Prurigo Nodularis

Prurigo is a skin disease. It is associated with severe itching and the formation of nodules on the skin. Statistically, this problem occurs in 1-2% of patients who visit a dermatologist. In general, a distinction is made between adult prurigo, pediatric prurigo, and prurigo nodularis.

Symptoms of Prurigo Nodularis

Prurigo Nodularis in children begins with small, pinhead-sized nodules appearing on the body. From time to time they are accompanied by intense itching, which leads to rapid skin lesions that later become crusty. In this case, children become naughty, poorly sleep and lose their appetite.

When the disease occurs in adults, it is mainly localized on the bending surfaces (elbows, knees), abdomen, back, buttocks. In this case, the itch is manifested by red papules the size of lentils. In this case, often a bubble is formed on the papule, and the skin around the papule itching. That is where the rash is gradually covered with crusts, which may later result in scars. And if there is still tearing papules, it can be complicated pyoderma. The itching can intensify at night, resulting in poor sleep.

Prurigo nodularis is characterized by hemispherical, dense nodules that are very itchy, about 0.2-0.5 in (5-12 mm) in diameter. The nodules can also be located throughout the body, but predominantly on the hands and feet.

That is, any Prurigo has quite characteristic symptoms, by which you can easily identify this disease.

Causes

There can be many causes of prurigo nodularis. In particular, in children, the disease occurs due to the gastrointestinal tract, which can occur due to improper diet. Also, the disease can cause intolerance to certain substances, including medications. The disease can last for several years and thus develop into an adult form.

Depending on the course, adult prurigo nodularis can be acute and chronic. In acute cases, prurigo nodularis can last up to 4 months. Women between 20 and 40 years of age are more likely to have an acute course of the disease. And in men, mostly diagnosed in a chronic course. In rare cases, chronic prurigo nodularis can last for years. Such scabies are characterized by large (up to 0.8 in), itchy nodes, which are localized in the thighs, shins and forearms.

The disease may have a mild form (prupigomitis) and a severe form (prurigoferox), depending on its severity.

Prurigo nodularis occurs more often in women over the age of 40 who have an unstable nervous system. It can accompany gallbladder and liver diseases, such as hepatitis, cirrhosis, chronic cholecystitis, and endocrine system disorders. It may occur more often after stress or from the bite of some insects.

In children between the ages of 5 months and 3 years, prurigo infantis may occur. It occurs most often when a child is switched to complementary foods.

Diagnosis

To make a correct diagnosis, scrapings should be taken from the localization of the disease and seeded on a nutrient medium. It is mandatory to do the following blood test – general – to determine the amount of sugar and hormones.

To determine the causes of prurigo nodularis, you may need to consult specialists: a gastroenterologist and an endocrinologist. An ultrasound examination of the parenchyma of the liver and pancreas should also be performed.

The disease must be differentiated from neurodermatitis, lichen planus macularis, Duhring’s dermatitis, and scabies.

Laboratory diagnostics

Laboratory tests are recommended before prescribing systemic drug therapy, when deciding on further treatment tactics, and for the purpose of differential diagnosis:

• clinical blood and urine tests;
• Biochemical blood tests: total protein, total bilirubin, creatinine, urea, glucose;
• Stool test for worm eggs;
• Serological diagnostics of parasitic diseases – detection of antibodies to antigens of giardia, ascarias, opisthorchiasis, etc;
• HIV testing (detection of IgM and IgG antibodies to HIV1, HIV2) and hepatitis B and C (detection of HCV antibodies, HBs-antigen);
• histological examination of skin biopsy specimens;
• microscopic examination of skin scrapings for scabies mites;
• determination of serum allergen-specific antibodies (food, household, pollen, epidermal, to drugs, insect bites).

Treatment of prurigo nodularis

The treatment of this disease depends on the causes of its occurrence. In cases where the disease is a consequence of helminthiasis, antihelminthic drugs are prescribed. When prurigo nodularis occurs due to violations in the diet, it is necessary to make adjustments to the diet.

People suffering from this disease are advised to diversify their diet with fruits and vegetables.

In all cases where prurigo nodularis occurs, its treatment is accompanied by anti-allergic (antihistamine) agents. For external use, ointments containing glucocorticoids are prescribed. Also recommended course of baths with herbs (oak bark), bran, potassium permanganate or sulfur baths. Excellent effect is observed in the treatment of ultraviolet irradiation and laser.

Detailed Information

The treatment of scabies in adults and children begins with a strict hypoallergenic diet: exclusion of obligate food allergens, products with dyes, preservatives, irritating foods, alcohol, restriction of table salt, carbohydrates.

The basis of therapy of the disease is antihistamines, the duration of which depends on the severity of the dermatosis. Itching is the main reference point for prescribing antihistamines, because the intensity of irritation of sensitive nerve endings in the skin depends on the histamine level. The action of histamine is mediated by different types of receptors, through the H1-receptor histamine increases tone of bronchial smooth muscles, which may cause asthmatic asphyxia, increases intestinal peristalsis, and in case of food allergy leads to diarrhea, increases the permeability of blood vessels, resulting in gaps between the endothelial cells of venules, through which plasma escapes and intraepidermal edema is formed.

Through the H2-receptor, histamine slows the heart rate and stimulates the formation of hydrochloric acid in the gastrointestinal tract. In the CNS, histamine acts as a neurotransmitter: it is essential for maintaining the waking state. H1- and H2-receptors can be blocked by selective antagonists. The first antihistamines (H1-histamine drugs) are nonspecific and block other receptors, such as M-cholinoreceptors. These drugs have been used as anti-allergic, antiemetic, nonspecific sedatives, and sleeping pills. Side effects of such drugs include drowsiness and atropine-like effects (dry mouth, constipation). New drugs (“second and third generation drugs”) do not penetrate into the CNS and therefore have no sedative effect. Perhaps in the endothelium of the blood-brain barrier they are transported back into the blood and have no atropine-like effect.

Recommended drugs for oral administration: chloropyramine, mebhydroline, chifenadine, clemastine, dimethinden, loratadine, desloratadine, cetirizine. A noteworthy third-generation antihistamine drug that is an active metabolite is cetirizine (Zodac). The active substance of the drug is a selective blocker of peripheral H1 receptors, so it has no significant antiserotonin and anticholinergic effects, which is important for patients with chronic allergic dermatitis. The active substance of Zodac does not cross the blood-brain barrier in a significant quantity, that is why the sedative effect, including somnolence, is not expressed or is expressed in a very mild way. It is important that the active substance of Zodac affects both the histamine-dependent – the early phase of allergic reactions, and the late cellular phase. The action of cetirizine inhibits the release of histamine from basophils and mast cells, reducing the migration of eosinophils and other cells. Bioavailability of active substance is the same for all dosage forms of the drug: syrup, drops and tablets.

In addition to antihistamines it is recommended to prescribe additional treatment: hypersensitizers (calcium gluconate, calcium pantothenate, calcium glycerophosphate, sodium thiosulfate) and enterosorbents (lignin hydrolysis, diosmectite, enterosgel, lactofiltrum). If necessary, include enzyme preparations for a course of three weeks (pancreatin, enzistal), sedative phytopreparations (tinctures of valerian or peony). Outwardly, 2% boron-naphthalene, 2% boron-ichthyol, III fraction in combination with glucocorticosteroid ointments shall be applied externally. If the course of prurigo is severe, or there is no tendency to regress of the rash, it is necessary to carry out detoxification therapy, glucocorticosteroids systemically (prednisolone 15-20 mg for 14-25 days, with a further reduction), tranquilizers. In the absence of contraindications, PUVA therapy may be used – 15-25 sessions 4 times a week.

An alternative approach can be surgical methods: injection of rash elements with dexamethasone, hydrocortisone, celeston, methylene blue solution in novocaine, irrigation with chloroethyl, liquid nitrogen; cryodestruction, diathermocoagulation.

Home remedies

Dietary changes
This is one of the natural treatments which are used to manage the prurigo nodularis. You ought to identify and eliminate the trigger foods. There are many individuals impacted with prurigo nodularis who take advantage of limiting gluten, artificial sweeteners and soy lecithin.

Salt bath
A journey to the ocean, or a bath in sea salt are really effective ways to lessen the prurigo nodularis. When you are taking in sea salt, then the salt water penetrates the pores and it is absorbed into the blood stream. The salt can help to eliminate the accumulated lactic acid in the body, dry out sores and remove infection.

Lower your stress levels
It is understood reality that the prurigo nodularis is often linked to psychological and psychological conditions, particularly since the itch– scratch cycle can cause stress and anxiety and anxiety. There was one study in 2008 in which was shown that psychosomatic elements exist in at least 1/3 of all patients with skin-related conditions [4] There was another study in 2011 in which was revealed that the acupuncture and hypnosis are very beneficial as natural treatments for prurigo nodularis and these natural treatments can assist to decrease the intensity of itching and the size and number of skin sores.

Beeswax
You can use the beeswax as your natural treatment for prurigo nodularis since it has Vitamin A which is very efficient for the skin and also it supports the cell restoration.

Neem
You can use neem as your natural treatment for prurigo nodularis. It has amazing medical properties and it is thought about as a time– evaluated natural home remedy for skin issues. This home remedy has anti– bacteria, antifungal and anti– inflammatory homes. You can use neem capsules as your natural treatment since it can eliminate contaminants from the body, purify the blood, remove excess of oil from the skin and provides appropriate nourishment to the skin.

Aloe Vera
This natural home remedy can assist in handling different types of skin conditions. It is rich in Vitamin C and Vitamin E which are extremely powerful for the total skin health. You must talk with your doctor about the best way for taking this natural home remedy for the prurigo nodularis. This natural home remedy can assist you to keep the natural radiance of the skin, stimulates the development of skin cells, minimizes soreness and dry skin patches, offers appropriate nutrition to the skin and keeps the skin hydrated.

Vitamin D3
A topical Vitamin D can help to recover sores that are caused by prurigo nodularis in those people who have become resistant to the steroid treatment. In this research study was observed that positive results have actually happened in a period of 4 weeks of using this cream.

Ginger tea
This is one of the best natural home remedy for prurigo nodularis. It is rich in gingerols which are really reliable anti-inflammatory representatives. These elements can help in the fight versus swelling and itching. You can drink ginger tea on daily basis. Also you can take a ginger juice with a spoon of honey or ginger root powder with jiggery. These are all efficient natural treatments for prurigo nodularis and they ought to be taken on day-to-day basis.

Thyme
This home remedy is not well studied about its capability to decrease the itching that is brought on by prurigo nodularis. It has active substance which has the capability to combat against skin infections however you need to talk with your doctor if you have decided to use thyme as your natural treatment for prurigo nodularis.

Vitamins
You require to talk with specialist about vitamin supplements, specifically Vitamin C, Vitamin E and Vitamin A. All of these vitamins are called skin vitamins and they can assist in the skin regeneration and recovery. You can get these vitamins from your foods, such as broccoli, carrots, nuts, tomatoes, papayas, strawberries, limes and apples. You should consume them on regular basis. When you are using Vitamin A and Vitamin E oil as your natural treatment for prurigo nodularis, then they can help you to recover quicker. But you require to talk with your doctor before you begin using a few of these vitamins since he or she will inform you if they benefit your condition.

Sunshine
One of the best natural treatments for prurigo nodularis is the direct exposure to sunshine due to the fact that it has restoring effect on this condition. When our skin is exposed to sun, then it releases a compound called nitric oxide which can reduce the high blood pressure and stimulate blood circulation. Also this part can help to remove the toxic substances from the blood because it boosts the blood filtration.

Capsaicin
You can apply capsaicin topically because it safe and reliable natural home remedy for prurigo nodularis. This is a substance which is providing the hot peppers their heat. When it is applied to the skin, then it causes the body to launch a compound called “compound P” which is just released when the tissues are damaged. The outcome of it is a burning pain however when the cream is frequently applied to your body, then the levels of “compound P” are diminished. Also the pain in that area is decreased. There was one research study in which were evaluated 33 patients was noticed that these patients have experienced a complete removal of the itchy skin nodules after months of the treatment with capsaicin.

Rosemary
Rosemary has active ingredients which can assist to minimize the skin infection. But this home remedy has not been studied about its effectiveness in minimizing the itching caused by prurigo nodularis so you require to talk with your doctor before you start utilizing the rosemary as your natural treatment for this condition.

Apple cider vinegar
You should take apple cider vinegar as your natural treatment for prurigo nodularis. It can help to relieve the pain and itching of prurigo nodularis. You must consist of five spoons of apple cider vinegar to your fruit juice and drink it on daily basis. You must continue utilizing this home remedy because it will offer you better results.

Eucalyptus oil
This is an extremely reliable natural home remedy which can assist to protect the irritated skin and also it will give you a relief from swelling and pain.

Sandalwood
There are numerous doctors who are suggesting sandalwood paste as a natural home remedy for prurigo nodularis since it was discovered that it is relaxing for the skin. You should use it in the evening before you go to sleep.

Peppermint oil
This natural home remedy has been used for centuries to relieve the itch and pain of the skin. It can be used as natural treatment for prurigo nodularis.

Jojoba oil
This is the world’s most nutrition abundant and long– lasting moisturizer. This natural remedy has distinct consistency which can help in the treatment of prurigo nodularis. Likewise it has been noticed that this natural home remedy have the ability to repair the cracked skin.

Prevention

Prevention measures for prurigo nodularis consist in the timely treatment of gastrointestinal, endocrine diseases and infections. In the chronic course of prurigo nodularis, it is necessary to follow all the recommendations of the doctor.

It is also very important to stick to a proper and nutritious diet, follow a work and rest schedule and avoid stressful situations.