4O JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS develop eczema because they have an inferior dry skin which is easily damaged. In atopic eczema, the flexural thickened skin is very itchy and troublesome. These people with abnormal skins suffer various disabilities. The first thing is reduction of the water content, leading to numerous minor disorders for which treat- ment is sought. For example, they may well have winter chapping of the hands. Another condition, mostly seen in children, is a dry, flaky eczema of the face during winter known as pityriasis alba, which clears up in the following summer it may leave white patches on the skin as the excessive moisture prevents solar pigmentation. Then there may be chapping of the lips, particularly in people who have any obstruction of the nose or large tonsils or adenoids so that they breathe through the mouth. These cracked and chapped lips may lead eventually to chronic eczema. We help them by trying to hydrate the keratin again and by lessening evaporation, through putting on silicones overnight. Some of these people have a habit of licking the lips and they can develop a chronic cheiliris. Chronic fissuring either side of the mouth follows the same principles. The skin is always wet in this area and as it dries, the skin loses its elasticity and cracks. This is more common with ill-fitting dentures but it often affects the atopic, dry-skinned person. Dry skin behind the ears is also liable to crack easily. This is a problem from the standpoint of infection. Most people carry organisms on the skin without ill- effect, but patients with eczema and ache are subject to repeated infections perhaps because they carry staphylococci in fissures or the nasal vestibule. Sepsis may occur behind the ears, in the nose, on the face or as boils on the trunk, in the groins or in any area of eczema. Many people are susceptible to solvents used for cleaning the hands, since these defat and dehydrate the skin. They are also susceptible to physical trauma. Contact dermatitis usually involves all the areas in contact, and bacteria also com- monly produce a sensitization eczema. The starting-point may well be friction with clothing, or hot bathing with alkaline soaps which open the way for penetration of bacteria and chemical sensitizers. Dry-skinned persons also have problems in industry. As the skin has diminished flexibility, a squamous eczema may develop on areas of pressure this is commonest in the 40-50 age group, when endocrine involutional changes are taking place. This type of eczema is especially difficult to treat successfully as the patient has to go on working. Another problem of the dry-skinned person may appear as difficulty in sweating freely. Microtrauma to the skin cause keratinous obstruction in the sweat pores, leading to various gradations of miliaria or "prickly heat." Such eruptions are extremely common I am sure that many people who complain of trouble with cosmetics do not suffer from a true contact dermatitis at all, but from a poral obstruc- tion due to friction or excessive sweating. Sweat obstruction also occurs on the hands in people wearing protective gloves for long periods of time and in emotionally unstable people who sweat a great deal. They develop a hand eczema termed pompholyx, cheiropompholyx or dyshidrosis. Mechanical obstruction to sweating is a common eczematous reaction which relapses easily. In the unusual event of a cosmetic contact dermatitis, a second episode is often caused by a pre-existing sweat obstruction due to previous inflammation or to the treatment given as soon as the patient gets hot, the eruption starts again. I have seen this in people holidaying in unfamiliar climates such as Italy, where they become excessively sunburned. On returning home, a miliaria may follow.

SOME DIFFICULTIES OF TOPICAL TREATMENT IN DERMATOLOGY 41 A dry skin itches very commonly because of the minor inflammations or from sweat obstruction which gives a prickling sensation. Many people notice that they start prickling all over when getting into bed. This is quite common in active eczema or in abnormal dry skins. Bacteria breaking down protein will cause itchiness, but minor itching is a universal symptom which may easily be produced by a variety of causative mechanisms. As to treatment, we deal with most of the dry skins by trying to replace the water content with emollient ointments. Conditions like cracked hands or brittle nails can do very well with polythene gloves and a hydrous ointment. Such gloves may, however, lead to a sweat obstruction syndrome with prickly heat or a dyshidrotic eczema. The more severe degrees of ichthyosis are difficult to manage and we would really like some help in providing a satisfactory preparation which would be con- tinuously emollient and keep the patients comfortable. Anti-itching agents are mainly designed to cool the skin- cooling being an effective way of reducing irritation- to lessen the dryness or to have an antibacterial effect on organisms that degrade proteins into polypeptides causing itchiness. Many of these antibacterials and the anti- pruritics which act on the sensory system are, however, sensitizing agents. Abnormal skins often recover completely to their original, slightly abnormal state after slight irritations, but if the skin is sufficiently damaged it seems to develop the "bad habit" of producing the eruption again and again. In this category falls the individual who becomes more and more sensitized to the topical applications applied for the treatment of a skin condition. If the areas of imperfectly keratinized skin are removed in psoriasis, the skin almost returns to normal although it can never be completely normal. If areas of psoriasis are left untreated, there is a tendency to produce further psoriasis the longer the patient has it, the more chronic it becomes and the skin is more liable to develop the habit of producing it. The anti-inflammatory steroids first introduced for the treatment of psoriasis proved extremely effective, but as they became more potent, they began to cause trouble. We had already found that giving steroids internally to patients would suppress the psoriasis, but as soon as one withdrew the steroid, the psoriasis rebounded and was then more difficult to control. This is also a real difficulty with topical steroids sometimes the skin becomes so unstable that it produces psoriasis as a result of almost any stimulus and the psoriatic reaction may change qualitatively. The topical steroids are easily absorbed and they can produce quite marked collagen degeneration locally with thinning of the skin. The whole skin becomes more transparent, with the venules and capillaries showing through. Not only may there be a local degeneration but absorption and systemic degeneration may follow elsewhere giving rise to striae, for example, either at the site of application or in a remote site. Acne is a condition representing just a physiological variation in the normal skin. I feel that many of the present day treatments are not very satisfactory. Bacterial infection probably plays a major part in producing the gross scarring and inflam- matory lesions, but basically the problem is one of cleaning the skin and of removing the sebum and keratin plugging the sebaceous orifices. This is illustrated by cutting oil folliculitis, also known as "oil acne," due to contact with an engineers' cutting oil which results in obstruction of the hair follicles. These people require help by providing them with a cleansing agent which will emulsify the collection of petroleum oil and sebum in the pilosebaceous orifices. A very large percentage of workers on multiple cutting machines may be afflicted.