๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
PRURIGO NODULARIS (PN)
PRURIGO NODULARIS (PN)ย ย ICD-10: L28.1
โข Often associated with AD but can occur without AD.
โข PN patients with AD are younger and have reactivity to environmental allergens; nonatopic PN patients are older and lack hypersensitivities to environmental allergens.
โข PN usually occurs in younger or middle-aged females, who often exhibit signs of neurotic stigmatization.
โข PN starts with piercing pruritus that leads to picking and scratching.
โข Dome-shaped nodulesโseveral millimeters to 2 cmโdevelop on sites in which persistent itching and scratching occur (Fig. 2-19). Nodules are often eroded, excoriated, and sometimes even ulcerated as patients dig into them with their nails.
โข Usually multiple on the extremities.
โข Lesions persist for months after the trauma has been discontinued.
โข Treatment: intralesional triamcinolone, occlusive dressings with high-potency glucocorticoids. In severe cases, methotrexate, cyclosporine, or thalidomide. Watch out for contraindications. Neuromodulators, such as gabapentin, can be helpful.
FIGURE 2-19 โข Prurigo nodularisโMultiple, firm, excoriated nodules arising at sites of chronically picked or excoriated skin. Often occurring in patients with atopy but also without it. In this 56-year-old patient, the extreme pruritus necessitated multiple hospitalizations.