668 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS Table V Analysis of prescriptions for impetigo Medicament Dyes Phenol Mercury salts Zinc salts Lead salts Corticosteroids Antibiotics Antibacterial agents Potassium permanganate Percentage of prescriptions 1951 50 25 50 0 0 1957 7 7 7 2O 7 14 6O 0 0 1967 0 0 0 0 0 25 75 12 12 The use of antibiotics in topical dermatological treatment has not been without problems. Early enthusiasm for penicillin led to its widespread use but it soon became apparent that local application frequently gave rise to sensitivity reactions, and this carried with it the added danger that topical application would create sensitization which precluded the later systemic use of penicillin in a more serious, and possibly life-threatening, infection. Since the realization of this danger, antibiotics for local applications have been selected from those which are not commonly used for systemic treat- ment. However, chlortetracycline appears to have a low sensitivity index and is one of the antibiotics commonly used in dermatology. Neomycin sulphate, selected because it is too toxic for systemic use, is still a commonly prescribed local antibiotic but sensitivity to neomycin is an increasing problem. The dyestuffs which were commonly used in 1951 no longer add to the temporary disfigurement of impetigo. However, other synthetic anti- bacterial agents, such as clioquinol, are sometimes used in preference to the antibiotics. These were present in 12% of the prescriptions analysed in 1967. Mercury compounds and phenol, commonly used in 1951, are no longer prescribed. VARICOSE ULCERS The prescriptions for patients suffering from varicose ulcers are analysed in Table VI. The declining use of dyestuffs in dermatology is again reflected in the analysis of these prescriptions. Scarlet red, which formerly had a reputation for stimulating the regeneration of tissue around an ulcer

THE CHANGING PATTERN OF TOPICAL DERMATOLOGICAL THERAPY 669 crater is now seldom, if ever, used. Zinc salts in the form of the oxide or carbonate are still a common ingredient of preparations applied to ulcers. Table VI Analysis of prescriptions for varicose ulcers Medicament Dyes Zinc salts Antibacterial agents Antibiotics Corticosteroids Tar Ichthamrnol Hydrous wool fat Percentage of prescriptions 1951 30 40 12 0 0 12 18 0 1957 lO 50 16 o o 16 16 o 1967 o 20 12 25 25 6 6 6 Antibacterial agents and antibiotics appear as ingredients in 36% of the prescriptions in 1967 and are used when infection is a complicating factor. Tar and ichthammo1 are still used to a limited degree, usually as ingredients of a paste-impregnated bandage applied to the ulcer. FUNGAL INFECTIONS The prescriptions for patients suffering from fungal infections are analysed in Table VII. The problem with the topical treatment of these conditions is to obtain a preparation which effectively carries the fungicide to the site of the infection. Hair and nail infections by fungi are particularly resistant to topical treatment. In the past, treatment of ringworm of the scalp often involved the removal of the hair by means of X-rays and surgical removal of the nail in nailinfections. The introduction of griseofulvin in 1958 marked a great advance in the treatment of fungal infections of the skin. This antibiotic is administered systemically, and is selectively taken up into the keratin layer which becomes resistant to the infection. As the outer, infected layers of keratin are shed, they are replaced by a keratin layer which is free from infection. The usefulness of griseofulvin in the treatment of fungal infections is reflected in the analysis of prescriptions for 1967 when it was used in 59% of the prescriptions analysed. However, it has not completely replaced topical treatments but there has been a marked reduction in the variety of topical fungicides prescribed. The well- established combination of salicylic and benzoic acids remains one of the