How Are Prurigo Nodularis and Lupus Related? | MyPrurigoTeam

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How Are Prurigo Nodularis and Lupus Related?

Medically reviewed by Kevin Berman, M.D., Ph.D.
Posted on February 7, 2023

Lupus is a lifelong autoimmune condition that affects roughly 1.5 million people in the United States, according to the Lupus Foundation of America. Prurigo nodularis (PN) is a skin disease that is diagnosed in over 87,000 people in the U.S. every year. Although much remains unknown about the relationship between these two conditions, research suggests that people living with PN may be twice as likely to have lupus.

If you’re living with PN, it’s important to understand how other health conditions such as lupus may affect your symptoms. It’s also helpful to understand how to get the right diagnosis and treatment for any underlying health issues — especially other skin conditions — to improve your overall quality of life.

What Is Lupus?

Lupus, also known as systemic lupus erythematosus (SLE), is a chronic autoimmune disease that can cause damage to the skin, kidneys, and other parts of the body. Autoimmune diseases develop when a person’s immune system mistakenly attacks their own cells, tissues, or organs. Different types of lupus can affect the body in different ways.

Symptoms of Lupus

Cutaneous lupus erythematosus (CLE) primarily affects the skin. CLE can cause red, scaly lesions and other symptoms such as:

  • Rashes
  • Ulcers
  • Hair loss
  • Swollen blood vessels
  • Sensitivity to sunlight

Systemic lupus erythematosus is the most common type of lupus. Unlike CLE, it can affect any part of the body. Symptoms of SLE can include:

  • Fatigue
  • Rashes
  • Fever
  • Mouth ulcers
  • Joint pain and swelling
  • Sensitivity to sunlight
  • Seizures
  • Mental changes like psychosis
  • Lung, heart, and kidney problems

In some people, certain medications can cause drug-induced lupus, which is an acute type of the condition — it’s not chronic (long-lasting). And infants can develop a rare type called neonatal lupus, which develops from lupus antibodies (immune proteins) in the mother.

How Is Lupus Diagnosed?

It can be difficult to diagnose lupus because it shares many symptoms with other conditions — and because there’s no single test to diagnose the condition.

If your doctor suspects that you have lupus, the path to a diagnosis starts with a thorough medical review and physical examination. Your doctor will go over your symptoms and check for any family history of the disease. During a physical examination, your doctor will check for symptoms that might be associated with lupus, like rashes, sensitivity to sunlight, joint pain, and ulcers.

Blood and urine tests can check for certain antibodies, like antinuclear antibodies, that are commonly associated with lupus. A skin or kidney biopsy (removal of tissue for testing in a lab) can help your doctor check for signs of inflammation, which can also point to a potential autoimmune condition.

Living With Both Lupus and Prurigo Nodularis

Researchers are still investigating the potential connection between PN and lupus, but we do know that many conditions can be comorbid (occur together). For example, some people living with PN may develop lupus, and some people living with lupus may develop PN, but it does not appear that one causes the other

If you’ve been diagnosed with both PN and lupus, here are a few questions you might have about managing both of these conditions.

Can Prurigo Nodularis Be a Sign of Lupus or Another Condition?

According to the American Academy of Dermatology Association (AAD), having certain health conditions that cause itchy skin may make a person more likely to develop PN. For example, atopic and contact dermatitis, lymphoma, and end-stage renal (kidney) disease have all been associated with an increased risk of PN.

However, there isn’t much research on whether PN can be a sign of lupus — and just because you’ve been diagnosed with PN, that doesn’t necessarily mean that you also have an underlying condition like lupus. If you’re worried about any new or developing symptoms, reach out to your doctor with your concerns, and they can discuss whether testing may be appropriate.

Can Lupus Flares Worsen Prurigo Nodularis Symptoms?

Although there is very little research on the impact of lupus symptoms on PN specifically, lupus can affect symptoms like itching and cause specific rashes.

In a 2021 review on the topic, researchers found that people living with lupus often experience mild to moderate itching. In earlier findings published in the Journal of Drugs in Dermatology, itching appeared to be closely associated with lupus flare-ups, as well as sun exposure.

Can Prurigo Nodularis Indicate Worsening Lupus or Other Conditions?

Researchers still aren’t entirely sure of what causes PN to develop, so it’s difficult to say why PN might develop in some people with lupus but not in others.

But if you are living with lupus and have noticed new symptoms — like itching or nodular sores on your skin — it’s important to let your doctor know. They can run more tests and help determine if these symptoms mean that your lupus is getting worse or that another condition, such as renal disease, is developing.

Prurigo Nodularis and Lupus Risk Factors

PN and lupus are separate diseases with different risk factors, causes, and symptoms. However, some research suggests a possible connection between the two — both are inflammatory conditions related to an immune system that is not acting properly.

Does Having Lupus Raise the Risk of Prurigo Nodularis?

Despite the lack of research exploring the relationship between lupus and PN, some findings do suggest that itching — a major symptom of PN — is extremely common among people living with lupus.

One study from 2018 explored the prevalence of itching in more than 550 people living with CLE. According to the study results, 75 percent of participants reported that they experienced itching, including 15 percent who described it as severe.

Does Prurigo Nodularis Make Lupus More Likely To Develop?

Research exploring PN as a risk factor of lupus is sparse, but one study found a higher association of autoimmune diseases in people living with PN.

In a large 2022 study, researchers found that PN was associated with an increased likelihood of having various autoimmune diseases — including twice the risk of developing SLE.

Do Lupus and Prurigo Nodularis Share Risk Factors?

Although there does seem to be some connection between lupus and PN, these conditions have few overlapping risk factors.

According to Mayo Clinic, lupus is more likely to affect women and people between ages 15 and 45, as well as African American, Hispanic, and Asian American people. However, the AAD says that PN is more common in older adults (above age 50) and those living with certain chronic health conditions.

One of the only common risk factors between lupus and PN is being Black — the increased risk of PN is especially high for Black people living with atopic dermatitis, according to the AAD.

Treating Lupus and PN

Treatment for PN involves helping people manage their symptoms, which primarily includes allowing the skin to heal by reducing the itching and preventing further scratching. People living with PN who have other underlying conditions may also experience symptom relief by treating those other conditions, too.

Some of the treatment options available for PN include:

  • Anti-itch medications, including moisturizers and other over-the-counter creams
  • Anti-inflammatory medications, including topical or systemic (injected) corticosteroids
  • Phototherapy, a type of light therapy that uses ultraviolet light to help reduce skin inflammation
  • Cryosurgery, a technique that can burn off nodules that develop as a result of the condition
  • Dupilumab (Dupixent), a medication the U.S. Food and Drug Administration (FDA) recently approved for PN

Other medications, such as thalidomide (Thalomid), gabapentin (sold as Gralise, Horizant, and Neuraptine), or even certain antidepressants, may be used as part of a long-term treatment plan to help manage the daily symptoms of PN.

Treatment Options for Lupus

Lupus can affect each person differently, and a combination of multiple treatment options may be needed to help manage symptoms and prevent organ damage. Common medications used to treat lupus include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen sodium (Aleve), to help manage pain and inflammation
  • Corticosteroids like prednisone and methylprednisolone (Medrol) to reduce immune system activity and inflammation
  • Antimalarial drugs like hydroxychloroquine (Plaquenil), which help regulate the immune system and reduce the likelihood of flare-ups
  • Immunosuppressants like azathioprine (Imuran and Azasan) and methotrexate (Otrexup, Rasuvo, Rheumatrix, Trexall and Xatmep), which work directly on the immune system to reduce autoimmune attacks

Biologic medications, like belimumab (Benlysta) and rituximab (Rituxan and the biosimilar Truxima), can be used in more severe cases of lupus to modify the immune system and prevent damage to tissues.

When To Talk to Your Doctor

If you’re concerned that you or a loved one may have lupus in addition to PN, reach out to your doctor to discuss getting a proper diagnosis.

If you’ve been diagnosed with both PN and lupus, it’s important to work closely with your doctors, dermatologists, and other care team members to manage both conditions. Sometimes medications, supplements, or other treatment options that can interact and cause new or worsening side effects. Make sure everyone on your care team knows the full story of your health.

With the right treatment, you can learn to manage the symptoms of both PN and lupus and improve your overall quality of life.

Meet Others Who Understand

MyPrurigoTeam is the social network for people with prurigo nodularis and their loved ones. On MyPrurigoTeam, members come together to ask questions, give advice, and share their stories with others who understand life with prurigo nodularis.

Are you living with PN and symptoms — or a diagnosis — of lupus? Do you have more questions about how these conditions might be related? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on February 7, 2023
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    Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Eleesha Lockett, M.S. is a nutrition professional and freelance writer who specializes in crafting empathetic, inclusive, and accurate health and wellness content. Learn more about her here.

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