WHAT IS PRURIGO NODULARIS?Prurigo nodularis is a skin condition that causes intensely itchy bumps. "Prurigo" means "itch ," while "nodularis" refers to the bumps. It is also called Hyde's prurigo nodularis, after the physician who first described it in 1909. Prurigo nodularis occurs primarily in adults and is a chronic condition. It is more common in women than men.
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| prurigo nodularis |
prurigo nodularis |
prurigo nodularis |
HOW DOES PRURIGO NODULARIS OCCUR?The exact cause of prurigo nodularis is unknown. One theory is that it begins with just one itch in a single spot, or with a sudden onset of itchy bumps. Acute itchy bumps (prurigo acuta) can appear suddenly, one at a time or dozens of them, and can have various causes (insect stings, allergies, eczema, etc.). Acute itchy bumps also disappear quickly or are scratched off. Some patients with prurigo nodularis also have these kinds of acute bumps in between, or had them initially. For many patients, it's unclear which came first, the itching or the bumps.
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acute itchy bumps |
acute itchy bumps |
What is clear, however, is that the hard bumps are caused by chronic scratching. The continuous mechanical damage to the itchy area leads to the formation of increasing amounts of scar tissue and connective tissue. Scratching the itchy bump temporarily relieves the pain, but during the healing phase, it starts to itch again, thus perpetuating the condition. Scratching also occurs unconsciously or during sleep, because the itch automatically triggers a scratch reflex. Psychological factors, problems, and stress can also play a role, as they can exacerbate scratching. Furthermore, prurigo nodularis also causes stress and sometimes sleep problems. People with dry skin or eczema can also develop prurigo nodularis because they experience a lot of itching. With atopic eczema, prurigo nodularis can also develop later in life, with chronic itchy bumps and frequent scratching. This is also called prurigo of Besnier.WHAT DOES PRURIGO NODULARIS LOOK LIKE?The itchy bumps range in size from a few millimeters to about a centimeter and can appear anywhere on the body, but are most commonly found on the arms and legs. Arms and legs, especially around the wrists and ankles, are frequently scratched. The bumps are convex, often damaged by scratching, and are red, purple, grayish-blue, or brownish in color. They feel hard and itch intensely. Scratching a bump causes wounds and scars. Scratching also causes new bumps to form. The recurrence of the itchy bumps can last for years; it is a chronic skin condition.IS PRURIGO NODULARIS CONTAGIOUS?Prurigo nodularis is not contagious; it's not caused by an infection. There is, however, an infection that is severely itchy and also causes itchy bumps, and that's scabies . Scabies is often recognized at some point and treated accordingly.HOW IS THE DIAGNOSIS MADE?The diagnosis is based on the clinical picture, its appearance. It is easy to recognize because of its characteristic appearance and the itching. Sometimes a skin biopsy is necessary to rule out other skin conditions.
Further investigation into an underlying cause of the itching is also often performed. For example, blood tests can determine whether someone is predisposed to atopic eczema. And there are some conditions that cause itching, such as liver disease and kidney disease, which can be detected with a blood test. Prurigo nodularis is usually detected spontaneously, or in cases of dry skin or atopy, where blood tests do not provide any further clues.HOW IS PRURIGO NODULARIS TREATED?Treatment should be initiated to reduce the itching, and you should also try to scratch as little as possible. Only by taking these two measures can you break the vicious cycle. It's very difficult not to scratch when the skin is itchy, but scratching only makes prurigo nodularis worse. When the scratched wounds heal, the skin often starts to itch again.
There are several options for treating the itching:
- Rich skin care creams. Dry skin becomes itchy, so it should always be well cared for with rich or moisturizing creams.
- Topical corticosteroids in the form of a cream or ointment. Topical corticosteroids are powerful inhibitors of eczema and itching. If necessary, the cream can be covered with a special plaster (a hydrocolloid plaster; see the leaflet on hydrocolloids ). Covering with a bandage prevents scratching but also ensures that the steroids penetrate the skin more effectively. Corticosteroids can also be injected directly into the prurigo nodularis bumps in persistent cases (provided there aren't too many).
- Anti-itch tablets (antihistamines).
- Light therapy, treatment with UVB light in light booths.
- Freezing with liquid nitrogen.
If the effect is insufficient and the itching is severe, several stronger medications can be prescribed, such as thalidomide, ciclosporin, or azathioprine. These medications can also have many side effects and should not be used lightly. Thalidomide must be used for at least 6 months. This drug, formerly known as Softenon, is very harmful to the unborn child; therefore, women must absolutely avoid becoming pregnant. It can also damage the nerves, causing symptoms such as sensory disturbances and muscle weakness.
Antidepressants can also help, as can psychological counseling to help you learn to cope with itching and tricks to avoid scratching.WHAT ARE THE OUTLOOK?If you can stop scratching, prurigo nodularis can be cured. Treatment with creams and other remedies should reduce the itching, but you'll have to stop scratching yourself. If you continue to scratch, the condition won't go away and can last for years, causing significant damage to the skin.WHAT CAN YOU STILL DO YOURSELF?Prevent your skin from drying out by not showering in too hot water. Use a good moisturizing lotion or moisturizing cream afterward. Try not to scratch. Keep your nails short to avoid scratching the affected area. |
