Prurigo is a chronic,
itching, papular Skin disease which has a predilection for the lower abdomen,
buttocks, and extensor surfaces of the limbs. Some lesions in addition are
likely to occur on the trunk, scalp, forehead, face, and neck. Prurigo begins
mostly in children from 2 to 5 years of age, being more common in boys.
Probably in time all cases of prurigo will be proven to be severe types of
papular urticaria caused by insect bites in hypersensitive children.
There are two forms of prurigo; namely, prurigo
mitis, the more common, which is comparatively mild; and prurigo agria or
ferox, which is severe though exceedingly rare in this country.
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| Prurigo is a chronic, itching, papular Skin disease |
Prurigo mitis usually begins as papular
urticaria and, persistently recurring, gradually assumes the characteristics
of prurigo and lasts indefinitely. Prurigo mitis, therefore, can only be
distinguished from papular urticaria after the second year of the disease by
the uniform type of its primary lesion (the prurigo papule), by the chronicity,
severity, scars, Iichenification, and cczematization. The prurigo papules at
first are easier to palpate than to see, but later become small, rounded,
extremely pruritic, flesh-colored or reddish elevations. The lesions are
symmetrically distributed and may be few in number or very
profuse. As time progresses the urticarial element is less noticeable but the
extreme pruritus persists and leads to even greater secondary changes. The
excoriations, lichenifica-tion, and eczematization become more and more
pronounced and are accompanied by enlarged glands and associated
constitutional symptoms.
In prurigo agria the hard, excoriated prurigo papules and
lichenification are
completely predominant, the urticarial elements being sparse or absent.
Incessant scratching causes pitted scars and pustulation. The adenopathy is not pronounced in the groins and axillae,
which are free from skin lesions.
There is often the history of excessive ingestion of carbohydrates, sweets
and raw fruits. The hair is lusterless. Examination of the blood shows
eosinophilia. There is usually an allergic family history, and skin tests reveal multiple sensitizations but these
have no direct bearing on the etiology or therapy.
Treatment.
Treatment includes the development of a hygienic regimen, consisting of liberal
and proper diet with green vegetables, meat and cereals but no egg, chocolate,
candy or citrus fruit. The addition of calciferol may be indicated. Small
doses of phenobarbital have value. Treatment
should be given for fleas as advised on pages 166 and 441, or for intestinal
parasites if present.
Antihistamine creams and hydrocortisone ointment are beneficial. The
combination of tar, sulfur, and green soap, known as Wilkinson's salve, has
special value in this condition, being applied in either quarter or half strength. The following
formula is beneficial:
R Prep, chalk.................................................................................. 1.0
Beechwood tar........................................................................... 1.5
Sulfur ppt................................................................................... 1.5
Green soap ................................................................................ 13.0
Lard........................................................................................... 13.0
M. and S. Apply locally morning and night.
