Sleep Disturbances and Psychological Burden of Prurigo Nodularis

Raj Chovatiya, MD (00:07):

Prurigo nodularis historically was somewhat of an orphan disease. In fact, if you presented in a symposium, many people might argue back saying, "This is really more of a psychodermatoses. It's all in patients heads. It's a psychiatric manifestation. It really doesn't have a primary lesion. Is this truly a dermatologic disease?" I can understand where those individuals were coming from. After all, we oftentimes think with our eyes about a primary lesion, and many of the lesions in prurigo nodularis are secondary.

(00:33):

But therein lies the dual interplay of the nervous system and the immune system in this disease state. By no means is this disease in somebody's head per se, but it's important to note that the nervous system is an equal contributor to disease pathogenesis along with the immune system. For that reason, we think of PN as a very classic and prototypical neuro-inflammatory disease, meaning that inflammation at cutaneous neurons and inflammation in the cutaneous nervous system communicating with each other are both driving the itch and the lesions that we think about in this disease state.

(01:07):

This elevated understanding has actually changed the way we look at a lot of different itchy diseases, and as it turns out, a variety of chronic inflammatory skin diseases where their components of itch and even pain probably involve dysregulation of both the immune system as well as the nervous system.