Diagnostic Workup and Evaluation of Patients with Prurigo Nodularis

Abstract

Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized oftentimes by symmetrically distributed, severely pruritic nodules. Currently, the pathophysiology of PN remains to be fully elucidated, but emerging evidence suggests that neuroimmune alterations play principal roles in the pathogenesis of PN. There are several associated etiologic factors thought to be associated with PN, including dermatoses, systemic, infectious, psychiatric, and neurologic conditions. We conducted a systematic literature review to evaluate the clinical presentation, diagnosis, and etiologic factors of PN. In this review, we discuss common differential diagnoses of PN and recommend an evidence-based, standardized diagnostic evaluation for those with suspected PN.

Clinical characteristics and disease burden in prurigo nodularis

“…Prurigo nodularis (PN) is an intensely pruritic, inflammatory skin disease characterized by symmetrically distributed, pruritic nodules on the limbs and trunk 1 . Patients typically report severe itch with associated pain, burning and prickling 2 . PN may initially present as grouped lesions but can disseminate to become more widespread 3 .…”

“…PN may initially present as grouped lesions but can disseminate to become more widespread 3 . Although the precise aetiology of PN remains unknown, it has been associated with comorbid dermatological conditions, such as atopic dermatitis (AD), 2,4–6 and with systemic inflammation and several systemic illnesses, including HIV, chronic renal failure, liver disease, thyroid disease and malignancy 2,6–15 . Compared with other chronic itch conditions, the itch of PN is among the most severe 16 …”

Association between Prurigo Nodularis and Etiologies of Peripheral Neuropathy: Suggesting a Role for Neural Dysregulation in Pathogenesis

“…Lesions are distributed symmetrically with involvement of extensor surfaces of the extremities. The intractable pruritus of PN is a significant contributor of morbidity for patients and commonly presents in the context of known pruritic conditions [1]. It is associated with other dermatologic conditions, such as atopic dermatitis and other systemic diseases [2].…”

Emergency department use by patients with prurigo nodularis in the United States

“…Overall, there were 390 visits with a diagnosis of prurigo nodularis (weighted frequency 1,709). Table I provides demographic information of patients with prurigo nodularis compared with the general emergency department patient population.…”

“…To the Editor: Onychomycosis is a chronic fungal nail infection affecting an estimated 0.35% to 5.5% of children worldwide, 1 although parents and health care practitioners are hesitant to use long-term systemic treatments in children. 2 Efinaconazole 10% topical solution is an azole antifungal approved by the US Food and Drug Administration to treat onychomycosis in patients 6 years of age and older.…”