Prurigo nodularis

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Prurigo nodularis
papules and scattered nodules can be seen (a) on the legs, (b) on the arms and (c) on the trunk of this patient with prurigo nodularis.
scattered excoriated nodules across the extensor surface of the bilateral hands
SpecialtyDermatology Edit this on Wikidata

Prurigo nodularis (PN), also known as nodular prurigo, is a

excoriated nodules caused by chronic scratching. Although the exact cause of PN is unknown, PN is associated with other dermatologic conditions such as untreated or severe atopic dermatitis and systemic causes of pruritus including liver disease and end stage kidney disease.[2] The goal of treatment in PN is to decrease the itch sensation. PN is also known as Hyde prurigo nodularis, or Picker's nodules.[3]

Signs and symptoms

Causes

The exact cause of prurigo nodularis is unknown, however, it is thought to be induced by other dermatologic conditions such as severe atopic dermatitis,

linear IgA disease[7]. PN is also associated with systemic causes of pruritus such as liver disease,[8] cholestasis, thyroid disease, polycythemia vera, uremia, Hodgkins lymphoma, HIV and kidney failure diseases.[9][10] Psychiatric illnesses have been considered to induce PN, although more recent research has refuted a psychiatric cause for PN. Patients report an ongoing battle to distinguish themselves from those with psychiatric disorders, such as delusions of parasitosis and other psychiatric conditions.[11][12]

Pathophysiology

Chronic and repetitive scratching, picking, or rubbing of the nodules may result in permanent changes to the skin, including nodular lichenification, hyperkeratosis, hyperpigmentation, and skin thickening. Unhealed, excoriated lesions are often scaly, crusted or scabbed. Many patients report a lack of wound healing even when medications relieve the itching and subsequent scratching.[citation needed
]

Patients often:[citation needed]

  • seek treatment during middle-age, although PN can occur at any age.
  • have a history of chronic severe pruritus.
  • have a significant medical history for unrelated conditions.
  • develop liver or kidney dysfunctions.
  • develop secondary skin infections.
  • have a personal or family history of atopic dermatitis.
  • have other autoimmune disorders.
  • have low vitamin D levels.

Diagnosis

Diagnosis is based on visual examination and the presence of itching for greater than 6 weeks duration.

eosinophils.[14] A culture of at least one lesion will rule out staphylococcus infection, which has been significantly linked to atopic dermatitis.[15][16][17]

Treatment

Prurigo nodularis is very hard to treat, but current therapies include steroids, dupilumab, vitamins, cryosurgery, thalidomide and UVB light[citation needed]. In the event that staphylococcus or other infection is present, antibiotics have proven effective, but tend to cause more harm than good for this particular disease. A physician may administer a strong dose of prednisone, which will almost immediately stop the itch/scratch cycle. However, cessation of steroids allows relapse to occur, usually within a few weeks. Horiuchi et al recently reported significant improvement in PN with antibiotic therapy.[18]

Another drug a physician may administer is Apo-Azathioprine. Azathioprine, also known by its brand name Imuran, is an immunosuppressive drug used in organ transplantation and autoimmune diseases and belongs to the chemical class of purine analogues.[citation needed]

Dupixent was the first medication approved by the FDA in September 2022 to treat Prurigo Nodularis.

History

Prurigo nodularis was first described by Hyde and Montgomery in 1909.[19]

See also

  • Pruritus
  • Skin lesion

Notes

  1. ^
    PMID 34077168
    .
  2. ^ "Prurigo nodularis: Causes". www.aad.org. Retrieved 2024-02-13.
  3. PMID 35417906
    .
  4. S2CID 218910999
    .
  5. S2CID 235429367
    .
  6. S2CID 32658695
    .
  7. S2CID 28166468
    .
  8. PMID 19797460
    .
  9. PMID 15301165
    .
  10. PMID 7593791
    .
  11. PMID 17533993
    .
  12. PMID 17173825.[permanent dead link
    ]
  13. PMID 31561504
    .
  14. S2CID 9095256
    .
  15. S2CID 27948096
    .
  16. S2CID 25203471
    .
  17. S2CID 38030209
    .
  18. PMID 16673805
    .
  19. ^ Hyde JN, Montgomery FH: A practical treatise on disease of the skin for the use of students and practitioners. 1909; 174–175.

External links

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