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Prurigo nodularis in a peritoneal dialysis patient

2013; Elsevier BV; Volume: 85; Issue: 1 Linguagem: Inglês

10.1038/ki.2013.228

1523-1755

Eun Hui Bae, Bo Mi Park, Yong Un Kang, Joon Seok Choi, Chang Seong Kim, Seong Kwon, Soo Wan Kim,

Skin and Cellular Biology Research

A 43-year-old man presented to our hospital with generalized skin papulonodular and pruriginous eruptions. Clinical examination revealed grouped and scattered pruritic papules and nodules on his legs, arms, and trunk (Figure 1). The patient had type 2 diabetes mellitus and hypertension, with no history of allergy or dermatitis. The papules first appeared on the lower legs when the patient began treatment with peritoneal dialysis, 2 years earlier. The papules gradually disseminated to the legs, arms, back, and chest. We performed a skin biopsy, and the biopsy findings indicated pseudo-epitheliomatous acanthosis, hyperkeratosis, and vascular hyperplasia of the upper dermis with mild inflammatory perivascular infiltration—symptoms that are characteristic of prurigo nodularis (Supplementary Figure S1 online). Prurigo nodularis is an unusual disorder of unknown etiology that could result from the accumulation of an unidentified pruritogenic, poorly dialyzable uremic substance in hemodialysis patients.1.Morton C.A. Henderson I.S. Jones M.C. et al.Acquired perforating dermatosis in a British dialysis population.Br J Dermatol. 1996; 135: 671-677Crossref PubMed Scopus (114) Google Scholar No data are available on this condition in peritoneal dialysis patients. Therefore, nephrologists should consider prurigo nodularis when this skin lesion is observed. It is notoriously resistant to therapy,2.Accioly-Filho J.W. Nogueira A. Ramos-e-Silva M. Prurigo nodularis of Hyde: an update.J Eur Acad. 2000; 14: 75-82Crossref PubMed Scopus (49) Google Scholar and is characterized by extremely pruritic nodules with well-defined clinical symptoms and histopathological findings. The patient was treated with a gradually tapered 16-mg dose of oral methylprednisolone, oral antibiotics, oral antihistamines, and cryotherapy. This treatment led to a temporary amelioration in the clinical symptoms, which later recurred. The patient has been on the wait list for a kidney transplantation, which is known to be the most effective treatment for uremic pruritus–associated prurigo nodularis. Download .jpg (.37 MB) Help with files Supplementary Figure Figure S1. Skin biopsy findings. Supplementary material is linked to the online version of the paper at http://www.nature.com/ki Download .doc (.05 MB) Help with doc files Supplementary Figure Legent