Prurigo Nodularis Linked to Elevated Cardiovascular Risk, Expanding View of Systemic Disease

Growing evidence indicates prurigo nodularis (PN) is associated with increased cardiovascular risk, reinforcing the disease’s systemic nature and the potential consequences of untreated inflammation, according to a talk by Shawn Kwatra, MD, at the 2026 American Academy of Dermatology Annual Meeting.

“Prurigo nodularis is evolving in real time in how we understand it,” Dr. Kwatra said, describing a shift from a purely dermatologic condition to a complex neuroimmune and systemic disease. 

He emphasized that PN often emerges in midlife and may result from a combination of genetic predisposition and environmental or metabolic triggers, such as type 2 diabetes. Nerve injury and immune dysregulation appear to play central roles.

“Damage to those nerves can stimulate immune cells,” he noted, linking neuronal and inflammatory pathways. 

Dr. Kwatra presented data presented demonstrating that patients with PN have an increased risk of major adverse cardiovascular events (MACE), including heart failure, myocardial infarction, cardiac arrest, and stroke. He connected these outcomes to systemic inflammation.

“When we look at these patients, they have high IL-6 levels, high C-reactive protein levels … biomarkers associated with poor cardiovascular outcomes,” he said. 

These findings suggest that PN-associated inflammation may extend beyond the skin, potentially contributing to cardiovascular morbidity.

The concept of “unchecked inflammation” emerged as a central theme. Dr. Kwatra described early research showing that even patients without known kidney disease may exhibit biomarkers of renal stress.

“Patients who have no history of kidney disease but unchecked PN, they are already showing something,” he said. 

This raises the possibility that chronic inflammation in PN may contribute to multi-organ effects, including cardiovascular and renal disease.

Sarina Elmariah, MD, FAAD, who also presented during the session, emphasized the complexity of these associations.

“There really may be more crosstalk,” Dr. Elmariah said, noting that factors such as sleep disruption—a hallmark of PN—may independently contribute to cardiovascular risk.

She emphasized the importance of multidisciplinary care.

“These patients need to be plugged in with their primary care doctor,” she said, adding that coordinated management is necessary beyond dermatology.

Dr. Kwatra suggested that these findings may influence how clinicians counsel patients.

“I don’t know what the side effects could be of unchecked chronic inflammation,” he said, adding that this uncertainty can help frame discussions around the importance of treatment. 

He also noted that itch severity correlates with broader systemic effects, including sleep disturbance and inflammatory burden, further reinforcing the need for comprehensive disease control.