Prurigo nodularis is a chronic dermatological disease. It appears on the skin as symmetrically distributed bumps referred to as nodules. These bumps are itchy and occur due to scratching the skin. They are red and seen mainly on the shoulders, legs, and back. It affects all ages and is common among middle and old-age people. This disease is neither hereditary nor contagious. They first manifest as red and itchy areas that become nodules and ulcers. There’s no specific etiology, but it’s often related to eczema (atopic dermatitis). Also, there’s no FDA-approved treatment for Prurigo nodularis. All treatments are supported by symptom remission.
Chronic Prurigo:
Chronic prurigo is considered a broad word that carries different clinical presentations. This type of disease depends on the manifestation: Are they nodules, papules, or plaques? , on the number of lesions and the location. Whatever the type of lesion, it starts as a small red and itchy lesion, becoming a papule, nodule, plaque, or even ulcer later on. These lesions are recognized as four clinical phenotypes: chronic nodular prurigo, chronic papular prurigo, chronic plaque Prurigo, and chronic umbilicated Prurigo.
Papular prurigo is an allergic reaction that occurs as a response to insect bites mainly. It is a misdiagnosed condition where papules predominate. What is the manifestation? It appears as skin lesions that have fluid within the skin layers.
Prurigo rash:
It happens due to a specific type of food or as a manifestation of type 2 diabetes. Prurigo rash looks like a mosquito bite and creates pimples on the skin, mainly affecting the neck, face, and scalp. The patches are crusty and irritating, and they might be black or pink.
Prurigo of pregnancy
It is a dermatological condition that occurs among pregnant women causing excessive scratching. One pregnant female over 300 gets the disease, and the risk increases if she is pregnant with twins. This condition is still under investigation to know the leading cause. Otherwise, it is thought to be related to hormonal changes that occur during pregnancy leading to changes in the immunity of the female. The rashes appear on the elbows and the knees first; they segregate like clusters and might contain hair follicles. There is no specific time to appear, but they seem mainly during the second trimester. How long do they remain? They remain for a few weeks after delivery. What about prevention? There is no need to prevent prurigo during pregnancy because it is not harmful to the female or her fetus. The only problem is their lousy appearance.
Moisturizers and loose-fitting clothes are the leading solutions used to decrease the symptoms.
The prurigo symptoms:
These bumps are characterized by being:
- Itchy
- Scabby
- Crusty
- Black or brown
- Burning
Extra-cutaneous symptoms include sleeping disorders, daily routine disturbance, and depression. It lasts longer than six weeks. After that, it worsens through sweat, heat, clothing, and stress.
What about the treatment? There are still no treatments that target the lesion or prevent its formation, so all we can do is take medications that relieve the symptoms, like steroids (topical or oral) and antihistamines to decrease redness and alleviate itching.
Prurigo nodularis differential diagnosis:
A microscopic examination and blood tests (liver, kidneys, and thyroid test) are needed to examine lesions. Prurigo nodularis differential diagnosis involves insect bites, infections, eczema, and acne.
Prurigo manifestations are not only affecting the patient’s physical appearance but also target the psychological state, where most patients suffer from depression, anxiety, and anorexia also. Unfortunately, the psychological effect remains even when the rashes disappear, primarily due to the persisting scars. For this reason, we are still waiting for new research in the dermatological field to find an appropriate treatment or prevention for prurigo nodularis.
