Scarification

SCARIFICATION (from the Latin scarificare—to notch, to incise), one of the favorite measures widely used even in ancient times, primarily as a form of counter-irritant therapy for certain disease processes. Numerous small, sometimes superficial and sometimes deep, incisions or punctures were performed for the purpose of bloodletting, the removal of edematous fluid, etc. A number of complex instruments were proposed for performing scarifications. Thus, in 1850, the Munich mechanic Baunscheidt invented a new method for treating various ailments using a special instrument equipped with a bundle of needles, which he called the "life awakener" (Lebenswecker). After pricking the skin, diluted croton oil or another irritating substance was rubbed into the resulting wound surface. Scarifications gained wide application in dermatological practice for therapeutic purposes from the time of Volkmann and Vidal. The method of treating certain skin diseases by means of scarification, thoroughly developed by Brocq, often yields very favorable results from a cosmetic standpoint. The specific scheme developed by him is called linear grid scarification (scarifications lineaires quadrillees). The choice of instrument for performing the grid, according to Brocq, is completely indifferent. With the help of a Vidal scarificator, a thin scalpel, or a surgical knife, scarifications are made extremely rapidly in the form of multiple parallel incisions, at a fairly close distance from each other and to the appropriate depth depending on the nature of the skin lesion, after which they are crossed with transverse incisions, usually at an acute angle, in such a way that small rhombuses or squares are formed. Scarifications sometimes cause, especially with an abundance of superficial vessels, quite significant bleeding, which can be stopped by pressure, the application of a thin layer of aseptic cotton wool, or a cotton swab moistened with a hot solution of boric acid. The cutting of vessels leads, through the formation of thrombi, to the emptying and obliteration of dilated capillaries. For more rapid thrombosis of the vessels, some authors (Nikolsky) recommend rubbing into the scarified surface a solution of ferric chloride diluted by half (Liquor ferri sesquichlorati, Aquae destillatae aa), which should be avoided, especially in cases where cosmetic goals are pursued, in view of the possibility of the development of linear scars. In intensive cases with sharply pronounced diffuse redness, such as, for example, in acne rosacea, one has to resort to repeated or multiple scarifications. This procedure can be repeated only after the disappearance of the inflammatory reaction and the healing of the incisions (on average once every 7–10 days). Scarifications are a valuable therapeutic factor and find wide application in various skin ailments, namely: in acne rosacea, staphylogenic sycosis accompanied by induration, cicatricial contractures, rhinoscleroma, keloids, localized torpid eczemas, atonic ulcers, various elephantiasic conditions of the skin, and sometimes in simple and erythematous lupus. In lupus, where it is required to destroy lupous foci, in addition to scarification, it is necessary, in order to enhance the decay of the lupous infiltrate, to rub caustic substances (strong solutions of silver nitrate, creosote, etc.) into the numerous incisions made. In persistent varicose ulcers, one can attempt to incise the callous edges of the ulcers in a radial manner around the entire circumference of the lesion. The most frequent complication arising from the performance of scarifications, especially on edematous skin, is erysipelas.