Distinct comorbidity profiles in atopic versus non-atopic prurigo nodularis: a cross-sectional analysis

Prurigo nodularis (PN) is a chronic inflammatory skin condition frequently associated with atopy, yet the relationship between atopic status and comorbidity profiles in PN patients remains poorly understood. Using the 2016-2019 National Inpatient Sample database, we analyzed 7,765 patients with PN to compare epidemiological characteristics and comorbidity patterns between atopic and non-atopic cohorts. Among these patients, 1,545 (19.9%) had concomitant atopy, defined as the presence of at least two atopic conditions (atopic dermatitis, allergic rhinitis, or asthma). Atopic PN patients were more likely to be female, Black, and reside in central metropolitan areas with higher median household incomes. After adjusting for demographic and socioeconomic factors, the atopic cohort showed significantly higher odds of cardiovascular conditions (including atrial fibrillation: aOR 2.84 [1.31-6.40]), gastrointestinal disorders (such as GERD: aOR 1.57 [1.18-1.95]), and neurological conditions (including chronic pain: aOR 2.08 [1.39-3.03]). Conversely, they demonstrated lower odds of renal complications, including acute kidney failure (aOR 0.58 [0.40-0.83]) and end-stage renal disease (aOR 0.62 [0.43-0.90]). These findings suggest clinically distinct subtypes of PN based on atopic status, which could inform risk assessment and guide personalized treatment approaches.