Knotty scrapie

Nodular pruritis (synonyms: Prurigo Bénier, persistent chronic papular urticaria) is a skin disease characterized by itching, the presence of nodules that usually appear on the hands or feet. For the first time the disease was described by Hyde and Montgomery in 1909, as itching nodules on the extensor surfaces of the lower limbs.

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Epidemiology

Nodular pruritis is a relatively rare disease. The disease can occur at any age, but is most common in middle-aged and older people.

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Causes of the gnarled pruritus

The causes of gnarled prurigo are unknown. Its relationship with Becker's nevus, linear IgA diseases, autoimmune diseases, liver diseases has been established. Systemic itching is associated with cholestasis, thyroid diseases, true polycythemia, uremia, Hodgkin's disease, HIV and other immunodeficiency diseases.

It is often found in persons with impaired endocrine gland function and neuropsychic disorders (recent studies (Kieć-Swierczyńska M, Dudek B, Krecisz B, et al., 2006). "[The role of psychological factors and psychiatric disorders in skin diseases] ) disproved the psychiatric cause of the development of the disease.In the pathogenesis of an important role played by immune disorders.

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Pathogenesis

Hyperkeratosis, pronounced acanthosis with the development of massive epidermal overgrowths are noted in the nodes. In the dermis there is a nonspecific inflammatory infiltrate, consisting of lymphocytes, eosinophils and histicites.

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Symptoms of the gnarled pruritus

The disease begins with the appearance of intense itching of the skin. On the front surface of the lower legs and the extensor surface of the forearm appear knots and knots. They are hemispherical or roundish, very dense, sharply protrude above the level of the skin, are located focally, symmetrically, their sizes reach up to 1 cm in diameter or more. Elements first have a skin color, and then become reddish-brownish. Their surface is smooth, often covered with hemorrhagic crusts. In the future, peeling or hyperkeratotic layers can occur. Sometimes the surface has a warty appearance. Itching is intense, paroxysmal, intensified after the development of rashes, which is explained by hyperplasia of nerve fibers in the affected areas of the skin.

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Differential diagnosis

Differential diagnosis is performed with a warty form of red flat lichen, hypertrophic neurodermatitis, warty tuberculosis, sarcoids, lymphoma, large-scaled chronic papular urticaria.

Treatment of the gnarled pruritus

It is recommended to observe a hypoallergic diet. Considering that nodular pruritis often develops in persons with internal diseases, they correct the revealed pathology. In mild cases, often limited to external means (chipping the elements with 2% solution of novocaine, corticosteroids, diathermocoagulation, irrigation with chloroethyl).

General treatment consists in the appointment of hyposensitizing (30% sodium thiosulfate, 10% calcium chloride or calcium gluconate), antihistamines (tavegil, fenistil, diazolip, pipolfen, etc.), vitamin and other drugs.

In the absence of the effect of conventional therapy and severe flow, selective photo- or PUVA-therapy or glucocorticosteroids is administered internally.

With pronounced itching, fenistil-gel helps as an antihistamine. There are reports of the effectiveness of the use of local glucocorticosteroids in combination with élidele.

The effectiveness of therapy is also enhanced with a combination of fenistil (in the morning - 1 capsule or drops depending on the age) and Tavegil (1 tablet or 2 ml solution in the evening), externally - Fenistil gel and elidea.