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prurigo nodularis (picker's nodules)
Etiology:
- emotional tensions induce a self-pertpetuating pruritus
- lesions are produced by picking of the skin
Clinical manifestations:
1) hyperpigmented papules or nodules
- firm, extremely itchy nodules can appear almost anywhere on the body [5]
- most commomly on the upper & lower extremities [3,5]
- lesions are always in reach of scratching [5]
2) overylying scale
3) lesions may become excoriated * ulcerated
4) lesions up to 2 cm in diameter
5) patients scratch in multiple locations
6) once itch improves, lesions gradually heal leaving light or dark spots often with scarring
Management:
1) if generalized, evaluate for internal causes of pruritus without primary cutaneous eruption
a) chronic renal failure
b) obstructive liver disease
c) malignancies, especially Hodgkin's disease
d) hyperthyroidism
e) hypothyroidism
f) polycythemia rubra vera
g) acquired immune deficiency syndrome (AIDS)
2) break the itch-scratch cycle
a) potent topical glucocorticoids
b) intralesional glucocorticoids
c) oral antihistamines at night
3) dupilumab FDA-approved
General
neurodermatitis
prurigo
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- Kwatra S
Clinical Review. Prurigo Nodularis: A Giant Leap Forward.
The Dermatologist. Sept 2022
https://www.hmpgloballearningnetwork.com/site/thederm/clinical-review/prurigo-nodularis-giant-leap-forward
- Whang KA, Le TK, Khanna R et al.
Health-related quality of life and economic burden of prurigo nodularis.
J Am Acad Dermatol. 2022;86(3):573-580
PMID: 34058278
- Kwatra SG.
Prurigo nodularis.
JAMA Dermatol. 2022;158(3):336.
PMID: 35138345
https://jamanetwork.com/journals/jamadermatology/fullarticle/2788623