Prurigo Nodularis 

  • Author: Daniel J Hogan, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 9, 2010
 

Background

In 1909, Hyde and Montgomery[1] first described prurigo nodularis as pruritic nodules on the extensor surfaces of the lower extremities in middle-aged women. Prurigo nodularis can be a bothersome-to-debilitating disease, usually seen as multiple, intensely pruritic, excoriated nodules erupting on the extensor surfaces of the limbs secondary to itching or rubbing. In current practice, prurigo nodularis is still a condition of unknown etiology. Many conditions have been reported to induce prurigo nodularis, from internal malignancy to renal failure to psychiatric conditions.

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Pathophysiology

Chronic mechanical trauma to the skin causes thickening of the skin proportionate to the trauma. Repetitive rubbing, scratching, and touching (induced by a foreign body or self-induced) results in plaque or nodular lichenification and hyperkeratosis. Pigmentary changes often result from such repetitive trauma to the skin.

With prurigo nodularis, a person feels intense pruritus at discrete points and cannot control the urge to rub or scratch these points on the body. Any abnormality or explanation for the pruritus is unknown; scratching by the individuals who are affected is obvious. The results are discrete, nodular, hyperpigmented/purpuric lesions with surfaces that are scaly, excoriated, and possibly crusted.

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Epidemiology

Mortality/Morbidity

Prurigo nodularis is benign and does not increase mortality; however, severe morbidity can occur in untreated and even in some treated persons who are affected. Pruritus and the extent of body surface area involved become so great for some patients that they no longer feel functional for work or other everyday activities.

Some conditions associated with prurigo nodularis may cause mortality. Prurigo nodularis has been documented to be much more common in immunocompromised and HIV populations. Some associations have been made of prurigo nodularis with internal malignancy and severely decreased kidney function.

Race

No racial disparity is known for prurigo nodularis.

Sex

Women were formerly believed to have a disproportionate amount of prurigo nodularis compared to men; however, no documented difference exists in frequency between the sexes.

Age

Prurigo nodularis can occur at any age, but it most often occurs in middle-aged and older persons.

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Contributor Information and Disclosures
Author

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Coauthor(s)

Siobahn M Bower, MD  Internal Medicine Resident, Creighton University

Siobahn M Bower, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

Sharron M Mason, MD  Staff Physician, Department of Internal Medicine, University of Kansas School of Medicine

Disclosure: Nothing to disclose.

Stephen H Mason, MD  Assistant Professor of Dermatology, Medical College of Georgia School of Medicine

Stephen H Mason, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Society for Dermatologic Surgery, Skin Cancer Foundation, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Prurigo nodularis. Courtesy of Jeffrey Meffert, MD.
Prurigo nodularis. Courtesy of Jeffrey Meffert, MD.
 
 
 
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