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      Diagnostic Workup and Evaluation of Patients with Prurigo Nodularis

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          Abstract

          Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized oftentimes by symmetrically distributed, severely pruritic nodules. Currently, the pathophysiology of PN remains to be fully elucidated, but emerging evidence suggests that neuroimmune alterations play principal roles in the pathogenesis of PN. There are several associated etiologic factors thought to be associated with PN, including dermatoses, systemic, infectious, psychiatric, and neurologic conditions. We conducted a systematic literature review to evaluate the clinical presentation, diagnosis, and etiologic factors of PN. In this review, we discuss common differential diagnoses of PN and recommend an evidence-based, standardized diagnostic evaluation for those with suspected PN.

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          International experiences with the Hospital Anxiety and Depression Scale-A review of validation data and clinical results

          Christoph Siegfried Herrmann (1997)
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            Clinical classification of itch: a position paper of the International Forum for the Study of Itch.

            T Luger, Ulf Darsow, Uwe Gieler … (2006)
            Chronic itch is a common and distressing symptom that arises from a variety of skin conditions and systemic diseases. Despite this, there is no clinically based classification of pruritic diseases to assist in the diagnosis and cost-effective medical care of patients with pruritus. The proposed classification focuses on clinical signs and distinguishes between diseases with and without primary or secondary skin lesions. Three groups of conditions are proposed: pruritus on diseased (inflamed) skin (group I), pruritus on non-diseased (non-inflamed) skin (group II), and pruritus presenting with severe chronic secondary scratch lesions, such as prurigo nodularis (group III). The next part classifies the underlying diseases according to different categories: dermatological diseases, systemic diseases including diseases of pregnancy and drug-induced pruritus, neurological and psychiatric diseases. In some patients more than one cause may account for pruritus (category "mixed") while in others no underlying disease can be identified (category "others"). This is the first version of a clinical classification worked out by the members of the International Forum for the Study of Itch. It is intended to serve as a diagnostic route for better evaluation of patients with chronic pruritus and aims to improve patients' care.
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              Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus.

              Ngoc Quan Phan, Christine Blome, Fleur Fritz … (2012)
              The most commonly used tool for self-report of pruritus intensity is the visual analogue scale (VAS). Similar tools are the numerical rating scale (NRS) and verbal rating scale (VRS). In the present study, initiated by the International Forum for the Study of Itch assessing reliability of these tools, 471 randomly selected patients with chronic itch (200 males, 271 females, mean age 58.44 years) recorded their pruritus intensity on VAS (100-mm line), NRS (0-10) and VRS (four-point) scales. Re-test reliability was analysed in a subgroup of 250 patients after one hour. Statistical analysis showed a high reliability and concurrent validity (r>0.8; p<0.01) for all tools. Mean values of all scales showed a high correlation. In conclusion, high reliability and concurrent validity was found for VAS, NRS and VRS. On re-test, higher correlation and less missing values were observed. A training session before starting a clinical trial is recommended.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicines (Basel)
                Journal ID (iso-abbrev): Medicines (Basel)
                Journal ID (publisher-id): medicines
                Title: Medicines
                Publisher: MDPI
                ISSN (Electronic): 2305-6320
                Publication date (Electronic): 26 September 2019
                Publication date Collection: December 2019
                Volume: 6
                Issue: 4
                Electronic Location Identifier: 97
                Affiliations
                [1 ]Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; rkhanna8@ 123456jhmi.edu (R.K.); Kwill184@ 123456health.fau.edu (K.A.W.); skwatra1@ 123456jhmi.edu (S.G.K.)
                [2 ]Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA; kwatr001@ 123456mc.duke.edu
                Author notes
                [* ]Correspondence: ckwon18@ 123456jhmi.edu ; Tel.: +1-281-777-4172
                Author information
                https://orcid.org/0000-0003-3059-7277
                https://orcid.org/0000-0002-7542-1016
                https://orcid.org/0000-0003-3736-1515
                Article
                Publisher ID: medicines-06-00097
                DOI: 10.3390/medicines6040097
                PMC ID: 6963711
                PubMed ID: 31561504
                SO-VID: 80fc32f2-6714-453f-864e-f15e0fb10bb3
                Copyright © © 2019 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 01 August 2019
                Date accepted : 23 September 2019
                Categories
                Subject: Communication

                Keywords: medical dermatology,prurigo nodularis,systematic review,itch,pruritus
                Data availability:
                Keywords: medical dermatology, prurigo nodularis, systematic review, itch, pruritus

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