Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Related Searches

Prurigo nodularis

INTRODUCTION

Prurigo nodularis (PN) is a chronic skin disorder characterized by multiple, firm, pruritic nodules typically localized to the extensor surface of the extremities (picture 1A-B). PN is frequently associated with a history of atopic dermatitis or chronic pruritus [1,2].

Prurigo nodularis will be discussed in this topic. Other skin conditions associated with chronic pruritus, including atopic dermatitis, nodular scabies, lichen planus, and bullous pemphigoid, are discussed separately.

(See "Pruritus: Etiology and patient evaluation" and "Pruritus: Overview of management".)

(See "Epidemiology, clinical manifestations, and diagnosis of atopic dermatitis (eczema)".)

(See "Scabies".)

             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Jul 17, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Lee MR, Shumack S. Prurigo nodularis: a review. Australas J Dermatol 2005; 46:211.
  2. Jorizzo JL, Gatti S, Smith EB. Prurigo: a clinical review. J Am Acad Dermatol 1981; 4:723.
  3. Iking A, Grundmann S, Chatzigeorgakidis E, et al. Prurigo as a symptom of atopic and non-atopic diseases: aetiological survey in a consecutive cohort of 108 patients. J Eur Acad Dermatol Venereol 2013; 27:550.
  4. Tanaka M, Aiba S, Matsumura N, et al. Prurigo nodularis consists of two distinct forms: early-onset atopic and late-onset non-atopic. Dermatology 1995; 190:269.
  5. Zancanaro PC, McGirt LY, Mamelak AJ, et al. Cutaneous manifestations of HIV in the era of highly active antiretroviral therapy: an institutional urban clinic experience. J Am Acad Dermatol 2006; 54:581.
  6. Magand F, Nacher M, Cazorla C, et al. Predictive values of prurigo nodularis and herpes zoster for HIV infection and immunosuppression requiring HAART in French Guiana. Trans R Soc Trop Med Hyg 2011; 105:401.
  7. Harris B, Harris K, Penneys NS. Demonstration by S-100 protein staining of increased numbers of nerves in the papillary dermis of patients with prurigo nodularis. J Am Acad Dermatol 1992; 26:56.
  8. Liang Y, Marcusson JA, Johansson O. Light and electron microscopic immunohistochemical observations of p75 nerve growth factor receptor-immunoreactive dermal nerves in prurigo nodularis. Arch Dermatol Res 1999; 291:14.
  9. Johansson O, Liang Y, Emtestam L. Increased nerve growth factor- and tyrosine kinase A-like immunoreactivities in prurigo nodularis skin -- an exploration of the cause of neurohyperplasia. Arch Dermatol Res 2002; 293:614.
  10. Ikoma A, Steinhoff M, Ständer S, et al. The neurobiology of itch. Nat Rev Neurosci 2006; 7:535.
  11. Liang Y, Marcusson JA, Jacobi HH, et al. Histamine-containing mast cells and their relationship to NGFr-immunoreactive nerves in prurigo nodularis: a reappraisal. J Cutan Pathol 1998; 25:189.
  12. Perez GL, Peters MS, Reda AM, et al. Mast cells, neutrophils, and eosinophils in prurigo nodularis. Arch Dermatol 1993; 129:861.
  13. Schuhknecht B, Marziniak M, Wissel A, et al. Reduced intraepidermal nerve fibre density in lesional and nonlesional prurigo nodularis skin as a potential sign of subclinical cutaneous neuropathy. Br J Dermatol 2011; 165:85.
  14. Fukushi S, Yamasaki K, Aiba S. Nuclear localization of activated STAT6 and STAT3 in epidermis of prurigo nodularis. Br J Dermatol 2011; 165:990.
  15. Zelickson BD, McEvoy MT, Fransway AF. Patch testing in prurigo nodularis. Contact Dermatitis 1989; 20:321.
  16. Schneider G, Hockmann J, Ständer S, et al. Psychological factors in prurigo nodularis in comparison with psoriasis vulgaris: results of a case-control study. Br J Dermatol 2006; 154:61.
  17. Dazzi C, Erma D, Piccinno R, et al. Psychological factors involved in prurigo nodularis: A pilot study. J Dermatolog Treat 2011; 22:211.
  18. Weigelt N, Metze D, Ständer S. Prurigo nodularis: systematic analysis of 58 histological criteria in 136 patients. J Cutan Pathol 2010; 37:578.
  19. Powell AM, Albert S, Gratian MJ, et al. Pemphigoid nodularis (non-bullous): a clinicopathological study of five cases. Br J Dermatol 2002; 147:343.
  20. Mattila JO, Vornanen M, Katila ML. Histopathological and bacteriological findings in prurigo nodularis. Acta Derm Venereol 1997; 77:49.
  21. Rowland Payne CM, Wilkinson JD, McKee PH, et al. Nodular prurigo--a clinicopathological study of 46 patients. Br J Dermatol 1985; 113:431.
  22. Doyle JA, Connolly SM, Hunziker N, Winkelmann RK. Prurigo nodularis: a reappraisal of the clinical and histologic features. J Cutan Pathol 1979; 6:392.
  23. Miyauchi H, Uehara M. Follicular occurrence of prurigo nodularis. J Cutan Pathol 1988; 15:208.
  24. Jacob CI, Patten SF. Strongyloides stercoralis infection presenting as generalized prurigo nodularis and lichen simplex chronicus. J Am Acad Dermatol 1999; 41:357.
  25. Shelnitz LS, Paller AS. Hodgkin's disease manifesting as prurigo nodularis. Pediatr Dermatol 1990; 7:136.
  26. Torchia D, Caproni M, Del Bianco E, et al. Linear IgA disease presenting as prurigo nodularis. Br J Dermatol 2006; 155:479.
  27. Savoia F, Casadio C, Tabanelli M, et al. Prurigo nodularis as the first manifestation of a chronic autoimmune cholestatic hepatitis. Int J Dermatol 2011; 50:1588.
  28. Wu TP, Miller K, Cohen DE, Stein JA. Keratoacanthomas arising in association with prurigo nodules in pruritic, actinically damaged skin. J Am Acad Dermatol 2013; 69:426.
  29. Saray Y, Seçkin D, Bilezikçi B. Acquired perforating dermatosis: clinicopathological features in twenty-two cases. J Eur Acad Dermatol Venereol 2006; 20:679.
  30. Nolano M, Simone DA, Wendelschafer-Crabb G, et al. Topical capsaicin in humans: parallel loss of epidermal nerve fibers and pain sensation. Pain 1999; 81:135.
  31. Kennedy WR, Vanhove GF, Lu SP, et al. A randomized, controlled, open-label study of the long-term effects of NGX-4010, a high-concentration capsaicin patch, on epidermal nerve fiber density and sensory function in healthy volunteers. J Pain 2010; 11:579.
  32. Ständer S, Luger T, Metze D. Treatment of prurigo nodularis with topical capsaicin. J Am Acad Dermatol 2001; 44:471.
  33. Wong SS, Goh CL. Double-blind, right/left comparison of calcipotriol ointment and betamethasone ointment in the treatment of Prurigo nodularis. Arch Dermatol 2000; 136:807.
  34. Ständer S, Schürmeyer-Horst F, Luger TA, Weisshaar E. Treatment of pruritic diseases with topical calcineurin inhibitors. Ther Clin Risk Manag 2006; 2:213.
  35. Katayama I, Miyazaki Y, Nishioka K. Topical vitamin D3 (tacalcitol) for steroid-resistant prurigo. Br J Dermatol 1996; 135:237.
  36. Saraceno R, Nisticò SP, Capriotti E, et al. Monochromatic excimer light (308 nm) in the treatment of prurigo nodularis. Photodermatol Photoimmunol Photomed 2008; 24:43.
  37. Bruni E, Caccialanza M, Piccinno R. Phototherapy of generalized prurigo nodularis. Clin Exp Dermatol 2010; 35:549.
  38. Hammes S, Hermann J, Roos S, Ockenfels HM. UVB 308-nm excimer light and bath PUVA: combination therapy is very effective in the treatment of prurigo nodularis. J Eur Acad Dermatol Venereol 2011; 25:799.
  39. Rombold S, Lobisch K, Katzer K, et al. Efficacy of UVA1 phototherapy in 230 patients with various skin diseases. Photodermatol Photoimmunol Photomed 2008; 24:19.
  40. Karvonen J, Hannuksela M. Long term results of topical trioxsalen PUVA in lichen planus and nodular prurigo. Acta Derm Venereol Suppl (Stockh) 1985; 120:53.
  41. Tamagawa-Mineoka R, Katoh N, Ueda E, Kishimoto S. Narrow-band ultraviolet B phototherapy in patients with recalcitrant nodular prurigo. J Dermatol 2007; 34:691.
  42. Wu JJ, Huang DB, Pang KR, et al. Thalidomide: dermatological indications, mechanisms of action and side-effects. Br J Dermatol 2005; 153:254.
  43. Doherty SD, Hsu S. A case series of 48 patients treated with thalidomide. J Drugs Dermatol 2008; 7:769.
  44. Andersen TP, Fogh K. Thalidomide in 42 patients with prurigo nodularis Hyde. Dermatology 2011; 223:107.
  45. Lan CC, Lin CL, Wu CS, et al. Treatment of idiopathic prurigo nodularis in Taiwanese patients with low-dose thalidomide. J Dermatol 2007; 34:237.
  46. Taefehnorooz H, Truchetet F, Barbaud A, et al. Efficacy of thalidomide in the treatment of prurigo nodularis. Acta Derm Venereol 2011; 91:344.
  47. Maurer T, Poncelet A, Berger T. Thalidomide treatment for prurigo nodularis in human immunodeficiency virus-infected subjects: efficacy and risk of neuropathy. Arch Dermatol 2004; 140:845.
  48. Berth-Jones J, Smith SG, Graham-Brown RA. Nodular prurigo responds to cyclosporin. Br J Dermatol 1995; 132:795.
  49. Siepmann D, Luger TA, Ständer S. Antipruritic effect of cyclosporine microemulsion in prurigo nodularis: results of a case series. J Dtsch Dermatol Ges 2008; 6:941.
  50. Spring P, Gschwind I, Gilliet M. Prurigo nodularis: retrospective study of 13 cases managed with methotrexate. Clin Exp Dermatol 2014; 39:468.
  51. Gencoglan G, Inanir I, Gunduz K. Therapeutic hotline: Treatment of prurigo nodularis and lichen simplex chronicus with gabapentin. Dermatol Ther 2010; 23:194.
  52. Kanavy H, Bahner J, Korman NJ. Treatment of refractory prurigo nodularis with lenalidomide. Arch Dermatol 2012; 148:794.
  53. Phan NQ, Bernhard JD, Luger TA, Ständer S. Antipruritic treatment with systemic μ-opioid receptor antagonists: a review. J Am Acad Dermatol 2010; 63:680.
  54. Mazza M, Guerriero G, Marano G, et al. Treatment of prurigo nodularis with pregabalin. J Clin Pharm Ther 2013; 38:16.
  55. Ständer S, Siepmann D, Herrgott I, et al. Targeting the neurokinin receptor 1 with aprepitant: a novel antipruritic strategy. PLoS One 2010; 5:e10968.