Plantago.- Hard white flattened isolated papules on the inside of the thigh. Some papules have a red point in the centre.
Phytolacca.- Pimples with itching on the left leg. Worse first part of the night.
Rumex crisp.- Red pimples on calves of the legs, with itching worse immediately after undressing.
Sepia.- Pimples close together on the face. Pimples on the legs, and in the bends of the joints.
Sulphur.- Pimples on inner parts of the thighs. In simple cases.
Sulph. iod.- Red pimples on the nose, chin and arms.
Tilia.- Eruption of small red, rather deeply seated pimples, with violent itching and burning like fire after scratching.
Lichen Scrofulosorum
The disease occur essentially in strumous subjects. It shows itself in the form of little elevations about the size of millet seeds either pale, or yellowish, or a brownish-red color. These papules never become vesicles; they are grouped together, sometimes in circles, sometimes in segments of circles. The papules are seated at the hair follicles, and are by-and-by covered by thin scales; the patches itch slightly, but not so much as to be scratched, and hence they are not excoriated.
The patches remain in one one condition a long time, and undergo no changes but exfoliation and involution. The disease is limited to the trunk, the belly, the breast, and back, being rare on the extremities. Its course is very slow. Generally speaking many groups of papules develop at the same time. They soon reach the height of development, and then remain awhile in status quo. In consequence of the absence of local symptoms, the disease exists unnoticed for some time. When at its acme, other symptoms are observed; between the groups, and at the same time, on parts free from lichen – that is, on the extremities and face- more or less numerous isolated bluish-red elevations are developed; these are about the size of lentils, and look very much like common acne; some of the papules are said to contain pus; then by-and-by they wither and disappear, leaving dark pigmented lentil-sized marks in some places whilst in others fresh formations take place. The skin between the diseased patches is the seat of desquamation, the scales being pale and shining, whilst the whole skin may assume a cachectic appearance. In 90 per cent., the disease is observed in markedly scrofulous subjects, and particularly children, together with swelling of the submaxillary, cervical, and axillary glands with caries and necrosis, or tabes mesenterica.
The treatment is the same as for scrofula. Cod-liver oil internally, with inunctions of oil externally is a great aid in treatment of these cases.
Strophulus
The disease is popularly known as the red gum, tooth rash, etc.; some authors look upon it as the lichen of infants. This is wrong, as lichen is an affection of the papillary layer of the derma, about the hair follicles, while strophulus is at the sweat follicles, and is characterized by the appearance of small red or white papules, varying in size from pins’ heads to small millet seeds; they are irregularly dispersed or slightly aggregated, and intermingled with more or less erythema; are attended with itching, sometimes slight moisture, and desquamation. It makes its appearance on the most exposed parts, the face especially but also the neck, arms and limbs, in successive crops. There are two forms of the affection. One variety, mostly due to over- clothing, appears in infants a few weeks old. The other variety is frequently met with during the period of dentition, lasts longer than the former variety, and is often associated with gastro-intestinal disturbance.
Treatment.- Scrupulous cleanliness must be observed; the diet should be carefully regulated; the child must not be too much wrapped up; the use of soap must be avoided; tepid sponging, spirit or alkaline lotions, may be used locally. A very useful lotion is:
Rx Carbonate of soda, gr. xx
Glycerine, dr. jj
Rose-water, vj.
M. Apply locally.
Almond emulsion and lime-water may be also used.
Lancing the gums is proper only when they are swollen or so tender as to distress the child.
Chamomilla is the principal internal remedy.
Other remedies may be indicated as follows:
Frequent starting in sleep as if in affright.
Antimon crud.- Child cannot bear to be touched or looked at. Disturbance of digestion, nausea, vomiting and diarrhoea. Tongue, thickly coated white.
Calcarea carb.- Eruption attended with swelling of glands, heat, thirst and want of appetite. Scrofulous children and during dentition.
Chamom.- Eruption of red pimples, itching worse at night. Great sensitiveness of the nervous system with irritability, cannot stand pain, the wind, or currents of air. Child very cross and restless wants to be carried.
Lycopodium.- The skin dry and hot, with yellow color, especially of the face, and emaciation. Eruptive itching, worse from 4 to 8 p.m. Red sand in urine.
Nitric acid.- Eruption with burning, itching pains, worse at night, from change of weather, or during perspiration. Strong smelling urine, like that of horses.
Prurigo
The older writers used this term in a variety of ways, and included under it several unrelated affections which possessed the common symptoms of itching. Modern usage, however, confines it to a definite affection, first clearly described by Hebra.
The disease is chiefly characterized by intense itching often commencing early in life, and extending over a number of years. In the beginning little will be found in the way of lesion other than a few scattered papules, which are little if at all raised above the surface of the skin, and are perceived more readily by the sense of touch than by that of sight. They appear to be seated in the skin, and do not, except when directly irritated, project above it. Accompanying the papules we find the usual indications of all itching affections, namely, “scratch- marks,” and these will be developed in direct ratio with the severity of the pruritus and the vulnerability of the skin. In addition to these we will find increased pigmentation, increased distinctness of the natural lines and furrows, and increased roughness, hardness, and thickness of the skin. The extensor surfaces of the limbs are the chief seats of the trouble. These phenomena may be embraced under the title of prurigo mitis, or vulgaris, but in exceptional cases, however, all the symptoms may be greatly aggravated, constituting the prurigo ferox of Hebra. The papules are larger, the excoriations more severe, and the papules may be torn open, giving exit to a little sero- purulent fluid; and a localized or general eruption may complicate, and to a certain extent mask, the primary affection. The whole surface becomes deeply pigmented, and the axillary and inguinal glands become enlarged.
Prurigo, whether in a mild or severe form, is a chronic disease, occurring even in childhood, and lasting for life.
The etiology of prurigo is unknown. The microscope throws about as much light upon the subject, as on many other cutaneous affections. Different observers obtain different results. The majority suggest the possibility of a connections with the sudatory apparatus.
Prurigo is mainly an affection of the poorer classes and occurs mostly on the extensor surfaces of the lower extremities, but is frequently found on the forearms and trunk. It is aggravated during the winter months.
Diagnosis.- The diagnosis of prurigo is not to be definitely made at the very beginning of the disease, but may be suspected in childhood when there is no other obvious cause for the pruritus. When, however, it has lasted for some years, this very fact is presumptive evidence; and the discovery of the peculiar papules in connection with the scratch-marks and their location, should in the absence of complications enable the diagnosis to be made.
The prognosis is bad, except when judicious treatment is instituted early in the course of the affection.
Treatment.- Relief may be obtained by means of prolonged baths and energetic frictions, and alkaline and tarry preparations, such as the tinctura saponis viridis, to which a liberal amount of tar has been added. Peppermint oil acts as a temporary sedative. As the violence of the disease is most fully displayed at night, the application should be made at bed-time, except in cases of such severity that the patient is obliged to abandon business or social life, and give himself up entirely to the treatment of his disease.
Prurigo as a Family Affection.- Dr. Sokoloff records the history of a family, in which, of six children (aged from 1 to 12), three (two girls and one boy) were suffering from a severe general prurigo. In each instance, the symptoms had first appeared about six months after the child’s birth to gradually attain their maximum intensity about the fifth year of the patient’s life, after which the itching as gradually decreased. The symptoms were always intensified during summer, and under the influence of heat in general. All the three patients were fair and fat, while those not affected were of dark complexion and lean.
