34 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS EFFICACY OF TOPICAL TREATMENT Sedative and emollient medicaments Most generally used for slight keratin disorders is hydrous ointment, Ung. Aquosum, B.P.-w/o emulsion with wool alcohols ointment. It is effective as a hydrating agent but very greasy and less cosmetically pleasant than many proprietary w/o emulsions of liquid paraffin, soft paraffin, adeps lanae and emulsifying agents specially formulated for dry skins. Dry, chapped hands and brittle nails respond well, especially when the cream is used overnight under occlusive polythene gloves which increase hydration through reabsorbed perspiration. Chapped lips are less satisfactorily treated although emulsion creams with silicones help to lessen water evaporation. Self-emulsifying bath oils should find in- creasing use for senile skins and dyskeratotic skins in adverse climates. The oils seem well absorbed by abnormal keratinized skin, mineral oils adhere better than vegetable oils absorption being increased by temper- ature and duration of immersion ($). Some atopic eczema subjects are more comfortable if they bath twice a day in colder, dry weather. More severe degrees of ichthyosis are usually less satisfactorily treated by routine baths followed immediately by emollient greasy creams such as hydrous wool fat ointment, ung. adeps lanae hydrous containing hydrous wool fat and yellow soft paraffin, or wool alcohol ointments B.P. (wool alcohol 6% with hard, soft and liquid paraffins), or white petroleum jelly. Sodium chloride 10•o has been used in petroleum jelly to increase water holding capacity but some development of preparations along the lines of cosmetics with humectants which can be prescribed under a national formulary would be welcome. Cleansing agents and barrier creams Intolerance of soapy detergent cleansing agent is often on a personal basis due to alkali intolerance or penetration of fatty acids, more likely through non-intact keratin. Industrial barrier creams are now sub judice until controlled industrial trials under actual working conditions support or disprove the makers' claims. Most agree that the complete protective "invisible glove" is impossible to attain or maintain under normal working conditions, but that they are not entirely useless. They do not on their own prevent dermatitis, nor stop the entrance of sensitizing chemicals, and are only to be considered as a part of the general prevention programme. They

SOME DIFFICULTIES OF TOPICAL TREATMENT IN DERMATOLOGY 35 are not helpful with such common irritants as cement, oils or continuous exposure to wet conditions. Vanishing creams and hydrophilic water-miscible creams help in hand- cleansing, but the soap content may be deleterious to alkali-intolerant and dry skins. Neutral soapy or non-soapy synthetic detergent barsrecently introduced as cleansing agents have been most helpful in alkali-sensitive persons. Similar difficulties arise in management of facial acne where excessive washing with soap on dry skin is not tolerated on the peripheral non-acne bearing areas of the skin, although the central acne areas require this. On the scalp, the removal of desquamated keratin as dandruff and scales by anionic and nonionic soapless shampoos has greatly facilitated head cleansing and ointment removal but difficulties have arisen with some shampoos containing alkyl benzene sulphonates and selenium which may actually increase oily seborrhoea and scalp greasiness (4). Anti-itching agents Cooling produces effective relief of itching, hence the temporary relief from evaporating lotions, simple w/o emollients or agents, e.g. menthol producing a cold sensation. Low sensitizing antibacterial or antibiotic agents which reduce the enzymic degradation of protein are usually effective when combined with hydrocortisone in the relief of pruritus ani, scalp itching or developed eczema although the effect of the application may not last sufficiently long. Many antipruritic agents can only act by anaesthetizing the nerve, endings, and having thus to penetrate through non-intact skin they can irritate or sensitize. Predominant among these are the local anaesthetic procaine-type ointments and the antihistamines, especially pyribenzamine both are very common sensitizers. Phenol and other coal tar distillates are much less likely to irritate, though a few are intolerant. A nti-infective agents A vast, post-war literature has been collected on the sensitization potential of chemotherapeutic agents (sulphonamides) or antibiotics (peni- cillin, etc.) Of increasing importance is neomycin with an ability to cross-sensitize with such other "mycins" as kanamycin, soframycin, framycetin, and bacitracin. Less likely to sensitize or irritate are quatern- ary ammonium salts and hydroxyquinoline derivates, but cross-sensitization exists between the members of this last family.