Prurigo Nodularis

Introduction:

Prurigo nodularis is an uncommon skin disease which is of unknown cause. As the the name suggests, it is derived from two words: prurigo = itching and nodularis = nodules. In this disease one gets nodules on skin which intense itching. Prurigo nodularis is understood to be an autoimmune disease.

Severe, unbearable itching is the major feature in the case of patients suffering with Prurigo nodularis.

Signs and symptoms:

Prurigo nodularis is a skin disease, especially found on forearms ,legs and neck. It can affect other areas as well. They are multiple nodular skin lesions with tiny open wounds due to intense itching. The are found in groups, which may vary from a few to a couple of hundreds.

It may appear as a small, red itchy bump about half an inch to about two centimeters in diameter, with crusting and scaling in recently scratched lesions which then turn to darker and paler compared to surrounding skin.

Skin between the nodules is usually dry with itching so intense that patient keeps on scratching it for hours on end which sometimes leads to secondary infection.

Repetitive scratching, picking, rubbing may lead to permanent changes to skin like nodular thickening (lichenification), hyperkeratosis, hyperpigmentation (dark pigmentation), and skin thickening in spots.

Scaly, crusted, scabbed and unhealed lesion are seen even after relieving the itch with medication. New nodules may keep on appearing but existing nodules may regress spontaneously leaving scars. This disease may run for a long time leading to stress and a lot of depression in patients.

Causes:

The exact cause of Prurigo nodularis is not known. Autoimmunity and genetic factors seem to play role in the development of this disease.

Many of the patients present with a personal or family history of eczema or atopic dermatitis, asthma or hay fever or some allergic disorders.

This disease is often associated with internal diseases such as kidney failure, anemia due to iron deficiency, or metabolic disease such as intolerance to protein (called as gluten enteropathy), and many other diverse conditions such as HIV infection, psoriasis, Lichen Planus, etc.

Emotional stress is often a trigger factor which could initiate or would help maintain the disease.

Diagnosis:

Prurigo nodularis can be diagnosed clinically by visual examination, as these are large, more or less symmetrical nodules with intense itching. There are several conditions which resemble Prurigo nodularis such as Lichen planus, psoriasis, even eczema at times. Careful examination, clinical experience and a support of biopsy report would help establish exact diagnosis.

Skin biopsy.

It is important to identify underlying diseases that are associated with nodular prurigo; blood tests may include full blood count, liver, kidney and thyroid function tests.

Treatment:

Prurigo nodularis is a challenging disease to treat. The conventional treatment includes the use of cortisone, cryosurgery and use of antibiotics wherever there is infection. Antihistamines are prescribed to take care of itching, which helps take care of the itching superficially. Thalidomide is a medicine stated in the medical books for this disease but it is not much used due to heavy side effects such as genetic birth defects.

Homeopathic treatment for Prurigo nodularis:

It is a difficult disease to treat. The homeopathic treatment will focus on the genetic and autoimmune factors in the background while deciding the medicine which works at a deeper level. The results are good and encouraging. The patient will require keeping patience. Homeopathy is strongly indicated.

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