Prurigo nodularis

From Wikipedia, the free encyclopedia

**Prurigo nodularis**
*Classifications and external resources*
ICD-10	L 28.1
ICD-9	698.3
DiseasesDB	32152
eMedicine	derm/350

Prurigo nodularis (PN) is a skin disease characterised by pruritic (itchy) nodules which usually appear on the arms or legs. Patients often present with multiple excoriated lesions caused by scratching.

1 History
2 Causes
3 Pathophysiology
4 The Lesions and Nodules
5 Diagnosis
6 Treatment
7 Synonyms
8 References
9 External links

[edit] History

It was first described by Hyde and Montgomery in 1909.^[1]

[edit] Causes

The cause is unknown, although other conditions may induce PN. These include HIV ^[2] and other immunodeficiency diseases. Internal malignancies, liver failure, renal failure, and psychiatric illnesses may induce PN.

[edit] Pathophysiology

Chronic and repetitive scratching, picking, or rubbing of the nodules may result in permanent changes to the skin, including nodular lichenification, hyperkeratosis, hyperpigmentation, and skin thickening. Unhealed, excoriated lesions are often scaly, crusted or scabbed.

Patients often:

seek treatment during middle-age, although PN can occur at any age.
have a history of chronic severe pruritus.
have a significant medical history for unrelated conditons.
suffer from liver or kidney dysfunctions.
suffer secondary skin infections.
have a personal or family history of atopic dermatitis.

[edit] The Lesions and Nodules

Nodules are discrete, scaly, generally symmetric, hyperpigmented or purpuric, and firm. They appear on easily-reachable spots on the body, generally the arms and legs. Excoriated lesions are often flat, umbilicated, or have a crusted top. Nodules may appear to begin in the hair follicles. Nodule pattern may be follicular.

[edit] Diagnosis

Diagnosis is based on visual examination and the presence of itching. A skin biopsy is often performed to exclude other diseases.

[edit] Treatment

Prurigo nodularis is very hard to treat, but current therapies include steroids, vitamins, and cryosurgery.

[edit] Synonyms

Hyde prurigo nodularis, Picker nodules, lichen simplex chronicus, atypical nodular form of neurodermatitis circumscripta, lichen corneus obtusus.

[edit] References

^ Hyde JN, Montgomery FH: A practical treatise on disease of the skin for the use of students and practitioners. 1909; 174-175.
^ Berger TG, Hoffman C, Thieberg MD: Prurigo nodularis and photosensitivity in AIDS: treatment with thalidomide. J Am Acad Dermatol 1995 Nov; 33(5 Pt 1): 837-8[Medline].

Feuerman EJ, Sandbank M: Prurigo nodularis. Histological and electron microscopical study. Arch Dermatol 1975 Nov; 111(11): 1472-7[Medline].
Hann SK, Cho MY, Park YK: UV treatment of generalized prurigo nodularis. Int J Dermatol 1990 Jul-Aug; 29(6): 436-7[Medline].
Hyde JN, Montgomery FH: A practical treatise on disease of the skin for the use of students and practitioners. 1909; 174-175.
Jacob CI, Patten SF: Strongyloides stercoralis infection presenting as generalized prurigo nodularis and lichen simplex chronicus. J Am Acad Dermatol 1999 Aug; 41(2 Pt 2): 357-61[Medline].
Lee MR, Shumack S: Prurigo nodularis: a review. Australas J Dermatol 2005 Nov; 46(4): 211-18; quiz 219-20[Medline].
Matthews SN, Cockerell CJ: Prurigo nodularis in HIV-infected individuals. Int J Dermatol 1998 Jun; 37(6): 401-9[Medline].
Miyauchi H, Uehara M: Follicular occurrence of prurigo nodularis. J Cutan Pathol 1988 Aug; 15(4): 208-11[Medline].
Noppakun N, Apisarnthanarax P: Multiple cutaneous granular cell tumors simulating prurigo nodularis. Int J Dermatol 1981 Mar; 20(2): 126-9[Medline].
Roenigk RK, Dahl MV: Bullous pemphigoid and prurigo nodularis. J Am Acad Dermatol 1986 May; 14(5 Pt 2): 944-7[Medline].
Sandbank M: Cutaneous nerve lesions in prurigo nodularis. Electron microscopic study of two patients. J Cutan Pathol 1976; 3(3): 125-32[Medline].
Seeburger J, Anderson-Wilms N, Jacobs R: Lennert's lymphoma presenting as prurigo nodularis. Cutis 1993 May; 51(5): 355-8[Medline].
Stoll DM, Fields JP, King LE Jr: Treatment of prurigo nodularis: use of cryosurgery and intralesional steroids plus lidocaine. J Dermatol Surg Oncol 1983 Nov; 9(11): 922-4[Medline].
Szeidemann Z, Shanabrough M, Leranth C: Hypothalamic Leu-enkephalin-immunoreactive fibers terminate on calbindin-containing somatospiny cells in the lateral septal area of the rat. J Comp Neurol 1995 Aug 7; 358(4): 573-83[Medline].
Tupker RA, Coenraads PJ, van der Meer JB: Treatment of prurigo nodularis, chronic prurigo and neurodermatitis circumscripta with topical capsaicin. Acta Derm Venereol 1992 Nov; 72(6): 463[Medline].
Vaalasti A, Suomalainen H, Rechardt L: Calcitonin gene-related peptide immunoreactivity in prurigo nodularis: a comparative study with neurodermatitis circumscripta. Br J Dermatol 1989 May; 120(5): 619-23[Medline].
Waldinger TP, Wong RC, Taylor WB, Voorhees JJ: Cryotherapy improves prurigo nodularis. Arch Dermatol 1984 Dec; 120(12): 1598-600[Medline].