prurigo nodularis (picker's nodules)

Etiology

• emotional tensions induce a self-pertpetuating pruritus
• lesions are produced by picking of the skin

Clinical manifestations

• hyperpigmented papules or nodules
  • firm, extremely itchy nodules can appear almost anywhere on the body
  • most commomly on the upper & lower extremities
  • lesions are always in reach of scratching
• overylying scale
• lesions may become excoriated * ulcerated
• lesions up to 2 cm in diameter
• patients scratch in multiple locations
• once itch improves, lesions gradually heal leaving light or dark spots often with scarring

Management

• if generalized, evaluate for internal causes of pruritus without primary cutaneous eruption
  • chronic renal failure
  • obstructive liver disease
  • malignancies, especially Hodgkin's disease
  • hyperthyroidism
  • hypothyroidism
  • polycythemia rubra vera
  • acquired immune deficiency syndrome (AIDS)
• break the itch-scratch cycle
  • potent topical glucocorticoids
  • intralesional glucocorticoids
  • oral antihistamines at night
• dupilumab FDA-approved

More general terms

• neurodermatitis
• prurigo

Patient information

prurigo nodularis patient information