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Prurigo Nodularis and Its Management
Claudia Zeidler1, Gil Yosipovitch2, Sonja Ständer1
1Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Von- Esmarch-Strasse 58, Münster DE-48149, Germany.
Abstract:
Prurigo nodularis occurs with chronic pruritus and the presence of single to multiple symmetrically distributed, hyperkeratotic, and intensively itching nodules. Diverse dermatologic, systemic, neurologic, or psychiatric conditions can lead to prurigo nodularis. Structural analysis demonstrated a reduced intraepidermal nerve fiber density and increased dermal levels of nerve growth factor and neuropeptides such as substance P and calcitonin gene-related peptide. Novel therapy concepts such as inhibitors at neurokinin-1, opioid receptors, and interleukin-31 receptors have been developed. The mainstays of prurigo nodularis therapy comprise topical steroids, capsaicin, calcineurin inhibitors, phototherapy, and the systemic application of anticonvulsants, μ-opioid receptor antagonists, or immunosuppressants.
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