Working up Prurigo Nodularis and Getting to the Source of Itch

Dr. Neal Bhatia (00:07):

Hi, I am Dr. Neal Bhatia. I'm Chief Medical Editor of Practical Dermatology and Director of Clinical Dermatology at Therapeutics Clinical Research in San Diego, California.

(00:16):

Prurigo nodularis is often a manifestation of something that's under the hood, whether it be the urge to scratch, some sort of psychogenic stimulus, or some metabolic issues such as nephrogenic pruritus, patients with liver disease, with other cholestatic diseases, for example, and even more so, the psychogenic components that need to be dealt with when patients have no quality of life from scratching, when they're digging into their skin, they can't sleep from itch, and everything else that goes in between.

(00:41):

I think part of, again, what the prurigo nodularis workup involves is looking at any potential infectious source, for example, examining their fingers and their toes for any web issues that could lead to scabies or fungus. Then you have patients, you want to look at their medication history, look at their lifestyle, is there anything that they're exposed to, whether it be at work or at home. And again, also talk to the spouse and ask, or even the parents, if you will, ask what's going on at home, if nobody is sleeping, if they're scratching or if there's something else that could be potentially contributing to the amount of prurigo nodularis patients are developing.

(01:14):

To have just pure itching without some source is not as common as perhaps some other trigger. But at the same time, that diagnostic workup, which should include biopsies, patch testing, any lab testing, for example, CBC, thyroid, liver function, kidney function, and everything else that's metabolic, all should have some role in the workup of prurigo nodularis. Even more so, again, getting to the source of the itch and whatever that trigger is, should be a top priority for dermatologists, as well as working with allergists, for example, but even moreso making sure the patients are aware that that cycle has to be broken for their skin to get better.

(01:47):

I would take into account also the psychological burden of prurigo nodularis, get into their lifestyle, any issues with anxiety or depression, for example, talk about their sleep habits, talk about any changes in their health in the last six months, for example. And again, talking to the parents or the spouse is also very important. We, in research, do a lot of the HADS scores, for example, H-A-D-S is an anxiety-depression scale. We talk about DLQI and the quality of life. These are all important surveys that can be downloaded and added to your clinic notes to really add to the intensity of the evaluation for the psychological component of prurigo nodularis.