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Scratching At What Might Have Caused Napoleon’s Itch | AAD 2024


Scabies, arsenic exposure and psychogenic pruritus are among the possibilities discussed in a poster presented at the annual meeting of the American Academy of Dermatology.

Portraits of Napoleon Bonaparte, the 19th century French emperor and general, often show him with this right hand tucked into an opening in his waistcoat. The familiar Napoleonic pose might have been just a mannerism, as it was not uncommon in his day.

But Zachary Leibovit-Reiben says his Napoleon might have been sneaking his hand in there to provide some scratching relief to chronic itch.

Leibovit-Reiben, a third-year medical student at the University of Arizona College of Medicine in Tucson, and his colleagues presented a poster about Napoleon’s itch this weekend at the annual meeting of American Academy of Dermatology in San Diego.

Zachary Leibovit-Reiben

Zachary Leibovit-Reiben

Others have written about Napoleon’s itch and offered up their theories about its etiology. In 1940, Reuben Friedman, M.D., an assistant professor at Temple University School of Medicine, published “The Emperor’s Itch: The Legend Concerning Napoleon’s Affliction With Scabies” to debunk the theory that the cause was scabies. A short article published in JAMA Dermatology in 2016 revisited the topic of the emperor's itching woes.

Leibovit-Reiben said he and his colleagues were motivated to explore the various explanations for Napoleon’s possible pruritus to “give awareness to people about the debilitating nature of chronic itch.”

Their poster observes that “chronic itch, is not as well understood, however it is a complex interplay of neurologic emotion and reward pathways, complex dermatologic diseases, psychiatric illnesses and a variety of other processes and disciplines.”

Although often viewed as mild and sometimes a source of humor, itch is increasing prominent in dermatological research, drug development and treatment. There were 71 posters concerning itch presented at the AAD meeting, and it was addressed at 11 of the meeting’s educational sessions. Brian S. Kim, M.D., M.T.R., vice chair of research in the dermatology department at the Icahn School of Medicine at Mount Sinai in New York and an expert on the complex neuroimmunology of itch, received an award from the academy and was one of the featured speakers at the plenary session this morning.

Leibovit-Reiben said he and his colleagues are “in the process of finding more sources on Napoleon’s chronic itch.” In the meantime, Leibovit-Reiben discussed several possible causes of Napoleon’s itch

Scabies is caused by Sarcoptes scabiei, a parasitic mite that burrows into the skin. Itchiness is one of the main symptoms, and the mites spread easily from person to person. Traditionally scabies has been associated with crowded living conditions and impoverished circumstances. Leibovit-Reiben said the evidence that Napoleon may have had scabies comes from memoirs and is also deduced from evidence that he was treated with sulfur baths.

Another possibility is that Napoleon was exposed to high levels of arsenic, which is well characterized as a source of itching. Analysis of samples of Napoleon’s hair after he died in exile in 1821 have reportedly shown elevated levels of arsenic. Whether he was deliberately poisoned with arsenic is still debated. Authors of an article published in the Journal of the Royal Society of Medicine in 2004 speculated that the arsenic exposure might have come from a green pigment called Scheele’s green, which was contained arsenic and was used in wallpaper in the 19th century.

Napoleon’s autopsy revealed gastric cancer, noted Leibovit-Reiben, and dermatitis herpetiformis, an itch-producing condition seen in celiac disease, is associated with gastric lymphoma.

Atopic dermatitis is a candidate explanation because it is one of the most common causes of itch, Leibovit-Reiben said.

Another possible cause the researchers want to explore is psychogenic pruritis — itch associated psychological factors, Leibovit-Reiben said. Depression is associated with psychogenic itch, and descriptions of Napoleon's bouts of apathy, poor sleep and weight gain are suggestive of someone dealing with depression, Leibovit-Reiben said.

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