Correspondence

Itching without a Rash

Authors: Richard Martin, MD

Abstract

To the Editor:


It is well known that persistent itching without a rash may be a symptom of serious systemic illness. About 25% of patients with Hodgkin's disease have pruritus at some time during their illness, and in approximately 10% of Hodgkin's disease patients, itching without a rash is the presenting symptom. In several editions ofHarrison's Principles of Internal Medicine (eg, the Sixth Edition 1 in 1970 and the Eighth Edition 2 in 1977), the connection between Hodgkin's disease and pruritus was easily found in a subchapter entitled “Generalized Pruritus.” In the 12th Edition of Harrison's Principles of Internal Medicine in 1991, 3 this section was replaced with “Skin Manifestations of Internal Disease.” Since the absence of rash is not a type of skin lesion, the discussion of itching without a rash disappeared. Pruritus can still be found in the index of the 12th Edition under the subheading, “and Hodgkin's disease” (p 1609). 3 In the 1994 and 1998 editions, however, this reference in the index also vanished. 4,5 In the 15th Edition, 6 however, in the section titled “Alterations in the Skin” beginning on page 305, pruritus is mentioned briefly, and a differential diagnosis is given that is correct, although Hodgkin's disease is not mentioned.

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References

1. Wintrobe MM, Thorn GW (eds): Harrison's Principles of Internal Medicine. New York, McGraw-Hill, 1970, ed 6.
 
2. Thorn GW, Adams RD (eds): Harrison's Principles of Internal Medicine. New York, McGraw-Hill, 1977, ed 8.
 
3. Wilson JD, Braunwald E (eds): Harrison's Principles of Internal Medicine. New York, McGraw-Hill, 1991, ed 12.
 
4. Isselbacher KJ, Braunwald E (eds): Harrison's Principles of Internal Medicine. New York, McGraw-Hill, 1994, ed 13.
 
5. Isselbacher KJ, Fauci AS (eds): Harrison's Principles of Internal Medicine. New York, McGraw-Hill, 1998, ed 14.
 
6. Braunwald E, Fauci AS (eds): Harrison's Principles of Internal Medicine. New York, McGraw-Hill, 2001, ed 15.
 
7. Freedberg IM, Fitzpatrick TB (eds): Fitzpatrick's Dermatology in General Medicine. New York, McGraw-Hill, 1999, ed 5.