Blackheads, Pimples, Flesh Worms, Whiskey Nose.
There are several forms of skin disease included under the general name of Acne. They are never fatal, but are very annoying, and cause the afflicted person to present an unsightly appearance. The difficulty is also very persistent, often baffling every endeavor to overcome it.[1] Acne punctata seems to be an archaic term, referring to acne with black open comedo (blackheads).
Acne Punctata[1] is caused by a retention in the skin of the secretion of the sebaceous glands. This secretion chokes up the little ducts and becomes hardened. These ducts are situated alongside of the hair follicles. The tips of the little masses of hardened secretion become black when exposed to the air, giving rise to the ordinary name of black heads or flesh worms[2]. Some suppose these are actual worms in the skin, and they do look very much like them, for by pressure the ducts may be emptied of their contents, which look like yellowish worms with black heads. This form of acne is most common between the ages of fourteen and twenty-five, and usually makes its appearance over the face, and sometimes on the chest and back. Sometimes the retained secretion is deeper seated where air and dirt cannot reach it, and it remains white.
Treatment. — Permanent relief can not be obtained until the system is regulated. Over eating and improper diet are often causes[3]. Eating fats or cheese or rich foods usually aggravate the trouble. Compound Syrup of Stillingia is an excellent internal remedy. Locally much may often be accomplished. Unskillful squeezing out of the "worms," is more detrimental than beneficial on account of increasing the inflammation present. First apply over the affected part a cloth wrung out of very hot water, let it remain a few minutes to relax the structures, then gently squeeze out the accumulations, taking care not to abrade the skin by pins or finger nails, then apply cloths wet with cold water and extract of witch. hazel in which borax has been dissolved.
Acne Rosacea, often spoken of as "whiskey nose," is a condition of enlargement and redness almost invariably at the tip of the nose, often causing the skin to look mottled by the dark blood in the minute venous capillaries of the parts. Indulgence in alcoholic liquors is the usual cause, though derangements through the system of special organs, such as the kidneys, liver and womb, may be indicated by its appearance. From whatever cause, this unsightly appearance of the nose is very annoying.
Treatment. — If from alcoholic drinking, it is an indication that should at once force the drinker to abandon his habit; for acne rosacea always indicates that damage is being done some organ or organs of the body. When caused by diseases of the kidneys, liver or other organic difficulty, the seat of the derangement must be found and attended to as mentioned under general diseases. Often this condition lasts for life despite all treatment, and occasionally it is seemingly inherited. Locally, but little can be accomplished. An ointment of sulphur and a very little boracic acid rubbed up in vaseline could be applied.
Acne Vulgaris very much resembles punctata and appears at the same places, but is a more aggravating difficulty. The retained secretions cause inflammation of a high degree, and as a result there is hardening of the parts or nodules formed in the skin, or else suppuration or pustules. Bad habits may cause acne vulgaris, but not always. Persons of scrofulous tendencies[4] are most prone to be affected. The disease rarely exists or continues after the twenty-fifth year.
Treatment. — Constitutional treatment, as the use of Compound Syrup of Stillingia, is good. Locally use the treatment for acne punctata, but if the pustules are profuse or the tissues hardened and swollen, as is usually the case, a thin lancet should be plunged into the seat of each induration and then a rubber "cup" applied to draw out the pus and congested blood. This is a most effectual method and should be persisted in until relief is obtained.
Acne Sycosis is a form of acne attacking the hairy portions of the skin. Little tubercles or pustules are formed by suppuration of the hair follicles, and the exudated pus, drying in masses, forms scabs in which the hair becomes matted. Acne sycosis usually occurs on the chin in the follicles of the beard, from which it gets its name of "Barbers' Itch."[5] It often follows eczema. After the scabs come off scars are left, upon which hair does not again grow, causing an unsightly appearance. By some this is regarded as a parasitic disease. It is contagious, and razors, combs, towels, etc., used by sufferers from it should be carefully kept from others. This disease of itself is never fatal, though erysipelas may follow[6].
Treatment. — It must be treated about the same as acne punctata, though more energetically. The hairs about the roots of which pustules are formed should be drawn out early, and the pustules themselves pricked as soon as they "come to a head." Persons afflicted with barber's itch should keep well shaven and very cleanly. Borax and ammonia dissolved in water can be used freely to advantage. The following ointment is of great benefit: Take sublimed sulphur, 40 grains; starch, 1 drachm, and mix thoroughly, then add to it glycerine, 1 fluid ounce; borax, 20 grains, previously heated together; rub all these to the consistence of ointment with vaseline. Occasionally persons afflicted with acne sycosis bear the appearance at first glance of those afflicted with small-pox or with syphilis. But it may be always readily known because it attacks only hairy parts. Persons who never shave may have the disease, and women may have the difficulty make its appearance among the hairs of the temples.
[2] There are surprisingly few hits in search engines for "flesh worms", thankfully. I refuse to believe that anyone was under the misapprehension that they were actually worms - the disease is just too common.
[3] The role of diet in acne is still controversial.
[4] "Scrofulous tendencies" referring to mycobacterial cervical lymphadenitis, or scrofula, as opposed to morally degenerate tendencies. Historically thought to be curable by a royal touch.
[5] Acne sycosis also seems to be an archaic term, referring to a form of folliculitis known as sycosis vulgaris. Other conditions known as "Barber's itch" include pseudofolliculitis barbae (PFB) or tinea barbae.
[6] Erysipelas is an acute infection of the upper dermis.