DERMATITIS CUPOLIFORMIS 465 



Treatment is difficult. A warm carbolic 2 per cent, foot bath daily- 

 can be tried, followed by some antiseptic dusting powder, such as zinc 

 oxide. 



Iodide is useful. Ointments are not to be used as the parts should 

 be kept dry. Moist applications should be avoided. 



DERMATITIS CUPOLIFORMIS. 



A nodulo-ulcerative condition, chiefly atTecting Europeans, seen in 

 Ceylon and described by Castellani. 



First one notices several small dusky spots about the lower ex- 

 tremities, some disappear, while others become hard, raised, infiltrated 

 sometimes without vesication or pustulation. Each may vary in size 

 from a cherry to a pea, the centre becoming cupoliform. Later there 

 is ulcer formation. These ulcers are painful, slow healing, requiring 

 about twelve months, and leaving hyperpigmented spots. 



A Gram-positive streptococcus, S. tropicalis, is said io be the 

 causative agent. 



The condition is very resistant to treatment. Autogenous vaccines 

 give the best results. Antiseptic lotions, followed bv Peruvian 

 balsam, can be tried. 



DERMATITIS EXFOLIATIVA (Pityriasis rubra). 



This is an inflammatory condition of the skin, characterized by 

 universal redness without infiltration or thickening, but accompanied 

 by profuse desquamation, the flakes varying in size with the various 

 parts of the body. It may follow other skin diseases or be independent. 

 The onset is sudden ; the eruption rapidly becomes general ; the tint, 

 bright scarlet in Europe, is white or brownish in tropical climes; the 

 scales are arranged like slates on a roof and are never clumped into 

 crusts. Itching is usually absent, but occasionally may be profound. 



The disease is rare. The causation is obscure. 



TREATMENT. 



Antimony is useful in acute cases, arsenic in chronic ones. 



Chills are liable to become dangerous. 



The following local applications will be found useful : — 



Diluted liquor picis carbonis. 



Very weak creoline. 



Carbolized oil, i in 20. 



^ Glycerine of sub-acetate of lead ... i oz. 

 Pure glycerine ... ... ... i ,, 



Water i pint 



Apply to the whole body on lint. 



