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ON THE VALUE
LOTION OF SULPHIDE OF ZINC
IN THE TREATMENT OF
SUPERFICIAL  LUPUS  ERYTHEMATOSUS.
             BY
      LOUIS A. DUHRING, M.D.,
PROFBSSOR OF THE DISEASES OF THE SKIN IN THE HOSPITAL OP THE
       UNIVERSITY OF PENNSYLVANIA.
     FROM
THE MEDICAL NEWS
  November 10, i88r
 
DORNAN, HR INTER, 
ON THE VALUE OF A LOTION OF SULPHIDE
  OF ZINC  IN THE  TREATMENT OF  SUPER-
      FICIAL LUPUS ERYTHEMATOSUS.1
  I desire to direct  attention to the value of a
certain  zinc sulphide  lotion  in  the treatment of
some  forms of lupus erythematosus.   It  may here
be stated that I have found  it useful in  what may
be termed the inflammatory superficial  form of the
disease, occurring either in discrete or  in confluent
patches of  recent or of long duration.   Where the
morbid process has settled deeper in the cutaneous
structures, and where there is but little  tendency to
variation from month to month, other  more stimu-
lating remedies will prove more serviceable.  Every
practitioner has doubtless encountered  instances of
this disease in which  the  usual, for the  most part
stimulating, remedies  have been of no value.   In
the majority of these cases they will be found to be
positively injurious, inflaming the skin,  and causing
the diseased areas to  spread.  Such  has been my
experience.   Any new remedy  or formula, there-
  1 Read before the American Dermatological Association, at the
Seventh Annual Meeting, August 29, 1883. 
4
fore, which for these  peculiar cases offers hope  of
relief,  must prove welcome to  both patient  and
physician.   The striking  good which has followed
the use of this remedy in  several cases that have
recently been under my care induces me to present
this note.   I do not wish to  claim for it any specific
power over the disease, nor  to say that it will cure.
I merely  wish to speak  of it as  a highly useful
remedy, which in  some cases has proved the only
application  that has at all benefited  the  disease.
I was first led to prescribe it because of the service
it  had  rendered in  the treatment of seborrhcea  of
the face.
  The lotion  consists  of equal parts of sulphate  of
zinc and  sulphuret  of potash, in  the strength  of
from five to fifteen grains each  to  the  ounce  of
water, together with  the addition of a variable quan-
tity of  alcohol.  Ether may also  often be  added
with benefit.  I am in  the habit of using the follow-
ing formula: Take of sulphate of zinc and sulphuret
of potash each thirty grains; rose-water, three fluid-
ounces  and a half;  alcohol, three fluidrachms.   If
this strength agree  with  the skin, the two active
ingredients  may be  increased to  the amount of a
drachm each to four  ounces of  the fluid.   More
alcohol  may also  be  used, to the  extent  of  one
ounce to  three of water.    A few minims  of glyc-
erine  to the ounce  may  sometimes be added with
advantage.   The  lotion,  which  contains a light-
grayish, pulverulent sediment, should  be  shaken
before  using,  and applied  lightly to the  part for 
5
from five  to  twenty minutes  by means of a sponge
or a rag mop, allowing  the sediment  to  adhere to
the surface.   The immediate  effect is usually cool-
ing and soothing.  The application may be repeated
two or more times in  the twenty-four hours.   The
skin should first be cleansed  of scales by means of
soap,  the  milder soaps  sometimes proving  more
beneficial  than the stronger soft soaps.
  The following note  by Dr.  L. Wolff, pharmaceu-
tical chemist, of Philadelphia,  explains  briefly the
chemistry, as well as the best method of making the
compound.
   "When equal parts of zinc  sulphate  and potas-
sium sulphide are mixed together  in  the presence
of water, a double decomposition takes place, result-
ing in zinc sulphide,  potassium sulphate, and pre-
cipitated sulphur.  The zinc sulphide thus formed is
a hydrate, and of a  white, pulverulent appearance.
   "When the two are to be combined in  a lotion
with water,   they are  best dissolved  separately in
half the prescribed quantity of water  each,  and
then the two solutions poured together.   When the
liquid, however, consists of alcohol, or alcohol and
ether, the two salts  must be rubbed down fine first,
whereupon a small  quantity of  water is added,  just
sufficient to allow the reaction  to take place, which
is known by  the white appearance of the mass; the
alcohol is then added, and lastly the ether.
   "As there are five potassium  sulphides, according
to the quantity of sulphur in  the combination, the
results will vary as to the amount of precipitated 
6
sulphur present.   Of  these sulphides,  the trisul-
phide and the pentasulphide are the most common.
The potassa  sulphurata of the United States and
British Pharmacopoeias are, according to their com
position, principally trisulphides, and  if these are
employed, two equivalents of sulphur will be formed,
as shown in the following formula:

 "K2S3-fZnS04+H20. = K2S04+ZnS.H20+2S.

   '•Again,  if potassium pentasulphide is employed,
an excess of four equivalents of sulphur would be
precipitated,  as follows:

 '<K2S5+ZnSO,+H20 = K2S04+ZnS.H20+4S."

   I shall now briefly refer to three cases  in which
the beneficial effects of the lotion were  striking:
   About a  year ago, Mr. W., aged  45,  presented
himself to  me,  exhibiting  six or eight  dull-red,
chronically inflamed,  slightly  scaly,   irregularly
rounded, ill-defined patches of lupus erythematosus.
The lesions were the size  of peas  and small beans,
and were scattered over the face.  They had existed
eight  months,  and  were subject  to considerable
variation.   The  patient had,  at  different times,
been under the influence  of arsenic, mercury, and
iodide of potassium, and locally had used mercurial
ointments—all  without benefit.  I  prescribed an
ointment of precipitated sulphur, one drachm to the
ounce, which in  a few days caused  heat,  and in-
creased redness.   Subsequently, tar  ointment; oil 
7
of cade;  liquor carbonis detergens; an ointment of
calomel,  thirty grains  to the ounce;  ointments of
pyrogallic acid, thirty and sixty grains to the ounce;
an ointment of iodoform;  tincture of iodine, were
all used,  with  the result that, in every instance, the
disease was made worse.   The zinc sulphide lotion
was now ordered, and gave almost immediate relief,
the skin,  in the  course of  a  few days,  becoming
paler and less  scaly, accompanied by a decrease in
the subjective  symptoms.  Improvement  continued
under the use  of the remedy, but, as cure did not
follow,  other  applications, including solution of
chlorinated  soda,  acetic acid, lead and mercurial
plaster, alcoholic solution of salicylic acid, carbolic
acid, ether and rhigolene spray, and the use of the
curette, were  resorted to.   All proved of not the
least value, while many were injurious.    The zinc
sulphide  lotion was  the only remedy that in any
degree favorably  influenced the disease.   Some of
the lesions disappeared under its use, and all were
benefited.
  Another case,  of the butterfly form of the dis-
ease, in a gentleman from Virginia, forty-six  years
of age, of two years' duration, who has lately been
under treatment, was  very  markedly benefited by
the remedy, other  applications having  previously
failed to  influence the disease favorably.
  A third case may be mentioned,  that of a  man,
aged 30, who was admitted to the clinic of the Uni-
versity of Pennsylvania a few months ago with an
unusually extensive development of the  disease of 
                       8
five years' duration,  involving the greater part of
the face.   The erythematous element was marked,
there being but very  little sebaceous glandular in-
volvement.
  In the course  of a week, a remarkable change
for the better took place under the lotion; in three
weeks the improvement was even more  decided, so
much so  that  the patch  was broken up here and
there, and apparently sound skin was in some places
beginning to show itself.