[전문의 Q&A 궁금하다! 이 질병] ‘The peak of itching’ nodular pruritus
Korea’s first clinic opened, Kim Hye-seong, professor at Incheon St. Mary’s Hospital, Catholic University of Korea
“It’s a pity that I can’t receive proper treatment.
Various causes, including incurable skin diseases
Appears on arms, legs, etc. in size ranging from several mm to 2 cm.
Recently, good new drugs such as ‘Dupilumab’ have been released.
“Do not touch it, use a coating agent, etc.”
Itching is a disease that is easy to take lightly, but for those who actually experience it, it is an extreme pain. It can be triggered by common stimuli in everyday life, such as light touch, temperature changes, or mental stress. Among them, nodular pruritus is so itchy that it is so unimaginable 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. Itching can get worse when you lie down to sleep, are under a lot of stress, after drinking alcohol, or when it is hot or your skin is dry.
Kim Hye-seong, a professor of dermatology at Incheon St. Mary’s Hospital of the Catholic University of Korea, said on the 1st, “Nodular pruritus is a chronic disease characterized by unbearable itching and red or brown nodules (hard lumps) measuring a few millimeters to 2 cm in size.” He added, “If you scratch the skin, the nodules get bigger.” “It is important to control the itch in the early stage because it gets bigger and the itchiness gets worse,” he emphasized.
Professor Kim also said, “Antihistamines are commonly used drugs to control itching, but they are not enough to control the extreme itching of nodular pruritus.” He added, “Recently, effective new drugs, such as biological agents that do not worsen chronic inflammation, have been developed, making it difficult to treat existing treatments. “As a new horizon has been opened in the treatment of pruritus, active treatment is needed,” he said. We learned about nodular pruritus with the help of Professor Kim, who opened Korea’s first itching clinic last September.
-Why did you open an itching clinic?
“I trained under Professor Josipovich at the University of Miami, USA, a world authority on itching research. There are many patients suffering from itching, but the reality in Korea is that they are not receiving proper treatment, which is unfortunate. In particular, many new drugs that are good for relieving itching, such as biological agents, have been released recently. Treatment conditions have improved compared to before. “We benchmarked the University of Miami Itch Center.”
-What are the main symptoms?
“Red or brown nodules measuring a few millimeters to 2 centimeters often appear on the arms, legs, back, or buttocks. The itchiness is beyond imagination. In most cases, it goes beyond scratching the skin and involves digging. The problem is that if you scratch until it bleeds, it can become sore and if bacteria proliferate through secondary infection, it can become even more itchy. “A vicious cycle continues.”
-What is the cause?
“It may be a problem with the skin itself, such as dry skin, or it may be caused by an incurable skin disease (atopic dermatitis, psoriasis, urticaria, etc.). It can also appear as a secondary disease caused by diabetes that cannot control blood sugar, liver disease, hemodialysis, blood/solid cancer, thyroid disease, AIDS (acquired immunodeficiency syndrome), pregnancy, kidney failure, insect bites, etc. Aging is also a cause. As we age, the skin barrier breaks down and the immune system becomes allergic, causing itchiness. Itching is a ‘sign of aging.’ In fact, as the elderly population increases, the number of patients with itching tends to increase. “Systematic testing to determine the cause is important.”
Professor Kim said, “According to a paper recently published in the academic journal Nature, it was reported that ingredients secreted by Staphylococcus aureus (skin flora) living on the skin cause nodular itching. He added, “He is also active in research on the skin microbiome (microorganisms).”
-How is the diagnosis made?
“In most cases, nodular pruritus is diagnosed clinically. However, in order to differentiate it from other diseases and confirm the underlying disease, it is common to first ask about detailed medical history and whether or not the patient is taking medications. In addition, fungal smear (KOH) tests, scabies tests, blood and urine tests, and skin tissue tests can be performed.”
-I heard that an effective new drug has been released.
“Patients with nodular pruritus have often used immunomodulators such as cyclosporine, and gabapentin or amitriptyline, which modulate the neuromodulatory system. Recently, the introduction of the biological agent ‘Dupilumab’ and ‘Januskinase (JAK) inhibitor’, which regulates various inflammatory pathways, has opened up new possibilities in the treatment of nodular pruritus. In particular, dupilumab was approved by the Ministry of Food and Drug Safety in the middle of last month as a treatment for moderate to severe nodular pruritus in people over 18 years of age who do not respond to existing treatments. “The treatment environment has improved.”
-What are the precautions and precautions?
“If you have nodular pruritus, it is important to avoid touching the skin as much as possible. In addition to the previously mentioned drug treatment, it is also helpful to use an itching-relieving liniment for a cooling effect that cools the skin. It is a good idea to keep the room temperature cool, wear cotton clothes, and apply plenty of moisturizer after a light shower. Alcohol, cigarettes, saunas, scrubbing, hot drinks, and spicy foods can also make itching worse.”
Professor Kim said, “Patients with pruritus nodules often complain of anxiety or depression, so appropriate evaluation and intervention are needed. “Also, as it is often found that patients are accompanied by underlying diseases such as diabetes, thyroid disease, or anemia, it is advisable to check or treat these issues,” he advised.
Text and photo = Medical reporter Taewon Min twmin@kmib.co.kr
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2024-01-01 12:05:00
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