Uncommon Dermatological Reaction to Spinal Cord Stimulation-Prurigo Nodularis

Spinal cord stimulation (SCS) is a widely used treatment for chronic neuropathic pain, demonstrating effectiveness in managing resistant symptoms in some cases. However, dermatological complications, though rare, can occur.

This case report examines a patient who developed diffuse itching and skin rash with features of prurigo nodularis after undergoing surgical revisions and stimulation adjustments. The rash improved upon deactivating the pulse generator and reappeared upon reactivation, suggesting a direct connection between the neurostimulation therapy and dermatological symptoms.

This raises the possibility that SCS may trigger dermatological reactions rather than allergic ones. The material of the SCS device was not identified as the cause through allergy testing, reinforcing the neurostimulation as a potential trigger.

This case emphasizes the importance of evaluating neurostimulation as a possible cause of itching in patients presenting unexplained rashes after therapy before opting for explantation. Clinicians should consider changing settings or temporarily deactivating the device as part of the diagnostic process when other causes are excluded. Further research is required to understand the underlying mechanisms better.