Comorbidities in prurigo nodularis

Prurigo nodularis (PN) is a chronic inflammatory skin condition characterized by intense pruritus and hyperkeratotic nodules commonly found on the trunk and extremities. The pathogenesis of PN involves neuroimmune dysregulation, mediated by various inflammatory cytokines and neuropeptides. PN significantly impacts patients' quality of life. There is greater disease severity, increased itch intensity, and a more pronounced reduction in quality of life in PN compared with other individuals with chronic pruritus. PN is associated with a range of systemic comorbidities, including chronic kidney disease, cardiovascular disease, metabolic disorders, HIV and tuberculosis infection, hepatic disorders, and autoimmune diseases. Additionally, PN is frequently accompanied by psychiatric comorbidities such as depression, anxiety, and obsessive-compulsive disorder, further complicating management. Sleep disturbances and neurologic comorbidities, including neuropathic pain and central sensitization, are also common in PN patients. Diagnosis should include a comprehensive review of systems to assess for comorbidities and evaluate disease severity, guiding personalized treatment approaches. Management strategies aim to reduce itch severity and improve quality of life, often involving immunosuppressants, neuromodulators, or emerging biologics such as dupilumab.