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PAROXYSMAL PRURITUS Severe, persistent, or recurrent pruritus, with or without prior skin lesions, is often paroxysmal in character: sudden

in onset, irresistibly severe, frequently awakening the patient, and stopping instantly and completely as soon as pain is induced by scratching. The pleasure of scratching is so intense that the patient despite his realization that he is damaging the skin- Is unable to stop short of inflicting such damage. Why is no pain but only intense pleasure felt while the fingernails are digging right into the dermis? It seems possible that Wolff's theory of antidromic impulses passing outward over sensory nerves, and thus temporarily incapacitating them, could, account for such a bizarre sensory aberration. The instant that a pain impulse reverses this flow, pain replaces the itching, and there is no itching until the injuries have healed. In a number of more or less dramatic instances, we have seen the sudden recall of a powerful but completely suppressed emotional reaction stop such pruritus in and completely, even when it had occurred daily for many years. When itching is stops, scratching stops. The "habit" of scratching is a mythat least in such cases. Itching of this distinctive character is never seen as a result of dermatitis venenata, or tinea, or scabies. It is characteristic of only a few dermatomes: lichen simplex chronics, atopic dermatitis, nummular eczema, dermatitis herpetiformis, neurotic excoriations, and prurigo nodularis. Only in these does pruritus regularly induce scratching of such violence as to induce bleeding and leave hyper pigmentation or scarring, or both. Such Itching is often a result not of feeling emotional tension but of rejecting and suppressing it. In cases of very, recent onset the victim may rarely, by patient questioning, be enabled to recall an emotionally traumatic incident that happened on the day the itching began and be dramatically cured thereby. But, as a rule, the cause is too deeply buried to be found; anti, indeed, it may be such a traumatic event that the patient is better off with the neurodermatitis than with the knowledge of its cause. It may be "too hot to handle." INTERNAL CAUSES OF PRURITUS Itching as a symptom may be present in a number of internal disorders. The degree of intensity and the duration of itching vary from one disease to another. Among the most frequent internal disorders causing itching are malignant lymphoma, uremia, diabetes mellitus, malignancies, obstructive biliary disease, intestinal parasitosis, polycythemia vera, hypo and hyperthyroidism, carcinoid, multiple sclerosis, and myeloma. In Hodgkin's disease itching is usually continuous and at times accompanied by severe burning. The incidence of pruritus is between 10 and 25 per cent and Amblard found it to be the first symptom of this disease in 7 per cent of 94 patients. Its cause is unknown.

The pruritus of leukemia has a tendency to be more generalized and less severe than in Hodgkin's disease.