Prurigo nodularis (PN) is a chronic skin inflammation that can cause firm, itchy, and pain-producing bumps (nodules) on the skin’s surface. PN usually begins with very itchy skin, which can be restricted to a small number of areas or spread out, according to the American Academy of Dermatology (AAD).
The itching can be so painful that it triggers an uncontrollable desire for rubbing and scratching, leading to more itching and swelling. After six months, hard (not filled with pus) nodules develop at the scratching site.
Most (but certainly not every) patients who suffer from prurigo nodularis also have another skin problem which causes itchy skin, states Steven Feldman, MD Ph.D., who is a researcher as well as a dermatologist with Atrium Health Wake Forest Baptist in Winston Salem, North Carolina.
“For example, if you have eczema or psoriasis and rub and scratch enough, you can develop prurigo nodules,” Dr. Feldman said. According to Dr. Feldman, scratching at insects can cause prurigo nodules to develop.
Common Questions & Answers
The reason for prurigo nodularis is unknown. However, it is believed to be caused by chronic or frequent skin irritation, insects or emotional stress other health conditions. How do I rid myself of prurigo nodularis? An autoimmune disorder? What is prurigo nodularis appear like?
Signs and Symptoms of Prurigo nodularis
The primary symptom of prurigo nodularis usually itchy skin. Some sufferers also report feeling burning or itchy, as per the AAD. Itching can occur all the time or occur in short periods.
According to Feldman, rubbing, scratching, or rubbing the skin could cause the development of complex, itchy bumps. The spots tend to appear in areas where it is easy to cross, according to Yale Medicine, and may include:
- Legs and arms
- Abdomen
- Lower and upper back
The nodules vary in size from just a few millimeters to three centimeters. They can be brown, red, or black. They may also be similar to the other skin.
Causes and Risk Factors of Prurigo nodularis
The precise reason for PN is unclear, but changes in the immune system’s functioning and the skin’s nerves could be linked with increased itchiness that causes frequent scratching, as per the National Organization for Rare Disorders (NORD).
Age: The condition is most frequent in those who are 50 or more, typically between the ages of 51 and 65, as per the AAD.
Conditions of the skin: people with a previous history of atopic dermatology, psoriasis, or other skin disorders are more prone to develop prurigo nodularis, according to Feldman.
Certain underlying illnesses, people with kidney disease, HIV, hepatitis C infection, as well as certain parasitic and bacterial illnesses, thyroid disease, lymphoma, or liver disease, could be more likely to develop prurigo nodularis, According to Yale Medicine.
Ethnicity or race Black people, particularly those who suffer from atopic dermatitis, which frequently flares, is at a higher risk of developing prurigo nodularis, AAD says. AAD.
How Is Prurigo Nodularis Diagnosed?
Dermatologists often detect prurigo nodularis by looking for skin bumps, according to Feldman, and carefully consider those that can be scuffed or rubbed.
The dermatologist might need a dermatology biopsy to confirm the diagnosis if you suffer from multiple skin conditions. The biopsy involves removing an insignificant amount of skin tissue from the nodule and studying it under a microscope to observe specific changes within the skin’s tissues and cells.
Some people who suffer from PN suffer from another illness like diabetes or hepatitis C, or untreated HIV. Therefore, blood tests can also be part of a diagnostic procedure.
Treatment and Medication Options for Prurigo nodularis
There’s no cure for prurigo nodularis. However, various remedies can end the scratch-itch-itch cycle, says Feldman. This includes:
- Corticosteroids: If you have just a few nodules, steroid creams, and ointments could aid in reducing itching and inflammation, as suggested by Feldman. According to Yale Medicine, corticosteroids that are injected orally can be utilized to treat more serious PN.
- Antihistamines: These medicines can ease itching.
- Phototherapy The UV (UV) light exposure can reduce itching and inflammation, claims Feldman.
- Cryosurgery: This procedure is a procedure that makes use of extreme cold to eliminate abnormal tissue and can be an alternative if other treatments fail to provide relief from pain or itch. It’s usually not an option first or last resort for darker skin as it could cause noticeable marks, light spots, or both.
- Immunomodulatory medications In more severe cases, or when nodules do not respond to other treatments, dermatologists might prescribe immunosuppressive drugs such as methotrexate or cyclosporin to reduce inflammation, according to Feldman. However, Feldman says these medications can have adverse health effects over the long run.
- Other medications: Dermatologists might suggest oral prescriptions for naltrexone, antidepressants, gabapentin, or pregabalin.
Dupixent (dupilumab) injection is the first treatment approved by the U.S. Food and Drug Administration (FDA) for treating prurigo nodularis. “Dupilumab is highly effective; it’s already been approved for atopic dermatitis,” Feldman says. Feldman.
Dupixent can be injected by subcutaneous injections of 300 milligrams delivered via a pre-filled syringe or pen every two weeks following an initial loading dose. In clinical studies, the drug significantly improved the itch of the skin and clearing of nodules, as per the FDA.
Lifestyle Changes and Complementary Therapies
While it’s tough, you should avoid scratching the nodules, suggests Feldman. “If you just have a few spots, placing a Band-Aid over them can help,” Feldman suggests.
Other ways to aid the scratching-itch cycle, courtesy of Yale Medicine:
- Make sure to use mild soaps or none at all while bathing.
- Apply moisturizer several times throughout the day.
- Use over-the-counter creams and ointments that soothe skin and lessen itching. Some of these include capsaicin cream, pramoxine hydrochloride (a topical anesthetic), and other products that contain camphor menthol and phenol.
- Keep fingernails trimmed.
- Use gloves or mittens when sleeping to avoid accidental scratching.
Although the results must be verified in more extensive studies, the results of a study published in November 2021 by Clinical Cosmetic and Investigational Dermatology found that Acupuncture treatment significantly reduced itching and improved sleep for four months.
Prevention of Prurigo Nodularis
Since the cause of PN is usually unknown, and there’s no way to determine why some people suffer from it while others don’t, there’s no proven method to stop it.
However, there are methods to stop the itch-scratch process from kicking in, per the AAD. Avoiding triggers common to stress, such as sweating, heat, humidity, dryness, perfumed personal care products, clothes made of wool or polyester, and any rough fabric could help reduce symptoms.
Complications of Prurigo Nodularis
Infection Although not common, scratching or rubbing nodules could result in conditions. The appearance of swelling, discoloration, hot or warm sensation, pus that leaks from the skin, and pain or fever are signs of an infection.
Consult the dermatologist of your choice or your primary doctor immediately if you notice any symptoms of an infection.
When medications and other self-care measures reduce prurigo nodularis itching, the nodules will heal over time. Still, they can cause scarring in those with dark and lighter skin, as noted in an article published in JAMA Dermatology. JAMA Dermatology.
Research and Statistics: Who Has Prurigo Nodularis?
According to NORD, Prurigo nodularis is relatively rare, with only about 88,000 people across the United States. Any age group may develop PN, but it’s more prevalent among those between 40 and 69. About 55 percent of those who suffer from PN are females, and 45 percent are males.
Black Americans and Prurigo Nodularis
It has a prevalence of 3.4 times more common among Black Americans, says NORD. Black patients with PN typically have more significant, firm, and darker bumps, which tend to create dark spots that may last for months or even years to fade, as per JAMA Dermatology.
Conditions Related to Prurigo nodularis
The Skin DiseasesOften, known as eczema, atopic dermatologic syndrome is a chronic condition caused by an active immune system that causes the skin to turn dry, irritable, and irritated. Around half of the people who suffer from PN are afflicted with Atopic dermatitis, as per the findings of a study published in the Journal of the European Academy of Dermatology and Venereology.
Other Chronic Diseases There is a connection between prurigo nodularis and various medical conditions, such as kidney disease, HIV, hepatitis C infection, parasitic and bacterial infections, lymphoma, thyroid disease, and liver problems. Certain people suffering from PN might also have diabetes.
Depression and anxiety Prurigo nodularis has been linked with various mental health problems. A study published in the Journal of Clinical and Aesthetic Dermatology discovered that more than half affected by PN had some mental health issue, with depression and anxiety disorders being the most frequent.
Living With Prurigo Nodularis
According to Feldman, Prurigo nodularis may cause severe emotional and physical discomfort that can negatively impact your life quality. People suffering from PN might be trouble sleeping and be self-conscious; they may avoid social events and avoid work and school. They might also have mental health issues.
Due to PN’s mental and emotional burden due to its mental and emotional burden, the AAD suggests that those suffering from PN seek help from a professional in mental health According to the AAD.