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Definition of Prurigo Nodularis
Prurigo is a chronic condition in which lesions, typically papules or nodules, that itch intensely erupt on the skin. The lesions may occur anywhere on the body, though typically form in locations that allow scratching.
Because the cause of prurigo, also called prurigo nodularis, remains unknown, dermatologists do not know whether the lesions develop in response to scratching or whether the itching of the lesions establishes the need to scratch.
Whichever is the case, one perpetuates the other. The lesions eventually develop coarse, scaly surfaces. The intense itching drives many people to scratch the lesions until they bleed, which causes scabs to develop. Lesions that heal often leave white scars. An outbreak of lesions may extend over months or even years.
Diagnostic Path and Treatment
Prurigo is sometimes associated with liver disease, kidney disease, hiv/aids, atopic dermatitis, generalized anxiety disorder (GAD), and also depression. Most people who develop prurigo are middle-age or older, though occasionally the condition occurs in young people. The diagnostic pathway may include biopsy to rule out other causes for the lesions.
Treatment generally incorporates topical corticosteroid medications and topical or oral antihistamine medications to subdue the itching. The dermatologist may choose to inject large or recurrent lesions with a corticosteroid medication. Some people who have prurigo benefit from psoralen plus ultraviolet A (PUVA) phototherapy or cryotherapy (freezing), which destroys the lesions and allows the skin to heal.
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