CHAPTER XVIIELECTROLYSIS IN DERMATOLOGY

Several references have been made in the preceding chapter to the specific use of electricity without a description, however, of its source or application. The author does not deem it necessary in this volume to go into the principles of electricity, and takes it for granted that the practitioner is sufficiently familiar with a knowledge of the rudiments of the subject and that he understands the meaning of an electric cell commonly known as a battery.

The Electric Battery.—An electric cell or battery is made up of two poles which are named positive, designated by the + (plus) sign, and negative by the - (minus) sign. In the usual form of cell used the parts are made up of a carbon and zinc cylinder placed into a glass jar containing the electrolyte or actuating fluid. The latter is either an aqueous solution of potassium bichromate or salammoniac contained in a glass jar.

For continuous use or open circuit work the Le Clanche type of cell is most practicable.

Fig. 502.—Electric Wet Cell.

InFig. 502a cell of this type is shown in which the positive pole or element is composed of a solid piece of carbon forming a cover to the glass jar as well, and the negative element is of zinc. The covering over of the jar prevents evaporation of the solution and adds much to its life.

The Voltage or Electromotive Force.—The voltage or electromotive force from such a cell averages about 1.5 volts. Voltage represents the force or propelling power of current known scientifically as the electromotive force and designated EMF. Owing to the great resistance of the body to the electric current, a proportionate force is required to attain therapeutic results.

The unit measure of the quantity of current is known as the ampère. As this is too great for therapeutic use, the thousandth part, ormilliampère, is employed, and for the purpose of measuring the amount of current given the patient the milliampèremeter is included in the circuit or flow of current.

The unit of resistance is termed the Ohm, and to simplify the method of electrotherapeutic administration the practitioner may refer to Ohm’s law as a guide. He must remember the average resistance to the current of the parts to be operated on by this process. The law is as follows:

or commonly written

The Rheostat.—When we consider that the resistance between electrodes placed on the palm of the left handand the back of the neck is about 4,000 Ohms, it may be readily understood that considerable voltage is required to overcome this resistance before the proper amount of current can be employed. Since each cell, for quick reference, may be said to represent one volt, at least twelve and not more than sixteen cells would be required for electrolysis. Not all of the current given off by a battery of such number of cells should be used on a patient for electrolytic purpose. Some method must be employed to reduce this voltage and to control it at will. This is necessary since the life of a cell varies and its current capacity is limited according to the use the cell is put to. An instrument of this nature is called arheostatand is usually made of graphite or metal wire. Water resistances are also used, but they do not permit of a constant current because of the consequent heating and decomposition of the water into its elements at the two metal poles exposed to the water. The proper instrument will be referred to later.

The electric cell represents a certain voltage; to add to this more cells are needed and connected with each other so that each adds its voltage to other or the circuit. The method of connecting cells in this manner is called series connection, in which the carbon element of one cell is connected with the zinc of the next, and so forth, until the last cell, leaving two free poles, one carbon and a zinc to which the wires to hold the electrodes for the patient are connected. As has been said, the carbon is the positive pole and the zinc the negative. The method of connection is shown inFig. 503.

Fig. 503.—Series Connection.

These two poles when brought in contact with humantissue exhibit different action and effect. Without going into electro-chemistry it may be said the current of the positive pole is sedative and that of the negative irritant or destructive. That oxygen and acids are freed at the positive pole and hydrogen and alkalies at the negative pole.

It is due to these properties of the current that it is employed therapeutically, but to properly employ it the current must be controlled so that the exact amount given or used can be estimated. This is accomplished first of all by the interposition of resistance within the circuit. This resistance should be such that the current can be increased or decreased at will. It has been referred to and is called a rheostat. Its position in the circuit is shown inFig. 504.

Fig. 504.—Shunt Rheostat Connection.

Cell Selector.—The physician may do without such a rheostat and use a cell selector with the object of adding one or more cells to the circuit at will. Such instrument is composed of a marble or wooden base with a number of disks upon it, each disk representing a cell of the battery. A metal arm is made to slide over these disks, and as it advances over each disk the current from that cell is added to the circuit. It may have a second arm which is used to cut out the current from the cell or cells at the beginning of the circuit—in fact, will permit of the selection of any cell in the circuit by proper manipulation. Such a selector is shown inFig. 505.

Fig. 505.—Cell Selector.

The connection of the cells of the battery when a selector is used varies from that just mentioned. The proper wiring with the disks of the Selector is shown inFig. 506.

Fig. 506.—Cell Selector and Battery Arrangement.

Milliampèremeter.—The fact that a proper resistance has been forced in circuit is not alone sufficient to permit of the proper use of current for electrolysis. A measuring device should be included, as has been referred to and called the Milliampèremeter or Milliammeter. It is shown inFig. 507.

Fig. 507.—Milliampèremeter.

The method of connecting this instrument in series with the current from the rheostat has been shown inFig. 509.

The Electric Current.—Where the operating room of the physician is provided with street current it will be foundmore economical and cleaner to use that current for this purpose.

Usually the direct current is furnished of a voltage varying from 100 to 125 volts. To utilize such a current a wall plate is employed and connected to the circuit, as shown inFig. 508. The resistance of an electric lamp is added to guard against injuring the patient if by any accident or negligence the circuit has been improperly closed.

Fig. 508.—Direct Current Switch Board or Wall Plate.

Whether the street or battery current is used with such a plate makes no difference except that with a battery circuit the lamp is not used. The connections are given inFig. 509.

Fig. 509.—Wall-Plate Connections.

It will be observed that a current changing switch has been added to the wall plate. This is included in the circuit to permit of changing the poles to the patient without interfering or disconnecting the electrodes if desired at any time during treatment.

Portable Batteries.—The above instruments and circuits refer to those to be used in the operating room and are stationary. The physician may be called upon to treat a patient at a distance and for this purpose must have a portable battery.

There are many such instruments on the market of both dry and moist cell type. The moist cells usuallyrequire a bichromate of soda or potash solution and are so constructed that the carbon and zinc poles are taken out of the electrolyte or solution and placed into water-tight compartments provided for them. Such an apparatus is shown inFig. 510a.

Fig. 510a.—Portable Wet Cell Direct Current Apparatus.

The best cell for this purpose is the silver chloride battery. It is compact, light in weight, and gives a steady current. The only objection is the high cost.

Portable batteries should be furnished with a milliampèremeter. A type of a compact dry cell direct current apparatus is shown inFig. 510b. In the end the best apparatus proves the most economical.

Fig. 510b.—Direct Current Dry Cell Apparatus with Rheostat and Interrupted Current Attachment.

Electrodes.—Having the circuit or current under control, it now becomes necessary to attach electrodes to the free poles to be able to properly apply it to the patient. These electrodes vary considerably according to their use. The author will refer to only those that are of service in electrolysis.

Sponge Electrode.—The one electrode held by the patient is usually made of a metal disk covered with feltor sponge attached to a wooden handle and is shown inFig. 511.

Fig. 511.—Sponge Electrode.

This electrode represents the positive; the negative pole is held by the operator. When used, the felt or sponge is moistened with warm water to which a little salt has been added and is placed into the palm of the hand, sponge inward.

The author prefers to use a plain metal disk with the sponge and places a piece of absorbent cotton or gauze over it when in use for hygienic reason.

When the operator prefers he may resort to arm or wrist electrodes which can be clamped upon the limb and be held in position and shown inFig. 512.

Fig. 512.—Arm Electrode.

The hand electrode is of greater service since the patient can regulate or make and break the current at will, a matter of no small consequence when fairly large currents are being used to destroy a growth upon the skin of the face.

Needles and Needle Holders.—For the negative electrode the operator uses a needle holder with a needle of proper form and material.

Two needle holders are shown inFigs. 513 and 514.

Fig. 513.Fig. 514.Electrolytic Needle Holders.

Fig. 513.Fig. 514.

Electrolytic Needle Holders.

When the operator desires he may employ an interruptingneedle holder with which he can make and break the current at will during the operation. It is shown inFig. 515.

Fig. 515.—Interrupting Current Needle Holder.

Such a device is not advocated, since the patient is liable to jump as the current is made suddenly, because of the sharp stinging pain felt at the point when the needle has entered the tissue or hair follicle, often resulting in the breaking of the needle and possible injury to the patient.

Other operators employ a small magnifying glass which may be attached to the holder, as inFig. 516, and by a sliding arrangement be moved up or down the handle to adjust the lens to the proper focus. This arrangement is indeed novel and may be of service in removing fine superfluous hairs, but the author has never resorted to the method.

Fig. 516.—Needle Holder with Magnifying Glass.

The proper kind of needle to be used for electrolysis varies with the device of the operator. The ordinary cambric needle usually advocated is too stiff and thick. Jeweler’s broaches are better, but are very brittle and easily broken. The ideal needle should be very thin and made of platinum or irido-platinum. The author prefers the sharp to the bulbous-pointed. For the removal of other blemishes than hair from the face the sharp needle only can be used.

The moistened sponge electrode connected to the (+) positive pole of the circuit is placed into the hand of the patient, who lies in a chair with her head on a level with the physician’s chin when operating. The light should be southern, or such that the shafts of the hairs show plainly.

The operator turns on the current, holding the needle holder in the right hand which is connected by a flexible cord to the (-) negative pole. The rheostat handle is brought back so that just the least current is flowing. The needle is now thrust down into the follicle containing the hair. This must be done very gently so as to feel when the papilla has been reached by the needle. The depth to which the needle goes varies very much according to the size and place of the hair. It may be less than one eighth and more than one fourth inch.

The patient holding the sponge will at once feel a stinging sensation when the needle enters the skin, which is later not as objectionable. The current is now increased by advancing the handle of the rheostat until about eight milliampères are shown by the index on the dial.

Within a few seconds a white froth will issue from the follicle, showing that decomposition of tissue is taking place. The operator must familiarize himself withthe time and amount of current required to destroy superfluous hairs. Coarse hairs may require as much as fourteen milliampères, but it is advisable to use a moderate amount of current and to leave the needle a little longer in the follicle to avoid scarring of the skin.

The papilla having presumably been destroyed, the patient loosens her grip on the sponge and the needle is withdrawn.

The operator now takes up an epilating forceps, such as shown inFig. 517, and removes the hair. If the hair does not come out of the follicle readily it shows that it has not been destroyed, and the same treatment, just described, must be repeated, but for a shorter duration.

Fig. 517.—Epilating Forceps.

When the hair is removed it will show more or less bulb according to its size and nourishment.

The physician now proceeds to remove the coarse hairs first. Hairs should not be removed too closely placed, as the current will destroy the tissue between the follicle and cause scarring. It is better to remove the hairs some distance apart, leaving the remaining hairs for later sittings.

About forty or fifty hairs may be removed at one sitting. This will require from half to an hour and a half of time, but the operator will soon accomplish considerable work in a minimum of time.

Some of the hairs removed will return, showing as black or dark specks in the skin, in from five to ten days. The number returning depends on the operator’s skill. At first he should not be surprised to see fifty per cent come back, but this ratio is reduced so that only three or four hairs out of fifty may return, and perhaps these stunted in growth.

The electrolytic removal of hair does not stimulate the growth of the finer hairs of the skin; that general belief has been erroneous.

Where there is considerable hair to be removed, as with a beard on a woman’s face, several sittings may be given a week and at different parts of the face, but with the average patient only one sitting should be given each week.

More or less edema follows the removal of hair, which may remain for a day or more. Warm applications will help to remove it.

The operator should at no time state a definite fee to remove the hair on the face, unless he is certain of the number present. Such judgment is, indeed, very misleading.

Moles, warts, fibromata, fungoids, and other excrescences are best removed with this method, especially where they are of the nonpedunculated type. It is hardly necessary to state that very light currents should be used for the light flat growths, such as a dark freckle or a small yellow mole. The amount of current required varies from 6 to 24 milliampères, according to the size of the body to be removed.

The same procedure as with the removal of hairs is followed. Positive electrode in the hand of the patient, negative pole to the needle holder. The needle is thrust through the growth on a plane with the skin and slightly above it. The current will at once produce a pale color in the mass and white froth will issue about the shaft of the needle. A comparatively greater amount of current is needed for this purpose than with the destruction of hairs. The operator must judge the amount and time required from experience.

The mass is punctured in stellate fashion to assure an even necrosis, as shown inFig. 518.

Fig. 518.—Electrolysis Method for Destroying Growths.

The mass will appear much softer after this treatment, is in some cases, as with flat moles, quite friable, but this disappears in a few hours and the mass begins to shrivel and dry up, forming a scab, which is between brown and almost black in color. This scab falls off in several days, according to its size, leaving a pink eschar, which gradually turns white and shows very little, if the growth has not been too large and the electrolysis carefully done. If little tumefactions, or tips of tissue, still appear, they are removed as soon after the scab falls off as deemed advisable by the same method. Warts show more or less recurrence.

In this condition there appear in the skin one or many dilated capillaries. It is quite common about the sides and lobule of the nose and just inferior to the malar prominence of the cheeks. To destroy these the fine platinum needle is thrust through the skin and directly through the canal of the vessel. The same disposition of the electrode is used as heretofore described.

Immediately the current is made, a series of bubbles of hydrogen will run through the vessel which presently becomes pale and empty, as a result of the electro-chemical action.

The needle should be allowed to remain in the vessel from five to ten seconds, according to the size of the latter.

The object is to set up sufficient irritation in and of the walls of the vessel so as to occlude it when cicatrization has been established. Some edema follows such a treatment, subsiding in a day or more. Several vessels may be treated in the same sitting, and at either side of the face. The operator should guard against too strong a current, to avoid scarring of the skin. The final result in this treatment shows fine punctate scars, as after the removal of coarse hairs, and sometimes pale linear scars, but these are observable only on close inspection.

Birthmarks, port-wine marks, and other pigmentary conditions may be entirely or partly removed from the skin of the face, according to the size of the area treated and the nature of the case. For this purpose the single needle attached to the negative pole is hardly sufficient, unless the spot is exceedingly small, therefore a bunch needle electrode is used. This electrode has a number of fine steel needles set into it, as shown inFig. 519.

Fig. 519.—Multiple Needle Electrode.

In this treatment the needles are made to puncture the skin at right angles to them to a depth corresponding to the papillary layer. These pigments lie above that, so that it is not necessary to include the derma. At each point of puncture a white spot will appear which soon turns red. In a day’s time a number of fine scabs, or a single scab, will form over the parts treated, which fall away in about five days eventually, leaving the partspaler than before, owing to a number of minute punctate scars.

The amount of treatment given in each case varies with the extent of the lesion. If the result from the first sitting has not accomplished as much as desired, it can be repeated over and over until the parts assume a normal tint. There may be more or less bleeding following the treatment; this is easily checked by pressure. If the part worked on is quite large, dry aristol dressing should be used to avoid infection. The scab should not be picked off by the patient, but allowed to fall off.

The best method of removing such pigmentations of the skin is to remove them with the knife when possible, and to cover the wound by sliding flaps made by subcutaneous dissection at either side of the wound, as in the Celsus method. Some authorities advocate their re-tattooing with papoid solution, while others prefer caustic agents, with the object of destroying the pigmented area. These methods are not to be preferred, since they leave unsightly burn scars.

Electrolytic needling may be tried and is quite successful when the marks are very small, but, as with gun-powder stains, they are best removed by punching, or cutting out, a little cone of skin containing the pigment. The secondary wounds thus made leave only very small punctate scars that are hardly noticeable. Of course a number of such removals would not be advisable.

Where the pigmentation is very pale, recourse may be had to the peeling method, as will be later described.

Not infrequently the cosmetic surgeon is called upon to remove or improve unsightly scars about the face,the result of injuries or burns and after the careless coaptation of such wounds. The scars vary in extent and degree, from a mere pit due to varicella or variola to the broad areas following the cicatrization of lupus and burns. Surgical scars vary also from a mere line to areas of greater or less extent, dependent upon the ablation of neoplasms or the granulation of wounds due to any cause.

The treatment of scars depends upon their size and location. A mere linear scar may be reduced by electrolysis, the needle, negative pole, being introduced equidistantly, from one sixteenth to a quarter inch apart, with the hope of causing a breaking down electro-chemically of the scar itself and waiting for secondary cicatrization. In other words, making a scar within a scar.

This mode of treatment may be repeated in two or three weeks and has the tendency of breaking up the shiny line of light that makes the scar stand out prominently from the skin.

Such scars, where nonadherent, or flat with the plane of the skin, may also be tattooed to reduce their white color.

For this purpose, the red or carmine pigment used for tattooing is diluted and pricked into the scar tissue with a fine cambric needle by hand or electric process.

When the scar is small the line is punctured here and there and the aqueous solution of the pigment is painted over the area, which is again worked over to make it take.

For larger scar surfaces multiple needles are used. These are composed of from four to ten needles soldered together at their eye ends, leaving the points at an even level.

The electric method is the most serviceable for tattooing large scars.

These instruments are electro-magnetic devices madeto accommodate single or multiple needle points and can be obtained from instrument makers.

The author has had a special electric synchronous reciprocal apparatus made, as here shown inFig. 520, which is much more compact than the ordinary electric apparatus found on the market. It works on the principle of the sewing machine needle.

Fig. 520.—Author’s Electric Apparatus for Tattooing Scars.

In using the electric apparatus the needle ends are dipped into the pigment paste, to which a little glycerin is added to bind it, and this is tattooed or pricked into the scar.

If, after the parts are healed, the color is too light, the scar may again be gone over until the tint matches somewhat the tint of the skin. Other pigments may be used, according to the complexion of the patient.

Some scars, the resultant of negligent coaptation, are to be excised according to the Celsus method and are brought together with a number of fine silk sutures.

If the skin is found to be attached too closely to the subcutaneous structure, it must be dissected up to render it mobile.

When the scar cannot be removed by excision the hypodermic use of thiosinamin may be tried.

Thiosinamin or rhodallin is only slightly soluble in water, but the addition of antipyrin according toMichelrenders it useful for hypodermic use. The formula preferred by the author is made as follows:

The above solution makes up a single injection, which is to be made directly under the scar or into the muscular tissue below it. Two injections are given each week.

The treatment is to be continued until the texture of the cicatrix is equal to that of the skin.

These injections are more or less painful and may be supplanted to advantage with the hypodermic use of fibrolysin (Mendel), in which each 2.3 c.c. correspond to three grains of thiosinamin.

For very small scars, as those occasioned by blepharoplastic operation, the author employs the twenty-per-cent thiosinamin plaster mull made by Unna. These are to be applied every day or night, according to the convenience of the patient, and allowed to remain on for several hours each day.

At first these plaster mulls are inclined to cause erythema and exfoliation of the epithelium, therefore they might be used on alternate days to keep the parts more sightly.

For scars of large extent the above method will answer best. If there is considerable contraction, the parts should be massaged daily to soften and stretch them. Eventually the depression of contour may be corrected by hydrocarbon protheses introduced subcutaneously following subcutaneous dissection, if deemed necessary.

Small pits, where discrete, are best removed with a fine knife and brought together by a fine suture which is to be removed on the fifth day.

Confluent pittings, as after variola, must be removed by decortication or peeling methods.

The pits, if spread about the face promiscuously, may be treated separately by the peeling method, but whenthey lie less than one inch apart, it is best to treat the skin of the whole face.

This is done by applying pure liquid carbolic acid to the skin with a cotton swab. The skin at once assumes a white color. If the pittings are not very deep, one application of the acid is sufficient. If deep, one or two more applications are made as the preceding one dries. In very deep pits, the surgeon should apply the acid to the pit proper several times, blending off the application at the periphery.

When the surface thus treated has become dry, adhesive plaster, cut in half-inch strips of desirable length, are put on the face, one above the other, slightly overlapping, until the whole treated surface is well covered, mask-like.

The author uses Unna’s zinc oxide plaster mull for this purpose, as it is backed with gutta-percha, which readily adapts itself to the curvatures of contour.

The adhesive plaster mask is not removed until about the fourth or fifth day, when it will be practically forced away from the skin by the excretions thrown out from the derma. In some cases there is considerable pus.

After removal of the mask the skin, now very red and tender, is cleansed with a solution of bichloride, 1 in 10,000.

After the cleansing a mild soothing ointment, such as zinc oxide in vaselin, is used for several days until the skin takes on its normal epitheliar layer and appears normal in color.

No water or soaps are to be allowed during the latter period. In the later days of the treatment the skin may be cleansed with a little borated vaselin or even olive oil used with absorbent cotton.

If there is a pigmentation of the new skin this should cause no alarm, as it will fade out in from six to eight weeks.

Tincture of iodine has been used for the same purpose, as well as its mixture with carbolic acid.

Resublimed resorcin is also advocated, but the resultant peeling will not prove thick enough to give a satisfactory result.

If, for any reason, the effect obtained is not as desired, the patient should wait for several weeks and have the treatment repeated.

It is hardly necessary to say that the application used should not get into the eyes. The upper eyelids should not be treated, since no benefit arises from it. If there is a redundancy of tissue, it should be removed surgically, as heretofore described.

Back to Index Next