Prurigo

(from prurio, to itch.) The prurigo is a genus of disease in the order papulous eruptions of Dr. Will an’s cutaneous diseases. “As it arises from diflerent causes, or at different periods of life, and exhibits some varieties in its form, he describes it under the titles of prurigo mitis, prarigo form i cans, and prurigo senilis. In these the whole surface of the skin is usually affected; but there are likewise many. cases of local prurigo, which will be afterwards noticed according to their respective situations. 1. The prurigo mitis originates without any previous indisposition, generally in spring, or the beginning of summer. It is characterized by soft and smooth elevations of the cuticle, somewhat larger than the papulz of the lichen, from which they also differ by retaining the usual colour of the skin; for they seldom appear red, or much inflamed, except from violent friction. ‘They are not, as in the other case, accompanied with tingling, but with a sense of itching almost ince ant, ‘This is, however, felt more particularly on undre ing, and often prevents rest for some hours after getting into a bed. When the tops of the papulz are removed by rubbing or scratching, a clear fluid oozes out from them, and gradually concretes into thin black scabs. This species of prurigo mostly affects young persons, and its cause may, we think, in general be referred to sordes collected on the skin, producing soine degree of irritation, and also preventing the free discharge of the cntaneous exhalations.; the bad consequences of which must nece arily be felt at that season of the year when perspiration is most copious. Those who have originally a delicate or irritable skin must likewise in the same circumstances, be the greatest sufferers. The eruption extends to the arms, breast, back, and thighs, and often continues during two or three months of the summer, if not relieved by proper treatment. When persons affected with it neglect washing the skin, or are uncleanly in their apparel, the irruption grows more inveterate, and at length changing its form, often terminates in the itch. Pustules arise among the papula, some filled with lymph, others with pus., The acarus scarabiei begins to breed in the furrows of the cuticle, and the disorder becomes contagious. 2. P. form i cans. This is a much more obstinate and troublesome disease than the foregoing. It usually affects persons of adult age, commencing at all seasons of the year indifferently; and its duration is from four months to two or three years, with occasional short intermi ions. ‘The papulze are sometimes larger, sometimes more obscure, than in the preceding species; but are, under every form, attended with an ince ant, almost intolerable itching. They are diffused over the whole body, except the face, feet, and palms of the hands; they appear, however, in greatest number on those parts which, from the ordinary mode of dre , are subjected to tight ligatures; as about the neck, loins, and thighs. The itching is complicated with other sensations, which are variously described by patients. They sometimes feel as if small insects were creeping on the skin; sometimes as if stung all over by ants; sometimes as if hot needles were piercing the skin in divers places. On standing before a fire, or undre ing, and more particularly on getting into bed, these sensations become most violent, and usually preclude all rest during the greater part of the night.. The‘prurigo form i cans is by most practitioners deemed contagious, and confounded with the itch. endeavouring to ascertain the justne of this opinion, Dr, Will an has been led to make the following remarks: 1. The eruption is, for the most part, connected with internal disorder, and arises where no source of infection can be traced. 2. Persons affected may have constant intercourse with several others, and yet never communicate the disease to any of them. Several persons of one family may have the prurigo form i cans about the same time; but he thinks this should be referred rather to a‘common predisposition than to contagion, having observed that individuals of a family are often so affected, at certain seasons of the year, even when they reside at a distance from each other. Although the prurigo form i cans is never, like the former species, converted into the itch, yet it does oceastonally terminate in a pustular disease, not contagious, AG 3. P. senilis. ‘This affection does not differ much in its symptoms and external appearances from the prurigo. form i cans; but has been thought by medical writers to merit a distinct consideration, on account of its peculiar inveteracy, The prurigo is perhaps aggravated, or becomes more permanent, in old age, from the dry, condensed state of the skin and cuticle, which often takes place at that period. Those who are affected with it in a high degree have little more comfort to expect during life, being ince antly tormented with a violent and universal itching. ‘The state of the skin in the prurigo senilis is favourable to the production of an insect, the pediculus human us, more especially to the variety of it ustially termed body lice. ‘These insects, it is well known, are bred abundantly among the inhabitants of sordid dwellings, of jails, workhouses, . and in such situations prey upon persons of all ages indiscriminately. Mut in the prurigo senilis they arise, notwithstanding every attention to cleanline or regimen, and multiply so rapidly that the patient endures extreme dis tre , from their perpetwal irritation. The nits or eggs are deposited ou the small hairs of the skin, and the pediculi are only found on the ~ skin or on the linen, not under the cuticle, as some authors have represented. In connection with the foregoing series of complaints, Dr. Will an mentions some pruriginous affections which are merely local. He confines his observations to the most troublesome of these, seated in the podex, preputium, urethra, pubes, scrotum, and pudendum muliebre. Itching of the nostrils, eyelids, lips, or of the ex ternal ear, being generally symptomatic of other diseases, cdo not require a particular consider a tion. 1. P. podicis. A sea rides in the rectum ex cite a frequent itching and irritation about the sphincter ani, which ceases when the cause is removed by proper medicines. A similar complaint often arises independently of worms, hzmorrhoidal tumors, or other obvious causes, which is mostly found to affect persons engayed in sedentary occupations; and may be referred to a morbid state of secretion in the parts, founded, perhaps, on a diminution of constitutional vigour. The itching is not always accompanied with an appearance of papule or tubercles; it is little troublesome during the day-time, but returns every night so on after getting into bed, and preciudes rest for several hours.. The complaint continues in this form during three or four months, and has then am intermi ion, till it is produced again by hot weather, fatigue, watching, or some irregularity in diet. ‘The same disease occurs at the des. cline of life, under a variety of circumstances. Women, after the ce ation of the catamenia, are liable to be affected with this species of prurigo, more especially in summer or autumn. ‘The skin between the nates is rough and papula ted, sometimes scaly, and a little humour is discharged by violent friction. Along with this complaint, there is often an eruption of itching papulz on the neck, breast, and back; a swelling and inflammation of one or both ears, and a discharge of matter from behind them, and from the external meatus auditos rius. The prurigo podicis sometimes occurs as a symptom of the lues venerea, 2. The P. preputii is owing to an altered state of secretion on the glans penis, and inver surface of the preputtum.. During the heat of summer there is also, in some persons, unusual discharge of rsucus, which becomes acrimonious, and produces a troublesome itching, and often an excoriation of these parts. Washing of them with water, or soap and water, employed from time to time, relieves the complaint, and should indeed be practised as an ordinary point of cleanline , where no inconvenience is immediately felt. If the fluid be secreted in too large a quantity, that exce may be restrained by washes made with the extract of lead, or by applying the unguentum ceruse acetate., 3. P, urethral is. A very troublesome itching sometimes takes place at the extremity of the urethra in females, without any manifest cause, It occurs as well in young women as in those who are of an advanced age. On examination no stricture nor tumour has been found along the course of the urethra. Probably, however, the itching may be occasioned by a morbid state of the neck of the bladder being tn some instances connected with pain and difficulty of making water. 5. P. seroti. The scrotum is affected with -a troublesome and constant itching from ascarides within the rectum, from friction by violent exercise in hot weather, and very usually from the pediculi pubis. Another and more important form of the complaint appears Im’ old men, sometimes connected with the prurigo podicis, and referable to a morbid state of the skin, or superficial glands of the part, The scrotum, in this case, a uines a brown colour, often also bécoming thick, scaly, and wrinkled. The itching extends to the skin covering the penis, more especially along the course of the urethra; and has little respite, either by day or night. 6. The P. pudendi muliebris is somewhat anal a go us to the prurigo scroti in men. It is often a symptomatic complaint in the lichen and lepra; it likewise originates from ascatides irritating the rectum, and is in some cases connected with a discharge of the fluor alb us. A similar affection arises in consequence of the change of state in the genital organs at the time of puberty, attended with a series of most distre ing sensations. Dr. Will an confines his attention to one case of the disorder, which may be considered as idiopathic, and which usually affects women soon after the ce ation of the catamenia. It chiefly occurs in those who are of the phlegmatic temperament, and inclined to corpulency. Its seat is the labia pudendi, and entrance of the vagina. It is often accompanied with an appearance of tension or falne of those parts, and sometimes with inflamed itching papulz on the labia and mons veneris. The distre arising from a strong and almost perpetual itching in the above situation may be easily imagined. In order to allay it in some degree, the sufferers have frequent recourse to friction, and to cooling applications: whence they are nece iated to forego the enjoyment of society. An excitement of venereal sensations also takes place from the constant direction of the mind to the parts affected, as well as from the means employed to procure alleviation. The complicated distre thus arising renders existence almost insupportable, and often produces a state of mind bordering on frenzy. Deep ulcerations of the parts seldom take place in the prurigo pudendi; but the appearance of aphthze on the labia and nympha is by no means unusual. From intercourse with females under these circumstances, men are liable to be affected with aphthous ulcerations on the glans, and inside of the preeputinm, which prove troublesome for a length of time, and often excite an alarm, being mistaken for chancres. Women, after the fourth month of their pregnancy, often suffer greatly from the prurieo pudendi, attended with aphthe. ‘These, in a few cases, have been succeeded by extensive ulcerations which destroyed the nymph, and produced a fatal hectic: such instances are, however, extremely rare. The complaint has in general some intervals or remi ions; and the aphthe usually disappear soon after delivery, whether at the full time, or by a miscar~ riage. 784 785