Pruritus is characterized by the occurrence of itching; in fact, pruritus is itching. It may co-exist with, or be entirely unaccompanied by, organic change in the skin; and a knowledge of the conditions under which it occurs is essential.
Pruritus occurs in the course of most inflammations of the skin; in connection with rheumatic manifestations; the circulation of morbid elements, as bile, urinary excreta; elevations of temperature, senile decay of the skin, gastro- intestinal disturbance, nervous diseases, Bright’s disease, genito-urinary and uterine derangements, sedentary habits, and stimulating diet; it is also occasioned by local causes; about the rectum by ascarides and piles, and over the body in various parts by parasites (animal or vegetable). When pruritus is spoken of in the abstract, itching, as constituting the primary and sole disease present, is signified, and the nervous character of the itching is frequently shown by its sudden appearance, its almost as sudden disappearance, and often its marked tendency to periodicity.
Pruritus may be general or local, and it is very generally followed by secondary changes in the skin. When general it is due to the causes of more general operation, mentioned above.
When pruritus occurs, of course in most cases the patient scratches more or less violently for the relief of the itching, and this induces certain special diseased conditions. In fact, the phenomena of a scratched skin are produced, or what is termed a “pruriginous eruption.”
In certain cases pruritus exists in the first place as apparently the sole disease, and in which scratching is practiced, and eruptions follow. These conditions we will now discuss.
Pruritus Senilis.-In old people whose skin begins to exhibit atrophous changes the sensibility of the skin is much disordered and more or less associated pruritus occurs. The practitioner is consulted for this pruritus, and at first there is nothing else to be observed in the skin but laxity and thinness of the integuments, with perhaps plugging up of a certain number of the follicles by the exuviae shed from the sebaceous glands. The pruritus is the evil from which the patient desires to be rid. It is increased by heat, cold, the warmth of the bed, by digestion, and other things. These cases may be relieved by the use of alkaline baths, free oiling of the surface, or some local anodyne application. Besnier advises in these cases that the patient bathe in a solution containing to each litre a solution of carbolic acid 10.00 to 500 grammes of acet. aromat. This should be followed by dusting the affected parts with amylum, 90; bismuth salicyl., 20.0.
After awhile the scratching practiced to relieve the irritation induces the development of distinct eruptive phenomena. A certain amount of hyperaemia occurs, and this is followed by the formation of lymph papules, which, being scratched, become pruriginous-that is to say, the apices are torn, a little blood oozes out and dries on these apices as a dark speck. These changes are followed by more or less infiltration of certain parts, by the intermingling of excoriations made by the nails with the pruriginous rash, and in some instances by ecthymatous pustules or urticaria. The pruritus is often intense, and takes the form of a stinging, creeping, or burning sensation. The pruritus is the primary, as it is occasionally the sole condition. The disease may be, of course, more or less general, or more marked in one place than another.
The cure of pruritus senilis is, too, effected by emollient and vapour baths, and anodynes, locally applied. The following formulae are often of benefit: Rx. Sodii Hyposulphit, dr.j.
Acid Carbol., dr. ss.
Glycerini, oz. j.
Listerine, oz.iij.
M. Sig.: Use as a lotion.
Or, Rx. Ammonium sulpho-ichthyolat, 3jj.
Aquae rosae, Glycerini, aa 3ss.
M. Sig.: Use as a lotion.
Or, Rx. Opium, gr. viij.
Creasote, gtt. x.
Lard, jj.
M. Sig.: Use locally.
Or, Rx. Tincture of myrrh, gtt. xxx.
Oxide of zinc, gr. xx.
Cold cream, z3j.
M. Sig.: Use locally.
Or, Rx. Carbonate of soda, 3ss.
Conium juice, z3j.
Elder flower water, z3j.
M. Sig.: Use locally.
The above formulae, and many others, may be used in any of the forms of pruritus. Under the varieties mentioned below, some other means of affording relief will be noticed.
Pruritus Ani.-Itching about the anus arises from a variety of causes. It is a common consequence of piles, ascarides, tinea circinata, the friction of the parts in stout people (intertrigo), gout, and uterine disorder. It occurs from the latter by reflex action. It is often very troublesome. The result of scratching is to give rise to the development of papulae, and it may be, considerable inflammatory thickening.
The practitioner must of course discover any local cause for the disease, and take care to negative its operation. The same local applications recommended for the preceding will be useful. In addition I would advise the following:
Rx Oil of bitter almonds Z3 ij.
Cyanide of potassium, gr. x Galen’s cerate, Z3 ij.
M. Sig.: Apply locally. This must be used with great caution.
Pruritus praeputii.- Is merely itching about the glands, connected with an abnormal secretion from the follicles of that part. The remedy is free washing with soap and water and the application of an oxide of zinc powder or lotion as follows:
Rx Oxide of zinc, 3 ij.
Glycerine, 3ij.
Lead-water, 3iss.
Lime-water, z3vj to viij.
M. Sig.: Apply locally.
Pruritus pudendi, or itching about the genital parts is common in women, and arises from a variety of causes eczema, intertrigo the presence of vegetable fungi, ovarian and uterine irritation, hemorrhoids, and varicosity of veins of the genital parts. In those cases in which there appears no structural change relief is to be obtained by the locally applied anodynes care being taken to treat any uterine or ovarian disease appropriately.
For the relief of the itching the following means may be used: The cure of the complaint in any of its above forms can only be accomplished by the administration of the properly indicated homoeopathic remedy, hints of which will be found at the close of this article. In many cases relief will be demanded for the excessive itching, and in such cases it is admissible to make use of one or more of the following:
Rx. Hyposulphite of soda, z3j.
Glycerine, z 3j.
water, z 3 iij.
M. Sig.: use locally.
Peppermint water is one of our best local applications in the above-mentioned forms of pruritus. Patients can easily make their own own lotion, as required for use, by putting a teaspoonful of borax into a pint bottle of hot water, and adding to it five drops of oleum menthae peperitae, and shaking well; the parts affected to be freely bathed with a soft sponge.
If cracks, or sores, or eczema, or rawness be present this lotion will be too severe. Olive oil, with five grains of iodoform to the ounce, is better.
A sitz bath of cold water is often beneficial.
Galvanism as a remedy, in pruritus vulvae et ani, is a vulvae et ani, is a valuable adjuvant. A current from six elements with the anode applied to the vulva and the cathode to the affected portions of the integument. The sitting should last about ten minutes.
Therapeutic Hints.-
Itching as if from ants: Lachesis, Phosphorus, Pulsatilla, Secale.
Bitings: Berberis, Bryonia, China, Colchicum, Lachesis, Ledum
Magn. acet., Mercurius, Nux vomica, Oleand., Pulsatilla
Burning: Agaricus, Argentum, n., Arsenicum, Bryonia, Caladium, Caps., Cicuta, Euphorb., Hepar, Ignatia, mercurius, Nux vomica, Ranunculus, Rhus., Sabad., Sabad., Spigelia, Staphysagria, Sulphur, Veratrum, Violod.
As if from congelation: Agaricus
Corrosive itching: Rhus ven.
Crawling: Argentum nitricum, Arsenicum, Dulcamara, Magn., c., sil., Spigelia, Staphysagria
Creeping: Silicea
Dull : Hepar.
As if electric sparks: Phell.
As if from fleas: Argentumn., Lyco., Magn. acet., Mercurius, Mezer., Oleand., Pulsatilla, Silicea, Spongia, Staphysagria, Tabac., Teucrium, Thuja, Zincum met.
Gnawing: Agn., Arsenicum, Cocc., Digitalis, Euphorb., Magn., aust., Oleand., Platina, Pulsatilla, Rhododendron, Ruta.
Intolerable: Mercurius, Silicea
Itch-like: Amb., Mercurius, Veratrum
Jerking : Staphysagria
Itching as of lice: Argentum, n., CAnth., Magn.m., Platina, Zincum met.
As from mosquito-bites: Rhus ven.
As of nettles: Colchicum, Lupul.
Painful: Alumina, Ammonium, Baryta, Chamomilla, Cocc., Lupul., Nitr.
Pinching: Mosch.
Pleasant: Mercurius
Pricking: Cin., Platina, Zincum met.
Stinging: Agn., Argentum, Arnica, Asafoetida, Bryonia, Conium, Cyclamen, Drosera, Graphites, Ignatia, Ledum, Magn. acet., Mercurius, Oleand., Pulsatilla, Ranunculus, sc., Rhus, Ruta, Sabina, Spigelia, Spongia, Squill., Stannum, Staphysagria, Thuja, Verbascum, Viol. tr.
Tearing: Belladonna, Bryonia
Tickling: Agaricus, Calcarea c., Euphorb., Mercurius, Platina, Pulsatilla, Ruta.
Titillating: Belladonna, Chelidonium, China, Platina, Rhododendron, Sabad., Squilla.
Violent: Agaricus, Drosera, Ipecac., Lachesis
Voluptuous: Anacardium, Mercurius, Sulphur
Wandering: Chamomilla, Graphites, Kali carb., Magn. m., Mez., Rhus v., Staphysagria, Zincum met.
