March 11. Nearly well. No pustules. 
June 25, 1884. Relapse. 
May 28, 1884. Diet. Shaving. Lassar’s paste with salicylic acid. Calx, 
gr. Ay every hour. 
July 22. Writes me that pustulation has entirely ceased, but some redness 
remains. 
4. May 9,1885. Began with a four-per-cent, salicylated oil, which used for 
three days. Then epilation, hot water locally, and Bronson’s ointment for 
one month. Patient made steady improvement. 
5. May 16, 1885. Treated for two months with oil of cade, 3 ij, in olive- 
oil, § j, with steady improvement but no cure. 
6. April 29, 1886. Local treatment for rhinitis, and laxatives as needed. 
Epilation, shaving, and Lassar’s paste with salicylic acid up to June 29th. 
Steady but slow improvement. 
June 29. Ichthyol, 10-per-cent, solution externally, and three grains twice 
a day internally. 
July 10. Growing constantly worse. Stop ichthyol externally and use 
Lassar’s paste with salicylic acid. 
Aug. 31. From the time of stopping ichthyol to the present date has been 
doing well. He disappeared for some months and then called in great glee 
to show me liow he had cured himself with a strong sulphur ointment he had 
made for himself. 
7. May 1, 1886. Diet. Ungt. diachyli. Calx, gr. t. i. d. 16 
Original Communications. 
May 25. Stop diachylon and use sulphur loti, 3 ss. to § j of lard. Calx, 
gr. £ every two hours. 
June 19. No new pustules for some days. Continue treatment. 
Oct. 24. Relapse after being nearly well. 
8. Jan. 27, 1887. Ungt. ac. boracis, 5 per cent. 
Jan. 29. Increase strength of boric acid to 20 per cent. Ext. hamamelis 
fid., ten drops t. i. d. 
March 8. Made great improvement up to this date, when he had a relapse. 
Put on sulphur, 3 ss. to § j of lard. 
April 9. Nearly well. 
June 18. Relapse. 
9. Jan. 29, 1887. Equal parts of sulphur ointment and simple ointment. 
Internally, fid. ext. hamamelis, ten drops t. i. d. 
No improvement after three weeks’ use of above treatment. Stop it and 
give a 20-per-cent, boric-acid ointment and internally calx sulphurata, gr. Ar 
every hour. 
March 12. Greatly improved. 
10. Feb. 3, 1887. Epilate. Ungt. ac. boracis, 20 per cent. 
March 19. No better. Stop boric acid and use sulphur, 3 j ad | j of 
lard. 
April 16. No pustules. 
May 14. Stop sulphur and use an ointment of tar and oxide of zinc. 
July 2. Is practically well. 
May 2, 1888. Relapse three weeks ago after having been entirely well for 
months. 
June 9. Is nearly well again. 
11. Aug. 13, 1887. Ungt. sulphuris. Tab. trit. sulphur., gr. \ t. i. d. 
Sept. 10. No better. Stop sulphur ointment and use mild white precipi- 
tate ointment. 
Oct. 11. No improvement. 
12. Dec. 13, 1887. Epilation. Resorcin, 3-per-cent, ointment. Local treat- 
ment for nose. 
Jan. 10, 1888. No improvement. 
13. Nov. 27, 1887. Diachylon ointment. Iron, arsenic, and strychnine 
internally. Hot-water fomentations. Epilation. 
Dec. 16. Cured. 
14. Feb. 25, 1888. Epilate. Resorcin, 3 per cent, in ointment. 
March 19. Not much change. Substitute diachylon ointment for the re- 
sorcin. 
March 29. No better. Stop diachylon and use a 3-per-cent, salicylated 
oil. 
April 5. Worse. To use Lassar’s paste and hot water. 
April 7. Calx sulphurata, gr. Ar every hour. 
April 28. Worse. Oil of ergot locally. Arsenic internally instead of 
calx. 
April 30. Much better. 
May 3. Fresh outbreak. Sycosis: A Clinical Study. 
17 
May 7. Still bad. Stop oil of ergot and use boric-acid ointment. 
June 9. Steadily improving. 
Sept. 29. I was out of town during the summer. He is now as bad as ever. 
Summary.—And now what lesson shall we draw from the foregoing 
notes, imperfect as they are ? 
1. As to AEtiology.—Nationality is unimportant. The fact that the 
greatest number of cases occurred in those of American birth is of no sig- 
nificance, as it is due purely to the accident of the place in which the cases 
occurred. Occupation seems more promising as an aetiological factor. All 
but four of the patients were engaged in occupations that compelled them 
to live in close rooms filled with dust. It has always seemed to me that 
the disease takes special hold upon tailors. Their mode of life is about as 
unphysiological as possible. 
A poor general condition of health is a prominent setiological factor. 
In about one third of the cases digestive disturbances (dyspepsia and con- 
stipation) were noted. Doubtless, if the notes were fuller, more cases of 
like kind would have been found. 
Nasal catarrh is noted in four cases in which the upper lip was 
affected. 
The disease may appear at any age after the beard has begun to grow, 
but is most frequent between the ages of twenty and forty, nineteen out 
of the twenty-two cases occurring between those ages. 
2. The Course of the Disease.—It is exceedingly chronic and shows 
little tendency to get well of itself. It may last for fifteen years and 
more. 
3. Location.—The upper lip alone or in combination with other regions 
is most often the seat of the disease—fourteen out of twenty-two cases. 
The whole beard is quite frequently involved—five times in twenty-two. 
The chin alone is rarely affected—only twice in twenty-two cases. The 
scalp may be invaded. 
4. Treatment.—While I have marked only one case as cured, nearly 
every case shows marked improvement under treatment, and without doubt 
some of them were cured but failed to report themselves so as to have the 
final result entered on the notes. If a study of these cases teaches any- 
thing, it is that one must be prepared to tack about from one method of 
treatment to another in conducting a case to a happy ending. The best 
results were attained by means of antiparasitics, which would support the 
theory of the coccogenous origin of sycosis. 
The first thing to be done is to open up the pustules and get rid of 
their contents. Epilation, soap frictions, and the use of the dermal cu- 
rette all do this, and all proved beneficial—twelve cases out of fourteen. 
After epilation or curetting, the chosen application should be made, 
whether as an ointment or oil. 18 
Original Communications. 
Salicylic acid with Lassar’s paste proved beneficial in four cases; as an 
oil, with castor-oil, it did well in one case and seemed to aggravate in 
another. 
Tar did well in two cases. 
Mercury was most valuable in the form of Bronson’s ointment (hydrarg. 
ammon., ; hydrarg. chlor. mitis, 3ij; vaseline, | j; M.), and I would 
say that ever since I learned its virtues, while I had the honor of assisting 
Dr. Bronson for a number of years at the New York Polyclinic, I have 
greatly esteemed it, and do regard it as the most elegant form of mild mer- 
curial ointment. The solution of corrosive sublimate was also useful. 
Sulphur in ointment-form did well in three cases, but was of no bene- 
fit in another case. 
Boric acid proved very beneficial in three cases, but did no good in 
another case. Where it benefited it showed its good effect promptly. 
Diachylon ointment was beneficial in two cases, and of no benefit in 
three cases. It is rather remarkable that the only case marked as cured 
got well while using this ointment. 
Ichtliyol proved harmful in the only case in which I used it. It should 
have been given a longer trial, perhaps, but at the time I had used it in a 
number of cases of other diseases without benefit, and so did not feel en- 
couraged to further experiment. 
Resorcin in three-per-cent, strength was used in two cases without 
benefit. 
The exhibition of sulphide of calcium by the mouth was of marked 
benefit in four cases in which there was a good deal of pustulation. The 
calcium was continued until either the disease was greatly aggravated as 
shown by the outbreak of many new pustules, or benefited as shown by a 
marked decrease of the pustulation. 
From a study of these cases I would formulate the treatment of sycosis 
as follows: 
In acute cases where there is much pustulation, epilate or curette and 
apply boric-acid ointment, or Lassar’s paste with salicylic acid. Give one 
tenth of a grain of calcium sulphide in fresh tablet triturates every one or 
two hours. If an acute outbreak of pustules occurs under it, stop it until 
a subsidence of the eruption takes place, and then begin again. 
In subacute cases where there is not so much pustulation, but more red- 
ness and the disease is more patchy, epilate or curette and use Bronson’s 
ointment, or one of sulphur or tar or other mild stimulant. Or use soap 
frictions, followed by protective ointments. 
In chronic cases epilate or curette, or apply a solution of caustic potash 
carefully to diseased parts. Locally, employ strong ointments or solutions 
of tar, provided caustic potash has not been used. If caustic potash has 
been used, then apply a simple soothing dressing. The use of tar in alco- Dr. Oberlander on Chronic Gonorrhoea. 
19 
hoi, as proposed by Pick, of Prague, has of late given brilliant results in my 
hands in some cases of chronic eczema, and in the last few days has greatly 
benefited one of the cases here reported, one which had shown itself to be 
very obstinate. Soap frictions are also valuable at this time. As chronic 
and subacute cases may take on acute forms under stimulating treatment, 
we must be prepared at any moment to apply more soothing methods of 
cure according to indication. 
For the best effect from our local treatment we must insist upon our 
remedies being kept constantly applied during day and night. To the 
same end the patient is to be advised to shave himself about twice a week. 
This is not absolutely necessary, but facilitates the action of our applica- 
tions upon the diseased skin. If a rhinitis be present, appropriate reme- 
dies must be used for that. 
While treating the skin affection we must not forget the man whom the 
skin clothes. We must address ourselves to the task of regulating the diet 
and general hygiene of the patient, and give medicine, if needs must, upon 
the same principles as we would if the patient came to us not for his 
sycosis, but on account of his poor general condition. 
5. The prognosis is always doubtful as to rapid cure. The disease is 
prone to relapse when apparently well. A cure can be effected only by 
persistent effort both by the physician and patient. 
14 East Thirty-first Street.