Abstract

*Dr. M. Anusha, M. Neha Sai, Mounika Nenavath

ABSTRACT

Prurigo nodularis (PN), or chronic prurigo, is a distinct disease characterized by the presence of chronic pruritus and multiple localized or generalized pruriginous lesions resulting from persistent scratching. We report a case of a 22-year-old female presented to the female dermatology ward with chief complaints of generalized itching persisting from one year and half years, with relative sporing of the trunk and face, and itchy lesions over the bilateral limbs and trunk for one year. On examination, multiple hyperpigmented papules and nodules with excoriations over the bilateral limbs and trunk, a few erosions, crusting, oozing, and tenderness were also present. Skin biopsy showed hyperkeratosis, parakeratosis, acanthosis, focal spongiosis and hypergranulosis, elongated and blunt rete ridges. Also seen perivascular and periadnexal inflammatory infiltrate composed of lymphocytes and plasma cells and fibrocollagenous thickening suggestive of PN. Serum vitamin D was low (18.2nmol/l). The patient was managed with antihistamines, topical corticosteroids, vitamin D supplementation and methotrexate. Significant improvement was noted. This case highlights the importance of recognizing nutritional factors like vitamin D deficiency and the role of immunomodulators in resistant prurigo nodularis.