Clinical characteristics and disease burden in prurigo nodularis

Abstract

Summary Background Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by intense pruritus, but information on patient experience and impact on quality of life (QoL) remains understudied. Aim To characterize disease characteristics and QoL in a global sample of patients with PN. Methods An anonymous survey was distributed via patient support groups for PN. Results In total, 231 members responded to the survey. The majority of respondents reported itch localized both to nodules and to intervening skin (67.0%). Associated symptoms included prickling, pain, stinging and burning. The extensor lower legs (69% right, 67.3% left) and flexor forearms (66.1% right, 62% left) were the most common sites of itch. Participants reported frequent healthcare utilization, with 36.3% visiting a doctor ≥ 10 times in the past year. Physician‐diagnosed anxiety (45.4%), depression (16.4%) and the atopic triad (18.7%) were commonly reported. Patients with PN had mean scores of 16.4, 11.6 and 16.8 on the Dermatology Life Quality Index, Pittsburgh Sleep Quality Index and 5‐Dimensions Itch, respectively. Conclusions Severe pruritus with accompanying pain, stinging and burning is characteristic of PN, with the majority of patients experiencing itch in both nodular and interlesional skin. Patients further report decreased QoL scores and impaired sleep. Patient experiences should guide future management of PN.

Association between prurigo nodularis and substance use disorders

“…The depressed mood associated with PN may trigger self‐medication with stimulants, as stimulants are shown to increase dopaminergic and serotonergic signalling systems in the brain 7 . Additionally, pain is commonly reported by patients with PN, 8 which may help explain the increased risk of opioid use disorder identified here. An association between PN and cannabis use disorder also has not been demonstrated previously.…”

Chronic Nodular Prurigo: An Update on the Pathogenesis and Treatment

“…TrkA expression was significantly enhanced by IL-4 and IL-13 in vitro study of normal human epidermal keratinocytes (NHEK) and overexpression of TrkA can further enhance the proliferation of NHEK, suggesting the interplay between Th2 cytokines and keratinocytes through neuroinflammatory mediator [ 74 ]. Furthermore, NGF can sensitize and modulate the peripheral nerves [ 76 ], which might contribute to the hypersensitivity to sensory perception [ 77 ], the common symptom found in AD [ 78 , 79 ] and CNPG [ 7 ].…”

“…A European cross sectional-study revealed that 406 out of 509 patients with CNPG experienced moderate to severe itch intensity scores [ 6 ]. In addition to high intensity of itch severity, the pruritus in CNPG is often persistent and associated with burning, stinging, and pain [ 6 , 7 ]. Meanwhile, the lesions have a negative impact on their appearance, daily activities, and quality of sleep [ 6 ].…”

Non-Atopic Chronic Nodular Prurigo (Prurigo Nodularis Hyde): A Systematic Review of Best-Evidenced Treatment Options

“…It is more common among African Americans, with the highest prevalence among the elderly and a mean age between 51 and 65 years [10]. There is an increased prevalence of dermatological, psychiatric, and systemic comorbidities among CNPG patients; thus, CNPG can occur as a comorbidity to existing disease [7, 11, 12]. Particularly, atopic predisposition is a major prompting factor seen among approximately 50% of CNPG patients [2].…”