Psychosomatic Dermatoses *From a Lecture delivered at Bath on 26th March, 1947.

During the last twenty years, attention lias been given to the psychological factor in skin disease : its importance is now generally recognized. May I submit a few examples for your consideration '? Alopecia Areata was once held to be due to infection ; the idea has been dropped. It has been attributed to some obscure nervous reflex action produced by molar teeth, defects of vision, and even to nits on the eyelashes ; these ideas, too, have been abandoned. Obscure toxins from the tonsil and large bowel have been charged and absolved. But the hairdressers, nowadays called " tricholo-gists," have always maintained that Alopecia Areata was of neurotic origin. It is found repeatedly to coincide with periods of nervous shock and strain : after a severe shock, it may even develop into total baldness. A different type of neurosis is found in Pruritus Ani. Many causes are alleged, but the obsessional nature of these patients is worth noting. Greeting the physician with the scantiest of acknowledgment the trousers are dropped and the posterior exposed : there the patient will stand with complete satisfaction whilst one looks for physical signs to support a history that is magniloquent and logor-rhseic. It is characteristic of these patients to be slow in dressing and to hang about the clinic in the hope of catching a few extra words, addressed to the students, that they may ponder over with ruminative satisfaction. They can be cured by X-ray treatment (helped naturally by sedative drugs) : even if a sheet of lead be interposed between the machine and the itching site ! The onset of Lichen Planus often corresponds with a personal calamity. I asked one patient why he remembered it had begun on the 8th and not the 5th of November, and he replied it was the day on which his eldest son had been arrested for embezzlement : you will add other histories like this to your collection. The peculiar and personal build-up of this type of patient is well illustrated by the group who suffer from Prurigo. Here we have a chronic papular irritation of the skin affecting perhaps the flexures and sometimes the whole body. We may distinguish between Prurigo mitis and * From a Lecture delivered at Bath on 26th March, 1917.