Prurigo

Any type of skin condition causing extreme discomfort and that is affecting your quality of life is serious.

It can feel overwhelming to get diagnosed with a condition you've never heard of. Or, if you think there's something wrong because you're experiencing symptoms of this rare skin condition, you've come to the right place.

Only a qualified medical professional will be able to diagnose a skin condition and offer an effective treatment plan, but at YourDNA, we've found helpful information about prurigo that may help answer some questions you might have, such as is prurigo nodularis cancerous?

What Is Prurigo? 

Prurigo is a skin condition that causes hard and itchy lumps called nodules on the skin. The itch from this condition can be very intense and affect the quality of life for individuals who have it. 

The itching can make it difficult for individuals to sleep at night, and also make it hard for them to enjoy regular activities.

It can get so bad that individuals will scratch themselves to the point of bleeding and pain, which can lead to scarring.

Types of Prurigo

Prurigo can come in several forms, and can also be the result of underlying conditions. 

Prurigo nodularis 

This is the most common form of prurigo and is also referred to as nodular prurigo. It causes hard wart-like nodules to form on the skin.

These nodules are very itchy, but they are also crusty in appearance and appear to be ulcerated.

There is also a net-like pigmentation associated with this type of prurigo.

Actinic prurigo 

This type of prurigo is caused when the skin has an abnormal reaction to sunlight, also referred to as photosensitivity.

This usually only has an effect on skin exposed to direct sunlight, but covered areas can also exhibit symptoms as well.

The result of this skin condition leads to the small and severely itchy papules of prurigo. It typically worsens during the summer months. 

Atopic eczema 

This condition typically affects children more, but it can occur at any age. Atopic eczema causes your skin to become red and itchy, and there is no cure.

This chronic condition flares up from time to time and can often be accompanied by hay fever and/or asthma. 

Prurigo simplex 

This form is also referred to as chronic prurigo of adults and prurigo mitis. It's classified as having small dome-shaped bumps that itch immensely, sometimes appearing as blisters.

They can form on any area of the body but generally appear on the buttocks, limbs, and neck. 

Signs & Symptoms of Prurigo 

The most common symptom associated with prurigo nodularis is the formation of hard crusty nodules approximately half an inch across in size. These nodules usually are dry, rough, and open on top, and lead to intense itching. 

The nodules from prurigo nodularis itch constantly and can often get worse at night. Individuals with prurigo often itch to the point of bleeding, which can eventually lead to scarring. 

Nodules from prurigo can form anywhere, but they're most common on arms, shoulders, and legs.

In some cases of prurigo, relief can only be found when the nodules are scratched to the point of becoming bleeding open sores and are painful. 

Other symptoms to watch for with prurigo include: 

• Nodules that form at the base of hair follicles 
• Flat excoriated lesions 
• Nodules that form before itching starts 
• Leathery and/or scaly patches on the skin 
• Raised pigmented skin 

The itching from prurigo can come and go, but it can also be consistent. Individuals affected by this skin condition can end up scratching out of habit, and can even scratch themselves in their sleep.

The symptoms associated with prurigo can start at any age, but most commonly occur in adults between the ages of 20 to 60.

Causes of Prurigo 

The exact cause of prurigo is not understood at this time. It is believed that nodules form as a result of itching, but it isn't known what causes the skin to have such an intense itch to begin with. 

Many individuals with prurigo also have allergies, eczema, or other skin conditions.

The itchy skin may be caused by a thickening of nerves, but it can be a variety of things that lead to the original itching sensation, which can differ in individual situations.

Prurigo is not believed to be a condition passed onto children from their parents. If someone has family members that do have prurigo, they may have an increased risk of developing the disease.

This is not thought to be due to genetics, though it's likely from sharing the same type of environmental conditions. Prurigo is not contagious, so you cannot get it from someone that has the condition. 

In less than half of the causes of prurigo, it is believed the symptoms are brought on by an abnormality in the liver, a nutritional deficiency, or uremia.

Prurigo can often be associated with decreased iron absorption, which can also be the result of not consuming enough iron in your diet. 

What Triggers Prurigo? 

The symptoms associated with prurigo can be triggered by various things such as heat, irritation caused by clothing, and sweating. 

Sleeping with a heavy blanket can make the symptoms worse, so it is recommended to sleep with light bedding in a cool room.

Scratching ends up making the symptoms worsen. It's extremely difficult for patients to refrain from scratching because the itching is intense.

It helps to keep your nails trimmed, and it can also help to sleep with gloves on to avoid causing irritation when scratching. 

Risk Factors for Prurigo

There are several things that can increase your risk of developing prurigo. Some psychological conditions can lead to this skin disorder. 

Other risk factors include: 

• Thyroid disorders
• Certain types of cancer
• Having a kidney or liver with reduced function 
• Eczema or other skin conditions 
• Immunodeficiency
• Certain types of infections including hepatitis 
• Type 2 diabetes mellitus 

Prurigo typically affects both men and women equally and does not affect one ethnicity over another.

Prurigo nodularis prevalence is in all age groups but commonly occurs more in middle-aged individuals. 

Associated Conditions 

Prurigo is often the result of another underlying condition such as: 

• Atopic dermatitis, or eczema 
• Severe cases of anemia 
• Kidney disease 
• HIV 
• Lymphoma 
• Hodgkin's disease ¹

In rare cases, prurigo comes as a result of cutaneous lupus mucinosis ². This seems to occur mainly in men and results in lesions and nodules appearing on the upper and lower extremities. 

Itching is not a sign that someone might have cancer, but prurigo can come as the result of certain cancer treatments.

Prurigo is not cancerous, and most skin cancers do not cause intense itching. Chemotherapy can cause the skin to become irritated due to hypersensitivity and can lead to prurigo. 

Approximately 20% of all pregnant women experience pruritus ³. Having this while pregnant can make it difficult to sleep, and it can also decrease the quality of life.

Pruritus during pregnancy can mean there's an underlying condition causing itchy dry skin. 

Some conditions that can have pruritus as a symptom include the atopic eruption of pregnancy, pruritic urticarial papules and plaques of pregnancy, intrahepatic cholestasis of pregnancy, and pemphigoid gestationis.

Physicians will evaluate prurigo in pregnancy with a physical examination and evaluate the patient's medical history. 

Diagnosis of Prurigo 

Itchy, scaly nodules on the skin can cause a doctor to suspect prurigo. Most doctors will perform a physical examination and take note of the symptoms the individual is experiencing. 

A doctor may request a skin biopsy to determine if the nerves are thickened and to rule out other conditions that would cause these symptoms to occur.

The doctor may also perform blood tests and tests of the kidney and liver to ensure there's nothing else going on. 

Doctors will have to rule out a variety of conditions before confidently diagnosing prurigo. Some conditions that may cause similar symptoms include:

• Insect bites 
• Infestations such as nodular scabies
• Bullous pemphigoid 
• Fungal or bacterial folliculitis 
• Mycobacteria 
• Acneiform eruptions 

While a biopsy is a useful tool in ruling out associated conditions, a doctor may also perform a patch test to rule out any allergies that can be causing the itching.

Treatment Options for Prurigo 

Treating a condition such a prurigo can sometimes be challenging to healthcare professionals because people respond differently to the various treatment options available. 

This condition causes such an intense itch, so it's likely affected individuals will have to try various treatment methods to see which ones provide the most relief.

There is also a chance that individuals can end up trying all available treatment methods and never get full relief from the symptoms. 

The currently available treatment methods for prurigo include: 

• Oral corticosteroids 
• Oral antihistamines 
• Corticosteroid creams 
• Selective serotonin reuptake inhibitors, or SSRIs 
• Corticosteroid injections that are injected into nodules 
• Capsaicin cream ⁴

• Ointments containing menthol and/or phenol

There is always the chance that affected individuals can try all of those treatment options without much success.

In these cases, there are procedures available that may prove to be more effective. These include: 

• Cryotherapy that uses extreme cold to make the nodules smaller 
• Photochemotherapy, which helps to increase the skin' sensitivity to UV rays 
• Immunosuppressants may also help for severe cases of recalcitrant prurigo nodularis

Homeopathy treatments for prurigo nodularis include applying menthol to the affected areas.

If menthol is not readily available, it can help to cool the itchy spots with an ice pack or wet cloth.

It can also help to keep a gentle lotion in the refrigerator so it's already cold for whenever you need it. 

Another remedy is to use wet wrap therapy. This is when you use gauze soaked in water and apply it to the areas that itch the most. Other methods include:

• Apple cider vinegar 
• Colloidal oatmeal 
• Baking soda 
• Moisturizing the areas on a regular basis 
• Using gentle soaps when taking a shower 
• Avoiding known irritants such as hot water and skincare products with fragrance 

Some individuals may experience prurigo as a result of food intolerances.

If you believe this may be the case, you can go on a nodular prurigo diet and start removing certain types of foods from your diet to see if your symptoms decrease.

Typically these are foods such as dairy or gluten.

The Prognosis for Prurigo 

Prurigo nodularis is not fatal, but it does not go away. There are many treatment options that can be effective, but there are many individuals who never receive full relief from their symptoms. 

The severe itch brought on by prurigo can make it hard for people to perform normal everyday activities, and may also make it hard for them to sleep at night. 

Living with this condition can be a challenge, and can end up leaving affected individuals feeling lost, alone, stressed, and very depressed.

There are prurigo nodularis support groups that can help by providing support and ways to manage the condition. 

Patients with prurigo should learn ways to keep their mind off of scratching the itch.

It can often be hard to realize when you're scratching because it's often done out of habit.

Patients can ask friends and family members to let them know when they notice any scratching so they can become aware of it and work toward stopping. 

While prurigo is not a deadly disease, it does cause a lot of discomfort to the individuals who have it.

It can also be difficult for family members to watch their loved ones scratch themselves constantly without any relief.

It helps to be patient and be willing to try a variety of treatment options to find what works the best. It can also help to attend support groups to find others with the same condition.

Sometimes it takes finding the underlying cause of the prurigo to finally experience relief.

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