Prurigo

PRURIGO (itch). Under this name should not be understood as one sharply delimited skin disease, but various clinical forms and varieties that are more or less similar to each other, united by relatively chronic course, itching, and morphologically so-called pruriginous serous papules with the possibility of lichenification and eczematization. Attempts to classify various varieties of P. have led to nothing; the desire to isolate one or another variety into a separate form has led to the accumulation of various forms with the names of authors and as a result created chaos. Clinical observations show that the varieties of P. are a continuous series of transitional clinical forms from urticaria to prurigo ferox. The skin lesion in the entire group of P. should be considered not in isolation, but in connection with changes occurring throughout the body, as a reflection and indicator of those changes that occur in the body, i.e., as a reaction of the body. Due to the impossibility of carrying out a complete etiological classification, only the main forms of the P. group are given below without a specific scheme. Childhood prurigo (strophulus infantum, urticaria infantum papulosa, lichen urticatus). The disease appears more often in early childhood; the main element is a small cone-shaped, dense papula located in the center of an urticarial disk, which when bloodless becomes pale-yellow. On top of the latter, a small more or less developed vesicle forms, usually giving a blood crust due to scratching. The eruptions are accompanied by severe itching and are located more often on the trunk, less frequently in other places. At the same time, up to 15-20 elements can appear in groups, the urticarial basis disappears quickly (8-10 hours), while the papules persist much longer (10-15 days). Such attacks can repeat daily, after 2-3 days, and less frequently over a period of several weeks to 2-3 months. Continuing for the first 3-4 years of life, the disease more often disappears, less frequently it passes into prurigo Hebra. The general condition of the child suffers relatively little. Histologically, the epidermis and superficial layers of the derma are edematous, with small-cell infiltration around dilated vessels. The diagnosis is not difficult; confusion with varicella, scabies, insect bites and urticaria is possible only with insufficient examination of patients. Disorders of nutrition apparently play a significant role in the etiology of the dermatosis. Improper feeding and care of the child, teething are of known importance. Urbach and Wiedmann showed that itching and papules appear after eating certain kinds of meat and eggs. In general, the intoxication hypothesis is most acceptable. Without overestimating the method of food intracutaneous tests, it can be said that it to a certain extent confirmed the above hypothesis. The essence of this dermatosis is undoubtedly connected with a congenital anomaly of constitution, diathesis, expressing a predisposition to angioneurotic inflammation. In the anamnesis of children suffering from P., there are almost always indications that the mother or father or their relatives also suffered in childhood from the same rash or other diseases: asthma, urticaria, etc. The child himself in the first months of life also usually suffers from eczema, after the disappearance of which P. appears. Therapy consists in regulating nutrition and digestion, giving laxatives; food rich in proteins and fats is excluded, milk is limited. In its place, the early introduction of plant food-vegetables, fruits-is proposed. Desensitization--Ca, peptones, etc. Locally: warm rubdowns, baths, powders, shaken mixtures. Sometimes irradiation with a quartz lamp is beneficial. Prurigo Hebra (P. Hebra), chronic itch. The disease manifests itself in the 1st or 2nd year of life, initially clinically in the form of strophulus infantum. After 1-2 years, the disease takes on an increasingly typical appearance for prurigo Hebra. Itching intensifies. Eruptions are abundant, almost continuous. On the skin there are excoriations from scratching, crusts, scars, eczematization and pyodermata are not uncommon. The skin cover as a whole, especially on the outer surface of the limbs, is dry, thickened, coarse, pigmented, lichenized with varying intensity. Hair gradually breaks off, thins out, lymph glands, especially inguinal and axillary, noticeably swell. In mild form, the extensor surface of the limbs is mainly affected (prurigo mitis), in severe form the trunk and face are affected (prurigo ferox). Eosinophilia in the blood. The general condition is significantly disturbed. Children lag in development, often remain infantile. The course is indefinitely long, intermittent; sometimes there is significant improvement, sometimes worsening; in the vast majority of cases, by the time of maturity or somewhat later, prurigo disappears. Histologically, hyperkeratosis, rarely parakeratosis. The epithelium is acanthotic, with phenomena of serous impregnation, spongiosis, infiltration with leukocytes. The papillary layer is edematous. The vessels of the superficial network are dilated and surrounded by an infiltrate, sometimes diffusely in the derma. The etiology is unclear. There is an assumption that prurigo Hebra is the result of a disorder of the nervous system, endocrine apparatus (Bettmann) and the autonomic nervous system, many propose the auto-intoxication hypothesis in connection with metabolic disorders and improper nutrition in early childhood. Darier insists that heredity plays a significant role here. It should be mentioned the important and frequent fact of improvement of the disease only when the patient moves from home to a hospital, more often in cases where there was poor nutrition and living conditions at home. Each of these hypotheses is perhaps not without a certain probability, and therefore it is very possible that the etiology of prurigo is not always the same and various causes can cause changes on the skin characteristic of Hebra's prurigo. In typical cases, the diagnosis presents no difficulties, difficulties may arise with the addition of eczematization. The prognosis for recovery is unfavorable, but favorable for life. With long-term rational treatment, good results can be achieved. It is necessary to take into account the special sensitivity of some patients to food products. The test method here can have only very limited significance. Baths are recommended, but not always helpful (starch, oak bark, better Sol. Vlemingkx). Autogenous blood therapy, intravenous administration of bromine preparations, calcium chloride, etc., arsenic and cod liver oil are used with variable success. Locally, indifferent ointments, sulfur or tar ointments are applied. Climatotherapy: sulfur baths, sea. Heliotherapy and in extreme cases, radiotherapy. Prurigo nodularis, urticaria per-stans papulosa or verrucosa (Pick, Kaposi), lichen corneus obtusus (s. vulgaris), nodular prurigo; large papules from a pea to a forest nut, either scattered or grouped in a small number (10-25 elements), more often on the limbs, pigmented with an excoriated and crusted surface, leaving a white spot with a pigmented border upon regression. The disease is accompanied by severe itching and lasts for an indefinitely long time. It would hardly be a mistake to include here also the giant or hypertrophic lichenification of Brocq and Pierre, which Brocq formerly called chronic nodular limited lichenification, and earlier Brocq-lichen obtusus corneus (see Lichenification). Close to prurigo Hebra are the various forms of P. by French authors (Darier, Jacquet, Besnier). There is little point in isolating them into special forms and perhaps it is better to consider them atypical forms of prurigo Hebra. Darier understands under prurigo simplex all that clinically cannot be isolated into the P. groups listed below. By uniting them under the name prurigo simplex, Darier divides them into subacute and chronic, diffuse and limited forms. Limited forms of prurigo vulgaris circumscripta are what can be fully attributed to the neurodermatitis of Brocq and what is understood under the name lichen simplex chronicus Vidal (see Vidal's lichen). What Darier understands under the diffuse form of prurigo vulgaris is in fact little different from prurigo Hebra. Almost the same clinical picture, but onset at a later age and more frequent localization on the trunk. See etiology and therapy above for prurigo Hebra. There is even less point in isolating the atypical prurigo of Jacquet. The distinctive features of prurigo Besnier are: periodic outbreaks of skin manifestations with itching in connection with the time of year - summer or winter. Pruriginous elements resemble wheals; subsequently eczematization; localization is indefinite. Summer prurigo (summer prurigo Hutchinson, 1879, eczema solare, summer eruptions, prurigo aestivalis). It arises depending on sun rays, which is why the open parts of the body are affected; somewhat more often in women in the flowering age [see separate table (pp. 847-848), fig. 1]. Clinically, pruriginous nodules, fairly intense redness, subsequent lichenification. Appearing in spring and summer, it disappears in autumn or early winter, reappearing again in spring. This disease must be distinguished from Hydroa vacciniforme (see). Unlike the latter, hematoporphyrin has not been established in summer prurigo.

There is reason to assume that in summer prurigo as well, the basis lies in moments of a photodynamic nature (Muhlmann, Akobjan).-Treatment and prevention, as in hydroa vacciniforme.-Prurigo hi emails is directly dependent on cold. Itching and lichenification appear every autumn and disappear in spring. Often begins in childhood. Predominant localization-extremities.-Treatment--as in summer prurigo.-Prurigo lymphadenica, lymphadenic prurigo. Clinically, besides severe itching, abundantly scattered prurigo papules, often excoriated, diffuse lichenification and swelling of internal and external groups of lymph glands, simultaneously there may be lymphodermias of another order. In general-this is a skin symptom of diseases of the blood-forming organs, which necessitates thorough blood examination. It is possible that lymphadenic prurigo is the result of absorption of toxins from the glands (Kreibich) (see Leukemia, skin manifestations of leukemia).

3. Grzhebny.