Itching is an unpleasant and common symptom that causes the urge to scratch or rub the skin. It’s easy to take it lightly, but for those who suffer from itching, it’s truly a pain. It can also be triggered by common stimuli in everyday life, such as light touch, temperature changes, or mental stress.
‘Nodular pruritus’ is famous for its unimaginable itchiness, so much so that it is nicknamed ‘the peak of itchy diseases.’ In severe cases, the pain goes beyond just scratching the skin to the point of having to dig it open. We learned about nodular pruritus with the help of Professor Kim Hye-seong of the Department of Dermatology at Incheon St. Mary’s Hospital, Catholic University of Korea.
Professor Kim Hye-seong, Department of Dermatology, Incheon St. Mary’s Hospital
Going beyond just scratching the skin, picking and digging… The peak of itchy diseases
Pruritus nodularis is a chronic disease characterized by multiple nodules, or hard lumps, accompanied by severe itching. The cause is not well known, but atopic dermatitis, anemia, liver disease, thyroid disease, AIDS (acquired immunodeficiency syndrome), pregnancy, renal failure, mental stress, insect bites, etc. may appear first.
The domestic annual prevalence of nodular pruritus is estimated to be 4.82 per 1,000 dermatology outpatients. In an epidemiological study of American adults aged 18 to 64 with medical insurance, the prevalence was 72 per 100,000, making it a relatively rare disease.
In those with atopic dermatitis, it occurs early, at an average age of 20, and in those without atopic dermatitis, it occurs late, at an average of 50 years of age. However, the prevalence of nodular pruritus is rising rapidly due to the recent increase in the middle-aged population.
Symptoms include red or brown nodules measuring a few millimeters to 2 centimeters that commonly appear on the limbs, upper back, or buttocks. The itchiness is beyond imagination and in most cases, it goes beyond the level of scratching the skin. Additionally, a vicious cycle occurs in which secondary infection in the area causes further itchiness.
Kim Hye-seong, a professor of dermatology at Incheon St. Mary’s Hospital of the Catholic University of Korea, said, “Itchiness can get worse when you lie down to sleep, when you are under a lot of stress, after drinking alcohol, or when it is hot or the skin is dry.”
When you scratch, the nodules get bigger and the itchiness gets worse… The key is to get rid of the itch in the beginning.
In most cases, nodular pruritus is diagnosed clinically, but it is common to first ask about detailed medical history and medication use to differentiate it from other diseases and confirm underlying diseases. In addition, a fungal smear test (KOH), scabies test, blood test, urine test, and skin biopsy can be performed.
Nodular pruritus is characterized by the nodules getting bigger and the itching getting worse when the skin is scratched. Therefore, it is important to control the itch early on. Antihistamines are commonly used to control itching, but they are not enough to control the extreme itching of nodular pruritus, so many people have been taking immunomodulators such as cyclosporine, gabapentin or amitriptyline, which regulate the neurotransmission system.
Recently, the biological agent Dupilumab and an anuskinase (JAK) inhibitor that can control various inflammatory pathways were developed, opening a new horizon in the treatment of nodular pruritus. In particular, dupilumab was approved by the Ministry of Food and Drug Safety on December 14, 2023 as a treatment for patients with moderate to severe nodular pruritus over the age of 18 who do not respond to existing treatments.
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When nodular itching occurs, it is important to avoid touching the skin as much as possible. In addition to drug treatment, it is helpful to use topicals that relieve itchiness for a cooling effect that cools the skin. In addition, it is recommended to keep the indoor temperature cool, wear cotton clothes, and apply moisturizer liberally after a light shower. Alcohol, cigarettes, saunas, hot drinks, and spicy foods can also worsen itchiness.
Professor Kim Hye-seong said, “Patients with nodular pruritus often complain of anxiety and depression, so appropriate evaluation and intervention are needed.” “As blood cancer is often found to be present, it is best to check or treat this condition,” he said.
2024-01-04 06:00:01
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