INDIVIDUAL ARTICLE: Prurigo Nodularis: Current Clinicopathologic Overview and Psychodermatological Perspectives

December 2023 | Volume 22 | Issue 12 | SF365502s6 | Copyright © December 2023


Published online November 28, 2023

Naiem T. Issa MD PhDa,b,c, Hannah Riva BSc,d, Mohammad Jafferany MDe

aForefront Dermatology, Vienna, VA 
bIssa Research & Consulting, LLC, Springfield, VA 
cDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
dPaul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX  
eDepartment of Psychiatry, Central Michigan University, Saginaw, MI

  1. NIH GARD information: prurigo nodularis. NORD (National Organization for Rare Disorders). Accessed 20 July 2023. https://rarediseases.org/gard‐rare‐disease/ prurigo‐nodularis
  2. Ständer S, Augustin M, Berger T, et al. Prevalence of prurigo nodularis in the United States of America: A retrospective database analysis. JAAD Int. 2021;2:28-30.
  3. Huang AH, Canner JK, Khanna R, et al. Real-world prevalence of prurigo nodularis and burden of associated diseases. J Invest Dermatol. 2020;140(2):480-483.e4.
  4. Ryczek A, Reich A. Prevalence of prurigo nodularis in Poland. Acta Derm Venereol. 2020;100(10):adv00155.
  5. Misery L, Brenaut E, Torreton E, et al. Prevalence and management of chronic nodular prurigo (CNPG) in Brittany (France): estimation by matching two databases. J Eur Acad Dermatol Venereol. 2021;35(9):e602-e604.
  6. Ständer S, Ketz M, Kossack N, et al. Epidemiology of prurigo nodularis compared with psoriasis in Germany: A claims database analysis. Acta Derm Venereol. 2020;100(18):adv00309.
  7. Morgan CL, Thomas M, Ständer S, et al. Epidemiology of prurigo nodularis in England: a retrospective database analysis. Br J Dermatol. 2022;187(2):188-195.
  8. Fostini AC, Girolomoni G, Tessari G. Prurigo nodularis: an update on etiopathogenesis and therapy. J Dermatolog Treat. 2013;24(6):458-462.
  9. Inui K, Ugajin T, Namiki T, et al. Chronic prurigo: A retrospective study of 168 cases. J Dermatol. 2020;47(3):283-289.
  10. Boozalis E, Tang O, Patel S, et al. Ethnic differences and comorbidities of 909 prurigo nodularis patients. J Am Acad Dermatol. 2018;79(4):714-719.e3.
  11. Vasavda C, Wan G, Szeto MD, et al. A polygenic risk score for predicting racial and genetic susceptibility to prurigo nodularis. J Invest Dermatol. Published online 2023.
  12. Doyle JA, Connolly SM, Hunziker N, et al. Prurigo nodularis: a reappraisal of the clinical and histologic features. J Cutan Pathol. 1979;6(5):392-403. 
  13. Ridolo E, Incorvaia C, Martignago I, et al. Sex in respiratory and skin allergies. Clin Rev Allergy Immunol. 2019;56(3):322-332.
  14. Ständer S, Stumpf A, Osada N, et al. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol. 2013;168(6):1273-1280. 
  15. Pereira MP, Steinke S, Zeidler C, et al. European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo. J Eur Acad Dermatol Venereol. 2018;32(7):1059-1065.
  16. Joel MZ, Hydol-Smith J, Kambala A, et al. Prevalence and comorbidity burden of prurigo nodularis in United States adults enrolled in the All of Us research program. J Am Acad Dermatol. 2023;89(5):1056-1058.
  17. Böhme T, Heitkemper T, Mettang T, et al. Klinische Charakteristika und Prurigo nodularis bei nephrogenem Pruritus [Clinical features and prurigo nodularis in nephrogenic pruritus. Hautarzt. 2014;65(8):714-720. 
  18. Sutaria N, Marani M, Choi J, et al. Racial differences in dysregulation of the renin-angiotensin-aldosterone system in patients with prurigo nodularis. J Dermatol Sci. 2022;105(2):130-136. 
  19. Sutaria N, Adawi W, Brown I, et al. Racial disparities in mortality among patients with prurigo nodularis: A multi-center cohort study. J Am Acad Dermatol. 2022;86(2):487-490.
  20. Whang KA, Kang S, Kwatra SG. Inpatient burden of prurigo nodularis in the United States. Medicines (Basel). 2019;6(3):88. 
  21. Whang KA, Gabriel S, Chavda R, et al. Emergency department use by patients with prurigo nodularis in the United States. J Am Acad Dermatol. 2021;84(4):1138- 1140. 
  22. Sutaria N, Choi J, Roh YS, et al. Association of prurigo nodularis and infectious disease hospitalizations: a national cross-sectional study. Clin Exp Dermatol. 2021;46(7):1236-1242.
  23. Cornman HL, Kambala A, Chen S, et al. Prevalence of tuberculosis in patients with prurigo nodularis: A multicenter cross-sectional study. J Am Acad Dermatol. 2023;89(2):406-408.
  24. Larson VA, Tang O, Stander S, et al. Association between prurigo nodularis and malignancy in middle-aged adults. J Am Acad Dermatol. 2019;81(5):1198-1201.
  25. Williams KA, Huang AH, Belzberg M, et al. Prurigo nodularis: Pathogenesis and management. J Am Acad Dermatol. 2020;83(6):1567-1575.
  26. Williams KA, Roh YS, Brown I, et al. Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis. Expert Rev Clin Pharmacol. 2021;14(1):67-77.
  27. Wang ZH, Feng Y, Hu Q, et al. Keratinocyte TLR2 and TLR7 contribute to chronic itch through pruritic cytokines and chemokines in mice. J Cell Physiol. 2023;238(1):257-273.
  28. Borgia F, Custurone P, Li Pomi F, et al. IL-31: State of the art for an inflammationoriented interleukin. Int J Mol Sci. 2022;23(12):6507.
  29. Tsoi LC, Hacini-Rachinel F, Fogel P, et al. Transcriptomic characterization of prurigo nodularis and the therapeutic response to nemolizumab. J Allergy Clin Immunol. 2022;149(4):1329-1339.
  30. Raap U, Gehring M, Kleiner S, et al. Human basophils are a source of - and are differentially activated by - IL-31. Clin Exp Allergy. 2017;47(4):499-508.
  31. Rüdrich U, Gehring M, Papakonstantinou E, et al. Eosinophils are a major source of interleukin-31 in bullous pemphigoid. Acta Derm Venereol. 2018;98(8):766-771.
  32. Stott B, Lavender P, Lehmann S, et al. Human IL-31 is induced by IL-4 and promotes TH2-driven inflammation. J Allergy Clin Immunol. 2013;132(2):446-54.e5.
  33. Hashimoto T, Yokozeki H, Karasuyama H, et al. IL-31-generating network in atopic dermatitis comprising macrophages, basophils, thymic stromal lymphopoietin, and periostin. J Allergy Clin Immunol. 2023;151(3):737-746.e6.
  34. Deng J, Parthasarathy V, Marani M, et al. Extracellular matrix and dermal nerve growth factor dysregulation in prurigo nodularis compared to atopic dermatitis. Front Med (Lausanne). 2022;9:1022889.
  35. Alkon N, Assen FP, Arnoldner T, et al. Single-cell RNA sequencing defines diseasespecific differences between chronic nodular prurigo and atopic dermatitis. J Allergy Clin Immunol. 2023;152(2):420-435.
  36. Patel JR, Joel MZ, Lee KK, et al. Single-cell RNA sequencing reveals dysregulated fibroblast subclusters in prurigo nodularis. bioRxivorg. Published online 2023.
  37. Ma F, Gharaee-Kermani M, Tsoi LC, et al. Single-cell profiling of prurigo nodularis demonstrates immune-stromal crosstalk driving profibrotic responses and reversal with nemolizumab. J Allergy Clin Immunol. Published online 2023.
  38. Deng J, Liao V, Parthasarathy V, et al. Modulation of neuroimmune and epithelial dysregulation in patients with moderate to severe prurigo nodularis treated with nemolizumab. JAMA Dermatol. 2023;159(9):977-985. 
  39. Sutaria N, Alphonse MP, Roh YS, et al. Cutaneous transcriptomics identifies fibroproliferative and neurovascular gene dysregulation in prurigo nodularis compared with psoriasis and atopic dermatitis. J Invest Dermatol. 2022;142(9):2537-2540.
  40. Silverberg JI, Kantor RW, Dalal P, et al. A comprehensive conceptual model of the experience of chronic itch in adults. Am J Clin Dermatol. 2018;19(5):759-769.
  41. Janmohamed SR, Gwillim EC, Yousaf M, et al. The impact of prurigo nodularis on quality of life: a systematic review and meta-analysis. Arch Derm Res. 2021;313(8):669-677.
  42. Whang KA, Le TK, Khanna R, et al. Health-related quality of life and economic burden of prurigo nodularis. J Am Acad Dermatol. 2022;86(3):573-580.
  43. Brenaut E, Halvorsen JA, Dalgard FJ, et al. The self-assessed psychological comorbidities of prurigo in European patients: a multicentre study in 13 countries. J Eur Acad Dermatol Venereol. 2019;33(1):157-162.
  44. Steinke S, Zeidler C, Riepe C, et al. Humanistic burden of chronic pruritus in patients with inflammatory dermatoses: Results of the European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) cross-sectional trial. J Am Acad Dermatol. 2018;79(3):457-463.e5.
  45. Lavery MJ, Stull C, Nattkemper LA, et al. Nocturnal pruritus: Prevalence, characteristics, and impact on ItchyQoL in a chronic itch population. Acta Derm Venereol. 2017;97(4):513-515.
  46. Gwillim EC, Nattkemper L, Yosipovitch G. Impact of itch on sleep disturbance in patients with prurigo nodularis. Acta Derm Venereol. 2021;101(3):adv00424.
  47. Ständer S, Fofana F, Dias-Barbosa C, et al. The Sleep Disturbance Numerical Rating Scale: Content validity, psychometric validation, and meaningful within-patient change in prurigo nodularis. Dermatol Ther (Heidelb). 2023;13(7):1587-1602.
  48. Dias-Barbosa C, Matos R, Vernon M, et al. Content validity of a sleep numerical rating scale and a sleep diary in adults and adolescents with moderate-to-severe atopic dermatitis. J Patient Rep Outcomes. 2020;4(1):100.
  49. Choragudi S, Yosipovitch G. Prurigo nodularis is highly linked with neural sensitization disorders of pain among hospitalized adults in the United States - National Inpatient Sample 2016-2019. Br J Dermatol. 2023;189(2):240-242.
  50. Jafferany M, Ferreira BR, Abdelmaksoud A, et al. Management of psychocutaneous disorders: A practical approach for dermatologists. Dermatol Ther. 2020;33(6):e13969.
  51. Brown GE, Malakouti M, Sorenson E, et al. Psychodermatology. Adv Psychosom Med. 2015;34:123-134.
  52. Lotti T, Buggiani G, Prignano F. Prurigo nodularis and lichen simplex chronicus. Dermatol Ther. 2008;21(1):42-46.
  53. Jørgensen KM, Egeberg A, Gislason GH, et al. Anxiety, depression and suicide in patients with prurigo nodularis. J Eur Acad Dermatol Venereol. 2017;31(2):e106-e107.
  54. Dhawan L, Singh SM, Avasthi A, et al. The prevalence of psychiatric comorbidity in patients with prurigo nodularis. Indian Dermatol Online J. 2018;9(5):318-321.
  55. Dazzi C, Erma D, Piccinno R, et al. Psychological factors involved in prurigo nodularis: A pilot study. J Dermatolog Treat. 2011;22(4):211-214.
  56. Jafferany M, Patel A. Understanding psychocutaneous disease: psychosocial & psychoneuroimmunologic perspectives. Int J Dermatol. 2020;59(1):8-15.
  57. Schut C, Dalgard FJ, Bewley A, et al. Body dysmorphia in common skin diseases: results of an observational, cross-sectional multicentre study among dermatological outpatients in 17 European countries. Br J Dermatol. 2022;187(1):115-125.
  58. Misery L, Patras de Campaigno C, Taieb C, et al. Impact of chronic prurigo nodularis on daily life and stigmatization. J Eur Acad Dermatol Venereol. 2023;37(7):e908-e909.
  59. Konda D, Chandrashekar L, Rajappa M, et al. Serotonin and interleukin-6: Association with pruritus severity, sleep quality and depression severity in Prurigo Nodularis. Asian J Psychiatr. 2015;17:24-28.
  60. Reichenberg JS, Kroumpouzos G, Magid M. Approach to a psychodermatology patient. G Ital Dermatol Venereol. 2018;153(4):494-496.
  61. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210-216.
  62. Ezzedine K, Shourick J, Bergqvist C, et al. Patient Unique Stigmatization Holistic tool in dermatology (PUSH-D): Development and validation of a dermatologyspecific stigmatization assessment tool. J Eur Acad Dermatol Venereol. 2023;37(2):443-450.
  63. Walker NA, Sunderram J, Zhang P, et al. Clinical utility of the Epworth sleepiness scale. Sleep Breath. 2020;24(4):1759-1765.

AUTHOR CORRESPONDENCE

Christine Emesiani PharmD Christine.Emesiani@galderma.com
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