Prurigo nodularis (in atopic dermatitis)
- produced by chronic, repetitive scratching or picking of the skin that leads to hypertrophy and increased density of substance P-positive nerves within affected skin, leading to perpetuation of the itch-scratch cycle
- classically sparing of the mid upper back ("butterfly sign") - often an underlying etiology can be found (xerosis, atopy, stasis, OCD, systemic disease)
- pramoxine and menthol
- high potency topical steroids under occlusion or ILK
- NBUVB
- hydroxyzine, doxepin (10mg qHS), SSRIs
Hi
Hello! How can I assist you today?
Treatment options for prurigo nodularis (in atopic dermatitis) include:
1. Avoidance of scratching or picking the affected skin: This is important to break the itch-scratch cycle and prevent further exacerbation.
2. Identifying and treating underlying causes: Prurigo nodularis can be associated with various underlying conditions, such as xerosis (dry skin), atopy (genetic predisposition to allergic conditions), stasis (poor circulation), obsessive-compulsive disorder (OCD), or systemic diseases. Addressing these underlying causes can help manage the condition.
3. Topical medications:
- Pramoxine and menthol: These topical agents can provide temporary relief from itching and discomfort. They work by numbing the skin and providing a cooling sensation.
- High potency topical steroids under occlusion: Applying strong topical corticosteroids on the affected skin and covering it with an occlusive dressing can help reduce inflammation and itching.
4. Photo(chemo)therapy:
- Narrowband ultraviolet B (NBUVB): This type of phototherapy involves exposure to UVB light, which can help reduce inflammation and itching.
- Intralesional corticosteroids (ILK): Injecting corticosteroids directly into the nodules can help reduce inflammation and alleviate symptoms.
5. Oral medications:
- Antihistamines: Hydroxyzine can be prescribed to relieve itching and promote sleep. Doxepin, at a low dose of 10mg taken at night, can also be used for its sedating and antipruritic effects.
- Selective serotonin reuptake inhibitors (SSRIs): In some cases, SSRIs such as fluoxetine or sertraline may be prescribed to help manage the underlying psychological component and reduce the itch-scratch cycle.
It is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to your specific condition.
Prurigo nodularis is a condition in which itchy nodules or bumps develop on the skin due to chronic and repetitive scratching or picking. It is commonly associated with atopic dermatitis, which is a chronic inflammatory skin condition.
The cause of prurigo nodularis is believed to be related to the increased density of substance P-positive nerves within the affected skin. Substance P is a neuropeptide involved in transmitting pain and itch signals. The repetitive scratching or picking of the skin in prurigo nodularis leads to hypertrophy or thickening of these nerves, which perpetuates the itch-scratch cycle.
One characteristic feature of prurigo nodularis is the sparing of the mid-upper back, often referred to as the "butterfly sign." This means that the nodules typically do not appear in this specific region.
There can be various underlying causes or predisposing factors for prurigo nodularis. These can include dry skin (xerosis), a history of atopy (such as allergic rhinitis or asthma), impaired blood flow in the legs (stasis), obsessive-compulsive disorder (OCD), or underlying systemic diseases.
Treatment options for prurigo nodularis aim to alleviate itching, reduce the inflammation, and break the itch-scratch cycle. One approach is the use of topical medications containing pramoxine or menthol, which provide temporary relief from itching.
High-potency topical steroids can also be prescribed. These are often applied under occlusion (covering the treated area with a dressing or plastic wrap) to enhance their effectiveness.
Another treatment option is narrowband ultraviolet B phototherapy (NBUVB). This involves exposing the affected skin to specific wavelengths of ultraviolet light, which can help improve the symptoms of prurigo nodularis.
Oral medications may also be prescribed in severe cases. Hydroxyzine is an antihistamine that can help reduce itching, while doxepin (at a low dose of 10mg taken before bedtime) is a tricyclic antidepressant that possesses sedating and antihistamine properties. Selective serotonin reuptake inhibitors (SSRIs), which are commonly used as antidepressants, may also be considered.
It is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan for prurigo nodularis or any skin condition. They can provide personalized advice and prescribe the most suitable medications based on the individual's specific needs and medical history.