Prurigo nodularis is a relatively rare but highly distressing skin condition that can severely impact one’s quality of life. Characterized by the development of itchy nodules on the skin, it can cause significant discomfort and affect one’s mental health. The condition can also worsen due to existing health issues. Understanding the causes, signs and symptoms, available treatments, and preventive measures of Prurigo Nodularis (PN) is crucial for timely intervention and better management.

What is prurigo nodularis and which parts of the body does it affect?
PN is a chronic inflammatory skin disorder characterized by the development of itchy nodules on the skin. It occurs when one engages in persistent scratching over an extended period. The nodules can vary in size, from a few millimeters to centimeters. They may be firm to touch, look like domes, and may be reddish-brown or brownish-black in color. PN can appear anywhere on the skin that one repeatedly scratches or rubs, but the most commonly affected areas include the legs, arms, lower and upper back, abdomen, and buttocks.

8 common signs and symptoms of prurigo nodularis
While the symptoms can vary from person to person, the following are common signs and symptoms associated with PN:

Intense itching
Pruritus, or itching, is the hallmark symptom of the skin condition. Itching can be persistent and severe, often leading to significant discomfort and distress. The itchiness may come and go in episodes, and it can last for a longer time and interfere with one’s daily life.

Burning or stinging sensation
In addition to itching, some individuals with PN may experience a burning or stinging sensation in the affected areas. This sensation can contribute to the overall discomfort associated with the condition.

Development of nodules on the skin
The defining feature of PN is the formation of small, raised nodules on the skin. These nodules can range in size from a few millimeters to centimeters and may vary in color. They are often firm to the touch and can be grouped closely together or scattered across the skin.

Trouble sleeping
Due to the intense itching and discomfort, people with PN often experience sleep disturbances. The itching may worsen at night, making it difficult to fall asleep or stay asleep, which can lead to fatigue and reduced quality of life.

Hyperpigmentation
Hyperpigmentation occurs when the skin darkens as a result of chronic inflammation, scratching, and healing. Over time, prurigo nodularis may cause one’s skin to become discolored.

Hypopigmentation
In some cases, there may be areas of hypopigmentation marked by lightening of the skin where the nodules have healed. This can result in a patchy or mottled appearance of the skin.

Secondary infections
Due to the breaks in the skin caused by scratching, individuals with PN are at risk of developing secondary bacterial or fungal skin infections. These infections can lead to additional symptoms such as pain, increased redness, and oozing of pus.

Localized swelling
The affected areas of the skin may become swollen, particularly in and around the nodules. This swelling can contribute to the discomfort and tenderness associated with the condition.

Prurigo nodularis signs and symptoms can significantly impact one’s daily activities, work, and relationships, reduce productivity, and adversely impact one’s overall quality of life. The condition can also lead individuals to limit social activities and develop mental health issues, including anxiety and depression.

Causes and risk factors of prurigo nodularis
What exactly causes prurigo nodularis is not known, but there are several risk factors and changes in one’s immune system and skin nerve system that are associated with the condition. Some of these changes are known to trigger the symptoms of prurigo nodularis, including itching and scratching.

Age
Those over the age of 50 are more vulnerable to developing PN. The American Academy of Dermatology (AAD) research suggests that among this range, those between the ages of 51 and 65 are the most affected.

Increased nerve activity
In people with prurigo nodularis, there may be more nerve fibers in the skin that contribute to itching. This could be related to a neuropeptide called Nerve Growth Factor (NGF) being overly active in prurigo lesions that trigger inflammation and itching.

Small fiber neuropathy
Prurigo has been likened to a condition called small fiber neuropathy. This means that the small sensory nerves in the skin are affected. Research has shown that in prurigo, there’s a decrease in nerve fiber density in the skin. The nerve fiber density plays an important role in transmitting sensory information, including pain and touch, from one’s skin to the central nervous system, including the brain and spinal cord.

Existing skin conditions
Those who already suffer from chronic skin conditions like psoriasis and atopic dermatitis or eczema caused due to an overactive immune system and experience regular flare ups of these conditions are more likely to develop PN.

Other diseases
Those with existing psychiatric or neurological disorders or systemic diseases should also be careful since they are more vulnerable to PN. Most of these diseases severely compromise one’s immune system and make an individual vulnerable to PN. These conditions include:

Diabetes mellitus
Renal or kidney failure
HIV
Hepatitis C
Chronic obstructive pulmonary disease (COPD)
Thyroid or liver diseases
Lymphoma
Cardiovascular conditions
Gluten enteropathy
Parasitic or bacterial infections.

Treatments for prurigo nodularis
Treatment options for PN primarily focus on addressing the symptoms and managing the condition’s underlying causes. Healthcare providers may recommend various therapeutic approaches, which can include strategies to alleviate itching, reduce inflammation, and improve overall skin health. These treatments often involve localized or oral treatments, doctor-recommended creams, UV treatment, lifestyle modifications, and counseling to minimize PN’s impact on one’s daily life.

Lifestyle changes to help with prurigo nodularis
Avoiding triggers that lead to itching and practicing good skincare, such as using mild fragrance-free soaps and cleansers, can help manage PN and reduce itching. Keeping one’s skin well-hydrated with moisturizers is also important to avoid dryness and injury due to scratching. One is advised to keep nails short to minimize the damage caused by scratching and also practice good hand hygiene to reduce the risk of infection from open sores. It’s best to keep away from any chemical detergents or personal care products that may trigger or worsen skin irritation. Additionally, managing stress and anxiety can sometimes reduce the severity of PN symptoms.