Pruritus

“ Persons often suffer from pruritus or itching of the anus, or in the parts immediately around. The affection is most common in old people, and in such as are of a weakly constitution. Women who have recently ceased to menstruate are also prone to it. The exciting causes are generally ascarides, hemorrhoidal excrescences, and a morbid state of the alvine secretions. Sometimes the skin around the anus is covered with an eruption of papulæ, or even tubercles, the former of which are often attended with vesication and the discharge of a thin, watery, irritating humour. ”

“ Exposed workers reported large decreases in most symptoms during the second period, when they handled the completed forms with broken microcapsules (280/day) rather than the fresh forms (1,200 per day) during the first period. These symptom decreases during the second period included a sixfold decrease in skin irritation and threefold decreases in eye irritation, pruritus, nasal congestion, nose-bleed, and cough. However, increases occurred in facial erythema, rash, and runny nose. Figure 4-2 shows the relationship between pruritus and increasing CCP exposure. ”

“ The most serious form is pruritus senilis, which affects old persons, and is often a cause of great suffering, depriving the patient of sleep. In such cases it is probably due to atrophic changes in the skin. No eruption is visible, except such marks as are produced by scratching. The treatment consists in the removal of any apparent cause, and measures to strengthen the system, such as the use of quinine, iron, &c. Soothing lotions composed of solutions of alkalis conjoined with chloral, opium, hydrocyanic acid, &c., may be applied to the affected skin at bedtime. ”

“ Sometimes it is so bad that the female is almost tormented to death; she cannot see company, or walk out, and often shuts herself up alone in her agony. Many have fainted from it, and some have even become delirious. I have seen patients whose hands it was necessary to tie, to prevent them tearing themselves to pieces.
"The causes of pruritus appear to be most of those that produce simple inflammation, which it very frequently accompanies or precedes. ”

“ Overwork, mental and physical exhaustion, have been charged with producing pruritus, and in some instances spinal irritation seems to have been unquestionably the exciting cause: now and again, pruritus ani has been produced by the pregnant condition, and in some cases this malady has persisted during the entire period of utero-gestation. ”

“ It is characterized by enduring sensations of itching and burning, which may be either periodic (and then usually nocturnal) or continuous; at times it becomes so severe that the women thus affected have an unceasing desire to scratch, avoid all society, and ultimately find life quite unbearable. In the slighter degrees of pruritus, no objective changes are to be observed in the genital organs, or at most some slight hyperaemia of the vaginal orifice. ”

“ Serapion recommends us, if there is a sanguineous plethora, to bleed, and then to purge with myrobalans, colocynth, and black hellebore, and along with these the warm bath is to be used, and the liniments for removing the pruritus, containing vinegar, roses, nitre, &c. The prurigo senilis he pronounces to be incurable. Rhases and Avicenna recommend similar remedies. They treat of prurigo and scabies together, and there is no doubt of their alliance. Hence Bateman says that prurigo, when neglected, terminates in scabies. Haly Abbas says that scabies and prurigo arise from a saltish phlegm. ”

“ Some animals become restless, make peculiar movements of the head, and soon display intense congestion of the parts free of wool, together with redness and swelling of the ears, eyelids, face, throat, etc. The condition develops with extreme rapidity, the animals being immediately afflicted with pruritus over the affected regions. If they are not removed to the quiet and warmth of the fold the symptoms increase and papules appear, which may be transformed into vesicles and bullæ. In the fold, on the other hand, all the symptoms rapidly disappear. ”

“ The symptoms are purely subjective, as in pruritus. The skin shows no alteration. It is usually a local disorder, confined to a small area, and is met with, as a rule, in adult age. It consists in a highly-sensitive state of the integument, with a feeling of positive pain having its seat in the superficial layers of the skin, which is remarkably sensitive to external impressions; the touch, contact of the clothing, and even the air, exciting more or less pain. In character the sensation is burning, pricking or darting, or like electric shocks. It is generally worse at night. ”

“ The pruritus, which is often very troublesome on retiring at night, so much so, indeed, as to prevent the patient from sleeping for hours, usually subsides after a few months, but is certain to return from the slightest irregularity in the diet, from fatigue, loss of rest, or from exposure to heat. “From constant rubbing the skin about the anus becomes thick, dense, and furrowed, even when there are no hemorhoidal tumours. The furrows assume a radiated direction, and converge in the anus ”

“ By-and-by various sympathetic phenomena, such as restlessness, general nervousness, itchings at the nose, involuntary twitchings, grinding of the teeth during sleep, chorea, convulsions, and even epileptiform seizures, may supervene. At the age of puberty special local disorders arise, the nature of which will be readily understood when merely spoken of as the morbid phenomena of sexual irritation. In the female the occurrence of pruritus and leucorrhœa is not uncommon, accompanied or not, as the case may be, with hysteria in various forms. ”

“ Instead of a fine pityriasic desquamation being always present, this is only distinct on the legs, sometimes just recognisable on the thighs and arms, while on the trunk it is absent, the surface being usually quite smooth.
134 (5) The presence of papules I have not observed, except at the commencement of Case 4.
(6) There is distinct infiltration in a large proportion of the patches, perceptible to the touch, though not to the eye.
The resemblances are: the absence of conspicuous pruritus, and there is often none; the occurrence in patches; the slow evolution; a pale redness ”

“ Describe the symptoms and course of prurigo.
The disease first appears upon the tibial regions, and its earliest manifestation may be urticarial, but there soon develop the characteristic small, millet-seed-sized, or larger, firm elevations, which may be of the natural color of the skin or of a pinkish tinge. The lesions, whilst discrete, are in great numbers, and closely crowded. The overlying skin is dry, rough and harsh; itching is intense, and, as a result of the scratching, excoriations and blood crusts are commonly present. ”

“ It is characterized by pimples, and an intense burning, itching sensation. Rubbing and scratching only irritate the skin, which becomes covered with thin black scabs. A good representation of prurigo may be seen in Colored Plate II, Fig. 6. The itching sensations are sometimes caused by chilling the body, by violent exercise, and heat; allowing the mind to dwell upon the affection aggravates it. ”

“ I found the Down begin to make my hand itch, and in some places to smart again, much like the stinging of a Flea or Gnat, and this continued a pretty while, so that by degrees I found my skin to be swell'd with little red pustules, and to look as if it had been itchie. But suffering it without rubbing or scratching, the itching tickling pain quickly grew languid, and within an hour I felt nothing at all, and the little protuberancies were vanish'd. ”

“ In different stages of the fever, after a few days, a cutaneous efflorescence is perceivable, from which the disease takes its name, preceded by and accompanied with itching and pricking heat of the skin, and eruption of diminutive{97} pustules, the size of millet seed, and, by the fingers, may be felt prominent: they are rarely seen on the face; commonly on the neck, back, breast, and extremities ”

“ It is during the stage of pustulation that the surrounding skin becomes swollen and œdematous, with an area of redness about the pustules giving the appearance of a bull’s eye. It is also during the pustular stage that the constitutional symptoms become more intense and the fever rises in proportion to the severity of the attack. The pustules are fully matured about the eighth day of the eruption.
During the pustular stage the affection of the mucous membranes reaches its height. The eyelids, lips, and nose are often tremendously swollen. The tongue swells and deglutition becomes impossible. ”

“ Peculiarities.—The miliary fever, though not contagious, is an epidemic disease, and sometimes a critical symptom in the autumnal putrid fever. It generally commences its attack with a cold shivering, which is succeeded by intense heat, pain in the head and loins, oppression on the breast, and difficulty of breathing. An itching and prickling sensation is felt in the skin, which, between the seventh and fourteenth days, is covered with numerous small, red, and distinct pimples, that appear first on the neck and chest, and gradually spread over the whole body, excepting the face. ”

“ It is during this stage that, owing to the softening of its membranous covering, the pustule is broken by the movements of the patient or the contact of rough bed-linen. The pustules of the face are usually the first ones broken, and an ulceration frequently occurs which destroys the true skin and results in a pit or scar. Pustules do not rupture spontaneously and discharge their contents. Dessication lasts usually from five to twenty days, the exposed parts being the first to dry and shed their crusts. ”

“ The penetration and presence of the parasites within the cutaneous structures besides often giving rise to several or more complete or imperfectly formed burrows, excite varying degrees of irritation, and in consequence the formation of vesicles, papules and pustules, accompanied with more or less intense itching. Secondarily, crusting, and at times a mild or severe grade of dermatitis, may be brought about. ”

“ Diseases of the skin tend to manifest themselves in certain parts of the body; i.e. certain diseases exert a selective influence on the sites of their eruption. Symmetry is characteristic of eczema, psoriasis, drug rashes and the eruptions of specific fevers, while others, such as herpes zoster, ring-worm, tertiary syphilis and new growths, tend to be asymmetrical. Eczema selects the flexor aspect of the limbs and the neighbourhood of folds of skin and opposed surfaces, while psoriasis favours the extensor surfaces and the outer side of the elbows and knees. ”

“ The signs peculiar to this disease are slight inflammation, itching, and the formation of minute scales.
Causes. Pityriasis is caused by nutritive debility, and is often associated with erysipelas, rheumatism, and bronchitis.
Lichen. (Papular Rash.) Lichen is a term used to designate an eruption of minute conical pimples, which are more or less transparent, red, and occasion great annoyance. The eruption is attended with a severe, hot, prickling sensation, as if the flesh were punctured with hot needles. The pimples contain no pus, but if opened, they exude a small quantity of blood and serum. ”

“ Itching, without apparent cause, may be due to parasites, as lice and fleas, and this must always be kept in mind; although debilitated states of the body and certain diseases, as gout and diabetes, are sometimes the source. Commonly, itching is caused by one of the many recognized skin diseases, and is accompanied by an eruption characteristic of the particular disorder existing, and special treatment by an expert, directed to remedy this condition, is the only reasonable way to relieve the itching and cure the trouble. ”

“ Itching, or a feeling of burning, slight or intense, is usually present.
What is the course of the eruption?
The vesicles show no disposition to rupture, but dry up in a few days or a week, disappearing by absorption and with slight subsequent desquamation; the papular lesions gradually fade away, and the affection, if the exciting cause has ceased to act, terminates.
What is the cause of miliaria?
Excessive heat. Debilitated individuals, especially children, are more prone to an attack. Being too warmly clad is often causative.
What is the nature of the disease? ”

“ Eczematous symptoms may be superadded. In severe cases the entire extensor surfaces of the legs and arms, and in some instances the trunk also, are invaded. It is worse in the winter season. [Pg 119]
What is known in regard to etiology and pathology?
It is a disease of the ill-fed and neglected, usually developing in early childhood, and persisting throughout life. It is extremely rare, even in its milder types, in this country. Clinically and pathologically it bears some resemblance to papular eczema.
Give the prognosis and treatment of prurigo. ”

“ The crutch, or axillæ, or both, are sometimes rendered so raw and tender that the patient may be unable to walk or even to dress. The irritation and itching are usually worse at night, and may keep the patient awake for hours. Even in the absence of treatment, when the cold season comes round the dermatitis and irritation subside spontaneously. The affected parts then become dry, pigmented, and scurfy, and the fungus remains quiescent until the return of the next hot weather.
Diagnosis.— The diagnosis of mycotic dermatitis is usually easily made. ”