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Prurigo Nodularis

Definition

Prurigo nodularis is the formation of hard, itchy bumps on the skin. It can cause scratching so intense that the skin is scratched open.

Causes

Excessive scratching of an itch causes prurigo nodularis. The initial cause of the itch is not always clear.

Risk Factors

Health factors that may increase your risk of prurigo nodularis include:
  • Psychological conditions
  • Reduced function of the liver and kidneys
  • Skin conditions that cause itching such as eczema
  • HIV/immunodeficiency
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Symptoms

Skin lumps are small and hard. The top of the lumps may be dry and peeling, or if it has been scratched, may be open and bleeding.
Scratching can make prurigo nodularis worse. Scratching can also cause damage to the surface of the skin and increase your risk of infection. Over time, there may also be some scarring.
A key sign of a prurigo nodularis lump is intense itching. The itching may be constant or sporadic.

Diagnosis

Your doctor will ask about your symptoms and your medical history. The diagnosis may be made based on the appearance of your skin and your symptoms.
Your bodily fluids and tissues may be tested. This can be done with:
  • Blood tests
  • Skin biopsy

Treatment

Treatment will focus on reducing the itchiness to prevent scratching. To relieve itchiness, your doctor may prescribe:
  • Topical steroid cream
  • Antihistamine cream or pills
If initial treatment does not work your doctor may try:
  • Steroid injections into the area
  • Antidepressant medications
  • Capsaicin creams
  • Cryotherapy to freeze affected skin
  • Phototherapy
  • Pulsed dye laser
  • Immunotherapy
Talk with your doctor about the best treatment plan for you.

Prevention

Work with your doctor to manage any skin conditions that cause itching.
If you have a skin condition or bug bite that is causing itching, then try to avoid scratching. Consider using over the counter itch medication or ask your doctor about ways to relieve the itching.

RESOURCES

American Academy of Dermatology http://www.aad.org

American Academy of Family Physicians http://familydoctor.org

CANADIAN RESOURCES

Canadian Dermatology Association http://www.dermatology.ca

The Eczema Society of Canada http://eczemahelp.ca

References

Matthews SN, Cockerell CJ. Prurigo nodularis in HIV-infected individuals. Int J Dermatol. 1998 June; 37(6):401-9.

Nodular prurigo. DermNet NZ website. Available at: http://dermnetnz.org/dermatitis/prurigo-nodularis.html. Updated June 29, 2013. Accessed September 19, 2013.

Prurigo nodularis. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/?page=PrurigoNodularis. Accessed September 19, 2013.

Prurigo nodularis. National Institute of Health Office of Rare Disease Research website. Available at: http://rarediseases.info.nih.gov/gard/7480/prurigo-nodularis/resources/1. Accessed September 19, 2013.

Prurigo nodularis Patient.co.uk website. Available at: http://www.patient.co.uk/doctor/Prurigo-Nodularis.htm. Updated September 28, 2013. Accessed September 19, 2013.

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