Prurigo Nodularis

Aka: Prurigo Nodularis

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II. Definitions

  1. Prurigo Nodularis
    1. Firm, pruritic Nodules, esp. on the arms and legs, forming in response to scratching

III. Epidemiology

  1. Bimodal age distribution
    1. Younger patients with Atopic Dermatitis and environmental allergies
    2. Older patients without Atopic Dermatitis or environmental allergies

IV. Risk Factors

  1. Actopic Dermatitis
  2. Young women

V. Pathophysiology

  1. Intense Pruritus leads to excessive scratching

VI. Signs

  1. Dome shaped Nodules
  2. Vary in size from millimeters up to 2 cm
  3. Distribution to sites of excessive itching and scratching (typically on extremities)
  4. Nodules may be eroded or excoriated
  5. Lesions may persist for months after the scratching and other Trauma has subsided

VII. Management

  1. Intralesional Triamcinolone injection
  2. High potency Corticosteroid under Occlusion
  3. Thalidomide has been used for severe cases
    1. Serious Teratogenicity (in addition to other precautions)
  4. Neurontin 300 mg orally three times daily
    1. May reduce intense itching and scratching cycles

VIII. References

  1. Wolff (2017) Fitzpatrick's Color Atlas of Clinical Dermatology, McGraw Hill, Chicago, p. 42

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