Prurigo Nodularis vs. Eczema: Causes and How They’re Related | MyPrurigoTeam

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Prurigo Nodularis vs. Eczema: Causes and How They’re Related

Medically reviewed by Raj Chovatiya, MD, PhD, MSCI
Posted on August 18, 2023

Eczema is a common inflammatory skin disease that affects 31 million Americans of all ages. Many people with prurigo nodularis (PN) also have eczema, atopic dermatitis, or another allergy-related condition such as asthma, hay fever, or hives. However, others with PN have no history of eczema.

The symptoms, triggers, and treatments for eczema and PN have a lot in common. Here are some of the similarities between these (sometimes related) skin conditions.

Which Comes First, Eczema or Prurigo Nodularis?

Oftentimes, people with prurigo nodularis start out with an itchy skin condition, such as eczema, before developing the raised nodules that are PN’s primary symptom.

PN can be tough to diagnose because it may resemble other skin disorders. Many members of MyPrurigoTeam report having more than one skin condition with overlapping symptoms. “I started with ingrown hairs on my legs. … I had so many scars, but they healed,” explained one member. “Then, the hives started. I already had eczema since I was 4. It took 10 dermatologists to figure out what I was dealing with.”

“I’ve had eczema and dermatitis most of my life,” said another MyPrurigoTeam member. “I live alone, and I have other health issues. I can’t stop picking.”

Skin Symptoms and Triggers

PN and eczema can both run in families, meaning there’s likely some genetic links that help determine who gets these diseases. However, neither condition is contagious, so you can’t get it directly from someone else. In addition, environmental irritants and allergens can trigger flare-ups for both conditions, so people who have them may need to adjust what they eat, what they wear, and which products they use.

Eczema has a clear connection to the immune system, but doctors are still trying to work out exactly what causes PN. Other health conditions associated with PN include:

  • Diabetes
  • End-stage kidney disease
  • Hepatitis C
  • Lymphoma
  • Untreated HIV

Eczema symptoms can appear at any age but commonly start during childhood. PN tends to develop later in life, affecting adults between the ages of 51 and 65. It can take several weeks of scratching and picking at the skin to form the itchy, raised nodules associated with PN. Recognizing skin problems like eczema or other itchy skin conditions early can help reduce the risk of developing severe PN.

The Itch-Scratch Cycle

If PN and eczema have one thing in common, it’s the intense itch. Both conditions make the skin feel itchy, making it hard not to scratch. Unfortunately, scratching damages the skin barrier, promotes inflammation, and worsens other skin symptoms. Scratching can also lead to scars, skin discoloration, and an increased risk of infection.

For people with PN, scratching and picking produce hard nodules or bumps that can take months or years to go away. The bumps are brought on by scratching the skin, and they intensify the itching sensation, causing another round of the itch-scratch cycle. PN nodules usually affect areas that are easy to reach (like the arms, abdomen, and legs). Places that are harder to scratch tend to be spared.

Getting to the root of this itch-scratch cycle is essential to managing eczema and PN. Treatments include topical creams, oral medications, and injections.

Treatment Options

Finding the right combination of topical treatments, systemic medications, and lifestyle changes to soothe eczema or prurigo nodularis may take time.

Localized Treatments

Topical corticosteroids can help reduce itch and inflammation in specific areas of the skin with eczema or PN. You can find these in lower doses over the counter or in prescription strength through your doctor. It’s important to let your health care provider know if you’re using topical steroids because they can cause side effects if they’re continued long term.

For persistent PN nodules, your doctor may inject them with a corticosteroid. Medicated ointments, including topical anesthetics and creams containing capsaicin, camphor, menthol, or phenol, can soothe pain and itching.

In addition, phototherapy may help reduce skin blemishes and symptoms of eczema or PN. Using a specialized phototherapy machine, your health care provider will expose affected parts of the skin to specific light wavelengths to reduce itching and inflammation. Phototherapy may be administered with a handheld device to target certain areas. If your symptoms cover large areas of the body, your provider’s office may offer a full-body machine you can step into.

Systemic Treatments

Medications to reduce the immune response may help eczema and PN. Your doctor may recommend antihistamines to clear up hives and help you sleep.

In severe cases of PN, immunosuppressants (drugs that calm down the immune system) can treat nodules that are resistant to other treatments. The biologic drug dupilumab (Dupixent), approved to treat both atopic dermatitis and PN, is injected under the skin every other week or every four weeks.

There’s speculation that people with PN have more sensitive nerve fibers that contribute to itchiness. Because of this possible nervous system involvement in PN, your doctor may also prescribe medications that affect nerve function, such as gabapentin (Neurontin). These types of drugs aren't commonly used for eczema alone.

Lifestyle Changes

PN and eczema raise the risk for depression or anxiety, and people who experience these conditions may benefit from therapy to reduce stress and promote good mental health.

In addition, there are some general lifestyle tips to manage itchy skin:

  • Keep your fingernails short.
  • Wear gloves to avoid scratching — especially when sleeping.
  • Don’t use harsh cleansers and detergents that trigger skin symptoms.
  • Moisturize with soothing creams and lotions approved by your dermatologist.

It’s a good idea to stick with soap and skin care products that are fragrance-free and designed for sensitive skin. Taking shorter, cooler baths or showers and wearing soft, breathable fabrics is also beneficial.

Members of MyPrurigoTeam share the different ways they adjust their lifestyle for skin relief. One member shared, “Coffee triggers my symptoms because I become hot. Especially on my head when I sweat. I changed to iced coffee and that hasn't bothered me.”

Another said, “For actual relief, I use cold packs from the freezer. Lay on them, wrap them, hold them close.”

Hearing from others managing similar symptoms can help you find helpful tips to improve how you feel. One member said, “Knowing that there’s other people I can discuss it with and let them know what has and hasn't worked for me, it truly is a blessing.”

Lots of Overlap

There’s a lot of potential overlap between eczema and PN. People may notice eczema symptoms first, which could lead to PN after prolonged itching and scratching. However, sometimes people develop PN without ever having another known skin condition. Many times, people with severely itchy and dry skin from eczema never have PN.

Your dermatologist may perform a skin biopsy to figure out the true underlying cause of your skin issues. Ultimately, both conditions require similar management strategies. Aim to alleviate itching and scratching by modifying your skin care routine and avoiding triggers. Topical creams, ointments, and medications can help prevent symptoms and control flare-ups. Finding support to address sleep issues or psychological effects, like anxiety or depression, can also improve your quality of life with eczema and PN.

Talk With 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 PN.

Do you have eczema along with PN? If so, how do you manage your medications and treatments? Share your experiences in a comment below or on your Activities page.

Posted on August 18, 2023
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Raj Chovatiya, MD, PhD, MSCI is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Learn more about him here.
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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