About Prurigo Nodularis
Prurigo nodularis is a chronic but rare skin condition that forms hard, itchy nodules (lumps) on the skin’s surface. It is characterized by a symmetrical and painful skin rash affecting the outer surface of arms and legs, abdomen, and upper and lower back.
Intense itching (pruritis), a significant hallmark of prurigo nodularis usually intensifies at night. The scratching continues to a point when the skin starts to bleed. Once the skin is scratched, it can trigger the formation of newer nodules, therefore new nodules keep forming in an endless itch-scratch cycle.
The exact cause of the disease is unknown so there aren’t any currently prescribed prurigo nodularis medications to target the condition’s itching particularly. Thus, it is crucial to comprehend the condition and develop an innovative treatment for prurigo nodularis, for those who suffer from it. In search of effective potential treatment options to help ease pain, multiple prurigo nodularis clinical trials are being conducted.
This blog is curated to maneuver around prurigo nodularis, a rare skin condition. Dive into this informative piece to learn everything you need to know about the condition.
What Does Prurigo Nodularis Look Like?
The nodules produced in prurigo nodularis usually initiate as small, red, itchy papules or rounded skin bumps. When the condition advances, these rounded lesions transform into large dome-shaped, wart-like growth (nodules) up to 3 cm in diameter, firm to touch.
As the nodules age, it undergoes a color change from red to brown-black to turning pale occasionally. The in-between traces of skin among the nodular clusters look dry and scaly in some instances and the size of these nodular groups frequently varies from singles to hundreds. The drying effect aggravates scratching, causing newer nodules to form secondary to scratching and rubbing.
Is Prurigo Nodularis An Autoimmune Condition?
The exact etiological cause of the disease is unknown but a number of factors have been found to contribute to the condition. Also, specific demographic, and underlying conditions are reported to produce prurigo nodularis from internal malignancy to renal failure to psychiatric conditions.
Pruritis is a common manifestation of autoimmune conditions affecting the skin. An example of chronic autoimmune cholestatic hepatitis produces pruritic nodules on the skin and is one of the first manifestations of the condition.
What Causes Prurigo Nodularis?
In about 50% of the cases, some inherited conditions (asthma, eczema, hay fever, and hives) act as an identifiable cause of the disease. Occasionally, prurigo nodularis is associated with pemphigoid nodularis (a rare autoimmune skin disease characterized by large blisters) and dermatitis herpetiformis (an itchy blistering skin condition associated with coeliac disease).
30% of the metabolic and chemical conditions linked to inducing itching are:
- A lack of nutrition
- Anomaly of the liver
Although some people are more prone to developing the condition, it is important to realize that everyone is at risk of developing the condition irrespective of age.
People with some of these long-term medical diseases are at high risk of developing prurigo nodularis:
- Atopic dermatitis,
- Contact dermatitis,
- End-stage kidney disease,
- Hepatitis C,
- Untreated HIV,
- Lymphoma (Hodgkin’s lymphoma, non-Hodgkin’s lymphoma), and
- Mental health conditions, including anxiety or depression.
Other groups of people are also vulnerable to developing the condition including:
- Elderly people (50 years or older), usually between 51- 65 years of age
- African American origins
- People with immuno-compromising conditions, e.g., (human immunodeficiency disease)
Prurigo Nodularis: Foods To Avoid
Your doctor might advise you to discontinue the ketogenic diet if prurigo nodularis is linked to ketosis. Certain foods most noticeably eggs and processed foods of any kind cause hard bumps to appear from nowhere with no warning. Typically, this entails eating a well-balanced diet while avoiding refined foods and foods that cause inflammation, such as:
- Red meat
- Processed foods with added preservatives
- Trans fatty acid
- Fried foods
So if you’re stressed, which, let’s face it, most of us are these days, your prurigo nodularis may itch even more. You may scratch even more. However, stress may not be the culprit, instead, you need to watch your diet.
Also read: Prurigo nodularis Foods to Avoid
Symptoms Of Prurigo Nodularis
The appearance of the bumps may vary from what appears initially as red itchy nodules to hard, scaly, warty growths of varying sizes and colors (flesh tones to pink, brown, or black scabby).
This painful condition might become a challenge to face every day for those struggling with it because of the vicious cycle of scratching and itching. Not only this but it might cause temperature elevation or a burning sensation in the skin for some. Newer nodules may appear every day and the healing of others may leave behind scars.
Other additional signs encountered by people with prurigo nodularis are as follows:
- Over time the painful skin rash may become distinctly symmetrical in appearance.
- Nodules have fixed sizes and shapes and do not go away on their own.
- The quantity of nodules increases with time.
- A common disorder in the family linked to prurigo nodularis.
- Mental health issues due to excessive itchiness and worrying.
- Loss of confidence.
Diagnosis Workup & Evaluation Of Prurigo Nodularis
Dermatologists can infer the diagnosis only after examing the itchy bumps and patches on the skin. For a definitive diagnosis, a skin scraping or skin biopsy might be performed during the appointment. Another indication of performing a skin biopsy is when the nodules persist for longer periods unhealed. A pathologist then examines the tissue sample under a microscope to finalize the diagnosis.
For patients suffering from prurigo nodularis concomitant with HIV, diabetes, and hepatitis C, certain blood tests indicated are:
- Complete blood cell count,
- Metabolic panel, and thyroid tests including TSH and T4,
- HIV antibodies, and chest x-ray.
Each nodule is 1-3 cm in diameter, hard, crusty, and surrounded by pale or dark-looking skin.
However, there is no specific appearance approved to identify the nodules as pruritic. People with prurigo nodularis often present with clusters or groups of widespread nodules (2-100) on the extensor surface of their arms, and legs and rarely on palms and soles.
If more than one skin condition is present, a differential diagnosis is made. Differential diagnoses to consider include the following:
- Insect bites,
- Scabies surreptitious,
- Lupus Erythematosus,
- Multiple Keratoacanthomas,
- Atopic Dermatitis, and
- Psoriasis Vulgaris.
Treatment For Prurigo Nodularis
Any treatment plan with the primary goal of treating the itch to allow the skin to heal should be considered:
- Anti-itch emollient (reduce scratch)
- Itch relief medication (relief pruritis)
- Corticosteroid tape
- Systemic steroids
Having prurigo nodularis can be tough. The frequent itch and painful rash can take an emotional toll on their lives. This makes them feel less confident, and stop getting together with people.
Getting psychological counseling can be helpful if this disease is taking an emotional toll.
Self-care is an essential part of treatment for prurigo nodularis therefore getting psychological help can be beneficial.
Also, there are multiple clinical research organizations investigating novel treatment for prurigo nodularis to help others better manage the condition.