Itchy Dermatologic Skin Disorder Is Common Than Thought

Johns Hopkins researchers report that prurigo nodularis (PN), a skin disease characterized by severely itchy, firm bumps on the skin, may be associated with other inflammatory skin disorder as well as systemic and mental health disorders. Compare with other skin diseases, however, not much is known about PN. While symptoms of PN can be managed, no cures exist. Researchers were looking to determine conditions that are more common in patients with PN; compare with similar patients without PN.

“A lot of patients who have prurigo nodularis also have severe health conditions that need more immediate attention, and many of these PN patients may fall through the cracks,” says dermatologist Shawn Kwatra, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine. While skin conditions such as psoriasis and eczema are know to be cause by an overactive immune system, the underlying molecular cause of PN remains unknown because the disease has been understudied.

In their study, they identify 7,095 people with PN, 23,882 with atopic dermatitis without PN and 38,283 with psoriasis without PN. Base on these numbers; so they calculate that more than 72 per 100,000 people are affect with PN; primarily females with an average age of 50 years. “The real numbers may be higher than this because our data only include people with health insurance and between the ages of 18 and 64,” says Johns Hopkins University School of Medicine fourth-year medical student Amy Huang.

According to The National Institutes of Health, PN may develop from other skin diseases or other health issues that may be common in families, and even environmental factors may place one at an increase risk of developing PN. Analyzing the data further, the team find that those with PN have increase risk of other conditions; so compare with people without PN, including HIV, kidney disease, non-Hodgkin’s lymphoma and mental health disorders.

Management of patients

They are eager to better understand PN because that will help in the management of our patients, says Kwatra. “Our goal is to inform other physicians about the frequency of PN-relate conditions to guide an evidence base target diagnostic workup. Enhance disease recognition and ongoing translational studies will provide further clues to the development of PN.”

While there is no cure for PN, current treatment includes phototherapy; topical steroids and off-label management with immune suppressants and anticonvulsants. Kwatra says it’s important for physicians to be well inform; so about relate conditions so PN can be properly diagnose and managed. Ongoing research initiatives include examining the patterns of PN in children and adults age 65; also over and how PN treatment affects these populations. Additional studies are ongoing by Kwatra’s group to understand the molecular explanation of PN.

Further research is need to clarify how chronic conditions such as atopic dermatitis, HIV, renal impairment; also mental health conditions may contribute to the development of PN. “With such a large population of people who have this neglected disease; so they’ve only scratch the surface and are happy to take the lead with investigating this understudied condition,” Kwatra says.