SULFUR.

Although benzoyl peroxide, retinoic acid, and antibiotic topical lotions have largely supplanted the older medications, sulfur, resorcin, and salicylic acid preparations are still useful and moderately helpful. Some of the more elegant preparations available are Dermik's Klaron Acne Lotion, containing 2 percent salicylic acid and 5 per cent colloidal sulfur; Rezamid lotion, containing 1 per cent resorcinol and 5 per cent sulfur, and Sulfacet-R lotion, containing 10 per cent sodium sulfacetarnide and 5 per cent sulfur. Westwood produces Fostril lotion, containing 2 per cent sulfur and 6 per cent laureth-4, and Transact, containing 2 per cent sulfur and 6 per cent laureth-4 in a medical gel. Azelizic Acid. Newest drug on the topical acne therapy scene is this dicarboxylic acid, believed to.be the agent responsible for the hypopigmentation induced by pityriasis versicolor. Nazzaro-Porro has worked with it for several years. It is remarkably free from adverse actions of any kind, and its effect on all forms of acne is good, in a 15 percent cream. It has the intriguing property of gradually destroying malignant melanocytes, as well. A double-blind comparison with vehicle study is needed to better assess efficacy. Abrasive Cleansers. Despite the therapeutic claims made for abrasive cleansers, Fulgbum et al were able to show no difference between lesion counts using a cleanser with and without abrasives, over an eight-week period. Surgical Treatment. Local surgical treatment is helpful in bringing about quick resolution of the comedones and pustules as well as the cysts. The edge of the follicle is nicked with a sharp pointed number 11 Bard-Parker scalpel blade and the contents of the coined are expressed with a comedo extractor. Several types of this instrument are available. Scat-ting is not produced by this procedure. Intralesional Corticosteroids. This type of treatment is especially effective in reducing inflammatory papules, pustules, and smaller cysts. Kenalog-10 (triamcinolone acetonide mg per nil) is best diluted with sterile normal saline solution to 5 or 2.5 mg per ml (or even, as Levine et al showed, 1.5 or 0.75 mg/m1) in order to safeguard against atrophy and hypopigmentation at the site of injection. Levine also tried betamethasone (Celestone) by the intralesional route and found it wholly ineffective even at 3 mg/ml concentration. After triamcinolone injections, no recurrence of lesions was seen at one month. A disposable 30-gauge half-inch needle on a disposable 1-ml tuberculin luer syringe should be used. The injection should be made near the surface, again to avoid atrophy at the site of injection. These injections largely obviate the need for incision and expression of most small acne lesions. Do not dilute the Kenalog suspension with Xylocaine or other anesthetics -it is not helpful and indeed will cause the otherwise painless injections to be painful. Cryotherapy. Hyperemia and peeling may be produced by solid carbon dioxide slush. Solid carbon dioxide is finely powdered by placing it into a strong canvas bag, such as a bank money bag, and pulverizing it with a mallet. The powdered

dry ice is placed onto four layers of 8-inch square gauze. The corners are gathered together and a _rubber band used to secure the dry ice into a ball. Using the gathered corners as a handle, the ball of carbon dioxide is dipped into a cup containing just enough acetone to moisten it.