WHERE THERE IS NO DOCTOR SKIN PROBLEMS
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- WHERE THERE IS NO DOCTOR SKIN PROBLEMS
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COMMUNITY HE • TH C -7.7
47/1. (Fiwi Floor; St. Marks Read,
S-16
Bangah-g - 560 001.
CHAPTER
Skin Problems
This is a reprint from
Where 'There Is No Docior
(Indian adaptation)
published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
!35
CHAPTER
Skin Problems
15
Some skin problems are caused by diseases or irritations that affect the skin
only—such as ringworm, diaper rash, or warts. Other skin problems are signs of
diseases that affect the whole body—such as the rash of measles or the sore, dry
patches of pellagra (malnutrition). Certain kinds of sores or skin conditions may
be signs of serious diseases—like tuberculosis, syphilis, or leprosy.
This chapter deals only with the more common skin problems in rural areas.
However, there are hundreds of diseases of the skin. Some look so much alike that
they are hard to tell apart—yet their causes and the specific treatments they
require may be quite different.
If a skin problem is serious or gets worse
in spite of treatment, seek medical help.
GENERAL RULES FOR TREATING SKIN PROBLEMS
Although many skin problems need specific treatment, there are a few general
measures that often help:
RULE #1
RULE #2
If-the affected area is hot
and painful,-treat it with
heat. Put hot, moist cloths
on it (hot compresses).
If the affected area itches,
stings, or oozes, treat it
with cold. Put cool, wet
cloths on it (cold
compresses).
236
RULE #1 (in greater detail)
If the skin shows signs of serious infection such as:
• inflammation (redness of skin.around the affected areas)
• swelling
• pain
• heat (it feels hot)
• pus
Do the following:
♦ Keep the affected part still and elevate
it (put it-higher than the rest of the
body).
♦ Apply hot, moist cloths.
♦ If the infection is severe or the person
has a fever, give antibiotics (penicillin
or a sulfonamide).
Danger signs include: swollen lymph nodes, a red line above the infected area,
or a bad smell. If these do not get better with treatment—use an antibiotic and
seek medical help quickly.
RULE #2 (in greater detail)
If the affected skin forms blisters or a
crust, oozes, itches, stings, or burns, do
the following:
♦ Apply cloths soaked in cool water
with white vinegar (2 tablespoons
of vinegar in 1 quart of pure or
boiled water).
♦ When the affected area feels better,
no longer oozes, and has formed
tender new skin, lightly spread on a
mixture of talc and water (1 part
talc to 1 part water).
♦ When healing has taken place,
and the new skin begins to thicken
or flake, rub on a little vegetable
lard or body oil to soften it.
237
RULE #3
If the skin areas affected
are on parts of the body
often exposed to sunlight,
protect them from the sun.
RULE #4
If the skin areas most affected
are usually covered by clothing,
expose them to direct sunlight
for 20 minutes, 2 or 3 times a
day.
o
Instructions for Using Hot Compresses (Hot Soaks):
1.
Boil water and allow it to cool until you
can just hold your hand in it.
2.
Fold a clean cloth so it is slightly
larger than the area you want to
treat, wet the cloth in the hot
water, and squeeze out the extra
water.
3.
Put the cloth over the affected
skin.
4.
Cover the cloth with a sheet of
thin plastic or cellophane.
5.
Wrap it with a towel to hold
in the heat.
6.
Keep the affected part raised.
7.
When the cloth starts to cool,
put it back in the hot water
and repeat.
238
SKIN PROBLEMS — A Guide to Identification
IF THE SKIN
HAS:_____
'' '.r-'
small or
'•.«*>
AND LOOKS
______________________ LIKE:_______________________
Tiny bumps or sores with much
'
itching-first between fingers, on
the wrists, or the waist.
•
——J~*r~
Pimples or sores with pus or
inflammation, often from
scratching insect bites. May cause
swollen lymph nodes.
\
’
gb
l/, .
.
m
Irregular, spreading sores
with shiny, yellow crusts.
’
S
infection
from bacteria
242
V
impetigo
(<■*
\
Pimples on young peopled faces,
sometimes chest and back, often
with small heads of pus.
243
infection)
252
pimples,
blackheads
i
JI
1
1 A—-S
A sore on the genitals, without
itching or pain.
a large, open
241
/*
/
W
|
\.
SEE
PAGE:
“V
/
’/
,c /
U
YOU MAY
HAVE:
f
A large chronic (unhealing) sore surrounded
by purplish skin-on or near the ankles
of older people with varicose veins.
syphilis
venereal
lymphogranuloma
)
L . /
U /
->(
)
281
283
ulcers from bad
circulation
(possibly
diabetes)
254
bed sores
255
leprosy
232
149
skin ulcer
Sores over the bones and joints
of very sick persons who cannot
get out of bed.
_
Sores with loss of feeling on the
feet or hands. (They dp not hurt
even when pricked with a
needle.)
A warm, painful swelling
that occasionally breaks
lumps under
the skin
/
A
d
7 y/
—s’“'
'(
_________ )
I
- ’ \d
W
A warm, painful lump in the
breast of a woman breast
feeding.
A lump that keeps growing.
Usually not painful at first.
,
|
A'^
abscess or boil
243
mastitis
(bacterial
infection),
possibly cancer
325
cancer
(also see
lymph nodes)
324
325
101
239
A Guide to Identification
240
A Guide to Identification
IF THE SKIN
HAS:
AND LOOKS '
______________________ LIKE:________________________
Simple warts, not very large^
wlrtt
YOU MAY
HAVE:
♦
common warts
(virus infection)
SEE
PAGE
251
.
Large warts (more than 1 cm.),
often on arms or feet.
’
•- • •
' st
_
.
Large circles with a thick border
that do not itch, and that have
feeling in them
“"'er)
. that
. are numbk in the
b
Large rings
center. (A needle prick does not
hurt them.)
\\
4
’ ’"-f;
’
.
.z
Small rings, sometimes
with a small pit in the
middle, found on the
temple, nose, or neck.
\
■
Small rings that continue
to grow or spread and
may itch.
rings
(spots with
raised or red
edges, often
. ... %
sj
\^'’i ’
_ f*• 4* 1
Very itchy rash, bumps, or
patches (They may appear and
disappear rapidly.)
_Z'o>
Blisters with bumps and much
itching and weeping (oozing).
253
ringworm
(fungus infection)
246
could be
advanced stage
of syphilis
282
leprosy
232
of the skin
252
allergic reaction
244
/
s'
\k
/f.
f*’
' t-.*-’
welts or hives
y.
a type of
tuberculosis of
the skin
J
t
\
]
"'A
\
/
/
1
contact
Small blisters over the
whole body, with some
fever.
These blisters later form scabs.
O
x>_
small reddish
spots or a
rash over the
whole body;
1_
A rash that very sick
children get over the
whole body.
245
chickenpox
358
''X
\
|
Herpes zoster
(shingles)
245
J
s'
gas gangrene (very
serious bacterial
infection)
254
measles
358
__ ,_ ___ — /"
--------- ' -—'
~7Si$K.
>—'
A patch of painful blisters that
appears only on one part of the
body, often in a stripe or cluster
A gray or black badsmelling area with blisters
and air pockets that spread.
(like poisonous
plants ;)
■1
f
~
-
~
'
/
Z'Ox
—--s
_
241
SCABIES
Scabies is especially common in children. It causes very itchy little bumps that
can appear all over the body, but are most common:
Scabies is caused by little animals—similar to tiny ticks —which make
tunnels under the skin. It is spread by touching the affected skin or by clothes
and bedding. Scratching can cause infection, producing sores with pus, and some
times swollen lymph nodes or fever.
Treatment:
•
If one person has scabies, everyone in his family should be treated.!.
Make the following paste. ’Boil some neem leaves with a little water. Grind this
with some turmeric powder (Haldi) to form a thick paste
Wash the whole body vigorously, scrubbing well, with soap and water. Smear the
neem and turmeric paste on the whole body, especially between the fingers, the
groin . and between the toes. Stand in the sun for sometime. Apply more paste
everyday for 3 days Do not bathe. Boil all clothes, towels.bedding, bedsheets used
during these three days and dry in the sun On the fourth day. bathe well.’and wear
the freshly dried clothes.
• Personal cleanliness is of first importance. Bathe and change clothes
daily. Wash all clothes and bedding, and dry them in the sun.
• Instead of neem and turmeric paste, you can mix some sulfur in an
equal amount of hot cooking oil and apply it on the body.
Note: Commercial ointment or solution of gamma benzene
hexachloride or benzyl bensoate (p. 411) also kill scabies, but are more expensive.
•
LICE
Head lice and body lice cause itching, and sometimes skin
infections and swollen lymph nodes. To avoid lice, take great
242
care with personal cleanliness. Put cots, pillows, and bedding in the sun every day.
Bathe and wash hair often. Check children's hair. If they have lice, treat them at
once. Do not let a child with lice sleep with others.
Treatment:
Make a solution of equal parts of kerosene
and hair oil.
Apply the solution in the evening
Apply the solution to each separate strand
of hair so that the medicine comes in
contact with all the lice and nits (lice eggs).
After applying solution, wrap the head in a
towel.
In the morning wash hair with soap nut powder, and comb it with a fine toothed
comb.
Soak the brush and comb in kerosene oil to remove the lice present in it.
To get rid of nits, soak hair in hot vinegar and water for half hour and then comb it
thoroughly with a fine toothed comb.
SMALL SORES WITH PUS
Skin infections in the form of small sores with pus often result from scratching
insect bites, scabies, or other irritations with dirty fingernails.
Treatment and Prevention:
♦ Wash the sores well with soap and boiled water,
gently soaking off the scabs. Do this daily as long
as there is pus.
♦ Leave small sores open to the air. Bandage large
sores and change the bandage frequently.
♦ If the skin around a sore is fed and hot, or if the
person has a fever, red lines coming from the sores,
or swollen lymph nodes, use an antibiotic—such as
penicillin tablets (p.397) or sulfa tablets (p.402).
♦ Do not scratch sores. This makes them worse and can spread infection to
other parts of the body. Cut the fingernails of small children very short—or
put gloves or socks over their hands so they cannot scratch.
♦ Never let a child with sores or any skin infection play or sleep with other
children. These infections are easily spread.
♦ Sores in babies may mean serious infection. Show the baby to the health
worker.
243
IMPETIGO
This is a bacterial infection that causes rapidly
spreading sores with shiny, yellow crusts. It
often occurs on children's faces, especially
around the mouth. Impetigo can spread easily to
other people from the sores or contaminated
fingers.
Treatment:
♦ Wash the affected part with soap and boiled
water, gently soaking off the crusts.
♦ Paint the sores with gentian violet (p. 409) or spread on an antibiotic cream
such as Polysporin (p. 409) or tetracycline, if that is all you have.
♦ If the infection is spread over a large area or causes fever, give penicillin
tablets (see p. 397).
Prevention:
* Follow the Guidelines of Personal Cleanliness (p. 1 67). Bathe children daily
and protect them from bedbugs and biting flies. If a child gets scabies, treat
him as soon as possible.
♦ Do not let a child with impetigo sleep or play with other children. Begin
treatment at the first sign.
BOILS AND ABSCESSES
A boil, or abscess, is an infection
that forms a sac of pus under the skin.
Sometimes it results from a puncture
wound or an injection given with a
dirty needle. A boil is painful and the
skin around it becomes red and hot.
It can cause swollen lymph nodes and
fever.
Treatment:
Put hot compresses over the boil several times a day (see instructions on p.
237).
♦ Let the boil break open by itself. After it.breaks, continue applying hot
compresses. Allow the pus to drain, but never press or squeeze the boil, since
this may cause the infection to spread to other parts of the body.
♦ If the boil causes swollen nodes or fever, take penicillin tablets (p. 397)or
erythromycin (p. 400).
244
ITCHING RASH, WELTS, OR HIVES
(ALLERGIC REACTIONS IN THE SKIN)
Touching, eating, injecting, or breathing certain
things can cause an itching rash or hives in allergic
persons. For more details, see Allergic Reactions,
p.203..
Hives are thick, raised spots or patches that look
like bee stings and itch like mad. They may come and
go rapidly or move from one spot to another.
Be on the watch for any reaction caused by certain medicine, like penicillin.
ampicillin, sulfas, phenobarbitone, and the antivenins or antitoxins made from
horse serum Iniections can be especially dangerous. A rash or hives may appear
from a few mmutestupto 10 days after the medicine has been injected
If you get an itching rash, hives, or any other
allergic reaction after taking or being injected
with any medicine, stop using it and never use
that medicine again in your life!
This is very important to prevent the danger
of ALLERGIC SHOCK (see p.83)).
Treatment of itching:
* Bathe in cool water or use cool compresses—cloths soaked in cold water or
ice water.
♦ Compresses of cool dalia (broken wheat) water also calm itching. Boil the dalia in
water, strain it. and use the water when cool. (Starch can be used instead of dalia).
♦ If itching is severe, take an antihistamine like chlorpheniramine (p. 41 9).
To protect a baby from
scratching himself, cut his
fingernails very short, or put
gloves or socks over his hands.
245
PLANTS AND OTHER THINGS THAT CAUSE ITCHING
OR BURNING OF THE SKIN — CONTACT DERMITITIS
Nettles, 'stinging trees', sumac, 'poison ivy',
and many other plants may cause blisters, burns,
or hives with itching when they touch the skin.
Juices or hairs of certain caterpillars and other
insects produce similar reactions.
In.allergic persons rashes or 'weeping' sore
patches may be caused by certain things that
touch or are put on the skin. Rubber shoes,
watchbands, ear drops and other medicines, face
creams, perfumes, or soaps may cause such
problems.
Treatment:
All these irritations go away by themselves when the things that cause them no
longer touch the skin. A paste of oatmeal and water helps calm the itching.
Aspirin or antihistamines (p.419) may also help. In severe cases, you can use a
cream that contains cortisone or a cortico-steroid (see p.4O9)-
SHINGLES(HERPES ZOSTER)
Signs:
A line or patch of painful blisters that
appears all of a sudden on one side of
the body is probably shingles. It is most
common on the back, chest, neck, or
face. The blisters usually last 2 or 3
weeks, then go away by themselves.
Sometimes the pain continues or returns
long after the blisters are gone.
Shingles is caused by the virus that
causes chickenpox and usually affects
persons who have had chickenpox before.
It is not dangerous. (However, especially
in older persons, it is occasionally a
warning sign of some other more serious
problem—perhaps cancer.)
Treatment:
♦ Put light bandages over the rash so that clothes do not rub against it.
♦ Take aspirin for the pain. (Antibiotics do not help.)
246
RINGWORM, TINEA (FUNGUS INFECTIONS)
Fungus infections may appear on any part of the body, but occur most
frequently on:
the scalp
the parts without
hair (ringworm)
between the
toes or fingers
between the lees
Most fungus infections grow in the form of a ring. They often itch. Ringworm of
the head can produce round spots with scales and loss of hair. Fingernails infected
with the fungus become rough and thick.
Treatment:
♦ Soap and water. Washing the infected part every day with soap and water
may be all that is needed. If possible, use a soap with hexachlorophene
(p.409).
♦ Do your best to keep the affected areas dry and exposed to the air or
sunlight. Change underwear or socks often, especially when sweaty.
♦ Use a cream of sulfur and oil (1 part sulfur to 10 partsioil ).
♦ Creams with salicylic or undecylenic acid (Whitfield's ointment p. 410) helps cure
the fungus between the fingers, toes, and groin.
♦ For severe tinea of the scalp, or any fungus infection that is widespread or
does not get better with the above treatments, take griseofulvin, ft may be
necessary to keep taking it for weeks
or even months to completely control
the infection, (p. 410).
Many tineas of the scalp clear up
when a child reaches puberty (11 to
14 years old). Severe infections
forming large swollen patches with
pus should be treated with compresses
of warm water (p. 237). It is
important to pull out all of the hair
from the infected part. Use griseofulvin,
if possible.
247
How to prevent fungal infections:
Ringworm and all other fungus infections are contagious (easily spread). To
prevent spreading them from one child to others:
♦ Do not let a child with a fungal infection sleep with the others.
♦ Do not let different children use the same comb or use each other's clothing
unless these are washed or well cleaned first.
♦ Treat an infected child at once.
WHITE SPOTS ON THE FACE AND BODY
Small dark or light spots with a distinct and
irregular border that are often seen on the neck,
chest, and back may be a fungal infection called
tinea versicolor. It usually does not itch and is of
little medical importance.
Treatment:
* Make a cream with sulfur and oil.i (1 part
sulfur to 10 parts oil) and apply it to the
spots every day until they disappear.
♦ Sodium thiosulfate works even better. This is the 'hypo' photographers use
when developing film. Dissolve a tablespoon of sodium thiosulfate in a glass
of water, apply it to the*skin, and then rub the skin with a piece of cotton
dipped in vinegar.
♦ To prevent the spots from returning, it is often necessary to repeat this
treatment every 2 weeks.
There is another kind of small whitish
spot that is common on the cheeks of
dark-skinned children who spend a lot of
time in the sun. The border is less clear
than in tinea versicolor. These spots are
not' an infection and are of no
importance. Usually they go away as the
child grows up. No treatment is needed.
Contrary to popular opinion, none of these types of white spots is a sign of
anemia. They will not go away with tonics or vitamins. The spots that are only on
the cheeks do not need any treatment.
248
Vitiligo (White Areas of the Skin)
In some persons, certain areas of the
skin lose their natural color (pigment).
Then white patches appear. These are
most common on the hands, feet, face,
and upper body. This loss of normal skin
color—called vitiligo—is not an illness. It
can be compared to white hair in older
people. No treatment helps or is needed,
but the white skin should be protected
from sunburn—with clothing or an
ointment of zinc oxide.
Other Causes of White Skin Patches
Certain diseases may cause white spots
that look like vitiligo.
Any whitish patch that has no feeling
when pricked with a pin is probably
leprosy (see p.232).
Some fungus infections also cause
whitish spots (see tinea versicolor).
MASK OF PREGNANCY
During pregnancy many women develop
dark, olive-colored areas on the skin of
the face, breasts, and down the middle
of the belly. Sometimes these disappear
after the birth and sometimes not.
These marks also appear sometimes on
women who are taking birth control pills.
They are completely normal and do
not indicate weakness or sickness. No
treatment is needed.
PELLAGRA
AND OTHER SKIN PROBLEMS DUE TO MALNUTRITION
Pellagra is a form of malnutrition that affects the skin and sometimes the
digestive and nervous systems. It is very common in places where people eat a lot
249
of maize (corn) or other starchy foods and not enough beans, meat, eggs,
vegetables, and other body-building and protective foods (see p. 128' and 129).
In winter most people in Northern India eat chapatis made of maize flour. They
should add some wheat flour before making the chapatis.
Skin signs in malnutrition (see the pictures on the following page):
In malnourished children, the
skin of the legs (and sometimes
arms) may have dark marks, like
bruises, or even peeling sores; the
feet may be swollen (see p. 133)-
When these conditions exist, often there are also other signs of
malnutrition: swollen belly; sores in the corners of the mouth; red, sore tongue;
weakness; loss of appetite; failure to gain weight; etc. (see Chapter 11, p.133).
Treatment:
♦ Eating nutritious foods cures pellagra. Every day a person should eat beans,
lentils, groundnuts, or some chicken, fish, eggs, meat, or cheese. When you
have a choice, it is also better to use wheat (preferably whole wheat) instead
of maize (corn).
♦ For severe pellagra and some other forms of malnutrition, it may help to
take vitamins, but good food is more important. Be sure the vitamin formula
you use is high in the B vitamins, especially niacin. Brewer's yeast is a good
source of B vitamins.
250
The swelling and dark spots on
this boy's legs and feet are the
result of poor nutrition. He was
eating mostly maize (corn) with
out any foods rich in proteins
and vitamins.
One week after he began to eat
beans and eggs along with the
maize, the swelling was gone and
the spots had almost disappeared.
The 'burnt' skin on the legs of
this woman is a sign of pellagra—
which results from not eating
well (see p. 249).
251
WARTS (VERRUCAE)
Most warts, especially those in children, last 3 to 5
years and go away by themselves. Flat, painful wart-like
spots on the sole of the foot are often 'plantar warts'.
(Or they may be corns. See below.)
Treatment:
♦ Magical or household cures often get rid of warts.
But do not use strong acids or poisonous plants, as
these may cause burns or sores much worse than the
warts.
♦ Painful plantar warts sometimes can be removed by
a health worker.
CORNS
A corn is a hard, thick part of the skin. It forms where sandals or shoes push
against the skin, or one toe presses against another. Corns can be very painful.
Treatment:
♦ Get sandals or shoes that do not press on the corns.
♦ To make corns hurt less, do this:
1. Soak the foot in warm
water for 15 minutes.
2. With a file or rasp, trim down
the corn until it is thin.
COwi.'.'i JNITY HEALTH CELL
4.7 f
kfrns>-t-lot^-Sv Mail.ii Piwodu
252
PIMPLES AND BLACKHEADS (ACNE)
Young people sometimes get pimples on their face,
chest, or back—especially if their skin has too much oil
in it. Pimples are little lumps that form tiny white
'heads' of pus or blackheads of dirt. Sometimes they
can become quite sore and large.
Do not pinch or touch any pimple. Pinching or
touching pimples on the nose and around the mouth
is especially dangerous.
Treatment:
♦ Wash the face twice a day with soap and hot water.
♦ Sunshine helps clear pimples. Let the sunlight fall
on the affected parts of the body.
♦ Eat as well as possible, drink a lot of water, and get enough sleep.
♦ For serious cases forming lumps and pockets of pus, if these do not get.
better with the methods already described, tetracycline may help.
CANCER OF THE SKIN
Skin cancer is most frequent in light-skinned persons who spend a lot of time in
the sun. It usually appears in places where the sun hits with most force, especially:
Skin cancer may take many forms. It usually begins as a little ring the color of
pearl with a hole in the center. It grows little by little.
Most cancers of the skin are not dangerous if treated in time. Surgery is needed
to remove them. If you have a chronic sore that might be skin cancer, see a health
worker.
To prevent skin cancer, light-skinned persons should protect themselves from
the sun and always wear a hat. Persons who have suffered from cancer of the skin
and have to work in the sun can buy special creams that protect them. Zinc oxide
ointment is cheap and works well.
253
TUBERCULOSIS OF THE SKIN OR LYMPH NODES
The same microbe that causes tuberculosis of the lungs also sometimes affects
the skin, causing painless
As a rule, TB of the skin develops slowly, lasts a long time, and keeps coming
back over a period of months or years.
Also, tuberculosis sometimes infects the
lymph nodes—most often those of the neck or in
the area behind the collar bone, between the
neck and the shoulder. The nodes become large,
open, drain pus, seal closed for a time, and then
open and drain again. Usually they are not
TUBERCULOSIS
OF THE
LYMPH NODES,
OR SCROFULA
painful.
Treatment:
In the case of any chronic sore, ulcer, or swollen lymph nodes, it is best to seek.
medical advice. Tests may be needed to learn the cause. Tuberculosis of the skin
is treated the same as tuberculosis of the lungs (see p. 220). To keep the infection
from returning, the medicines must be taken for many months after the skin
looks well.
ERYSIPELAS
This is a very painful, acute infection in the skin. It
forms a hot, red, swollen patch with a sharp border. The
patch spreads rapidly over the skin. It often begins on —
the face, at the edge of the nose. This usually causes
swollen lymph nodes, fever, and chills.
Treatment:
Begin treatment as soon as possible. Use an antibiotic: penicillin tablets,
400,000 units, 4 times a day; in serious cases, injectable procaine penicillin,
800,000 units daily (see p. 399). Continue-using the antibiotic for 2 days after all
signs of infection are gone. Also use hot compresses—and aspirin for pain.
254
GANGRENE (GAS GANGRENE)
This is a very dangerous infection of a wound, in
which a foul-smelling gray or brown liquid forms.
The skin near the wound may have dark blisters and
the flesh may have air bubbles in it. The infection
begins between 6 hours and 3 days after the injury.
It quickly gets worse and spreads fast. Without
treatment it causes death in a few days.
Treatment:
♦ Open up the wound as wide as possible. Wash it out with boiled water and
soap. Clean out the dead and damaged flesh. If possible, flood the wound
with hydrogen peroxide every 2 hours.
♦ Inject penicillin (crystalline if possible),
♦
Leave the wound uncovered so that air gets to it. Get medical help.
ULCERS OF THE SKIN CAUSED BY POOR CIRCULATION
Skin ulcers, or large, open sores, have many causes (see p. 238). However, chronic
ulcers on the ankles of older persons, especially in women with varicose veins,
usually come trom poor circulation. I he blood is not
moved fast enough through the legs. Such ulcers may
become very large. The skin around the ulcer is dark
blue, shiny, and very thin. Often the foot is swollen.
Treatment:
♦ These ulcers heal very slowly—and only if great
care is taken. Most important: keep the foot up
—as high and as often as possible. Sleep with it
on pillows. During the day, rest with the foot up
high every 15 or 20 minutes. Walking helps the
circulation, but standing in one place and sitting
with the feet down are harmful.
♦ Put warm compresses of weak salt water
on the ulcer—1 teaspoon salt to a liter of boiled
water. Cover the ulcer loosely with sterile gauze
or a clean cloth. Keep it clean.
♦ Support the varicose veins with elastic stockings
or bandages. Continue to use these and to keep
the feet up after the ulcer heals. Take great care
not to scratch or injure the delicate scar.
Prevent skin ulcers—care for varicose veins early (see p. 212).
255
BED SORES
These chronic open sores appear in persons so ill they cannot roll over in bed,
especially in sick old persons who are very thin and weak. The sores form over
bony parts of the body where the skin is pressed against the bedding. They are
most often seen on the buttocks, back, elbows, or feet.
How to prevent bed sores:.
♦ Turn the sick person over every hour: face up, face down, or from one side
to the other.
♦ Bathe him every day and rub his skin with rubbing.alcohol
♦ Use soft bed sheets and padding. Change them daily and each time the
bedding gets dirty with urine, stools, vomit, etc.
♦ Put cushions under the person in such a way that the bctny parts rub less.
Feed the sick person as well as possible. If he does not eat well, extra
vitamins may help (see p.139).
I
■
A child who has a severe chronic illness should be held often on his mother's
lap.
Treatment:
• Do all the things mentioned above.
♦ Wash the sores with boiled water mixed with a little salt or hydrogen
peroxide. Protect them with sterile gauze bandages.
256
SKIN PROBLEMS OF BABIES
Diaper Rash
Reddish patches of irritation between
a baby's legs or buttocks may be caused
by urine in his diapers (nappy) or bedding.
Treatment:
♦ Bathe the child daily with lukewarm water and mild soap.
♦ To prevent or cure the rash, the child should be kept naked, without diapers,
and he should be taken out into the sun.
If diapers are used, change them often. After washing the diapers, rinse them
in water with a little vinegar.
Use talc (talcum powder) only after the rash is gone.
Cradle Cap (Seborrhea, Dandruff)
Cradle cap is an oily, yellow crust that forms on a baby's scalp. The skin is often red and irritated.
Cradle cap usually results from not washing the
baby's head often enough, or from keeping the head
covered.
Treatment:
* Wash the head daily. If possible use a medicated
soap (see p.409).
♦ Gently clean off all the dandruff and crust. To loosen the scales and crust,
first wrap the head with towels soaked in lukewarm water.
♦ Keep the baby's head uncovered, open to the air and sunlight.
♦
For home remedies, see page 20.
DO NOT COVER A
BABY'S HEAD
WITH A CAP OR
CLOTH.KEEP
THE HEAD
UNCOVERED.
NO
YES
| BARE IS BEST |
♦ If there are signs of infection, treat as for impetigo (see p. 243).
257
ECZEMA (RED PATCHES WITH LITTLE BLISTERS)
Signs:
• In small children: a red patch or rash forms
on the cheeks or sometimes on the arms and
hands. The rash consists of small sores or
blisters that ooze or weep (burst and leak
fluid).
• In older children and grown-ups: eczema is
usually drier and is most common behind
the knees and on the inside of the elbows.
• 11 does not start as an infection but is more
like an allergic reaction.
Treatment:
♦ Put cold compresses on the rash.
♦ If signs of infection develop (p.101) treat as
for impetigo (p.243).
♦ Let the sunlight fall on the patches.
♦ In difficult cases, use a cortisone or cortico-steroid cream (see p.409).
♦ If the eczema patch is moist, apply linseed oil over it. This prevents the skin
from drying up and relieves itching. Do not apply mustard oil.
PSORIASIS
Signs:
Thick, rough patches of
reddish or blue-gray skin
covered with whitish or----- ”
silver-colored scales. The
patches appear most
commonly in the parts shown
in the drawings.
The condition usually lasts a
long time or keeps coming
back. It is not an infection and
is not dangerous.
Treatment:
Leaving the affected skin open
to the sunlight often helps.
Bathing in the sea some
times helps.
Ointments with cortico-steroids
<P- 409) or coal tar may help.
In severe cases, seek medical
advice.
The book Where "There Is No Doctor is available
at Rs 29/- plus postage. Multiple copies of reprints
of various chapters are also available.
Please write to:
Publications Officer
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
Rs. 2.00
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