Prurigo Nodularis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPrurigo NodularisSCE Dermatology

A 21-year-old man presents with multiple itchy papules and nodules on the extensors of his forearms and shins, present for 3 years. They show a lichenified excoriated surface. He denies any psychiatric history and the itch preceded the lesions. What is the most likely diagnosis?

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Correct answer: A — Prurigo nodularis

Prurigo nodularis presents with intensely pruritic, firm, dome-shaped nodules and papules with excoriated, hyperkeratotic surfaces, typically on the extremities. The itch-scratch cycle drives the disease. It is often associated with underlying conditions (atopic eczema, hepatic/renal disease, HIV, lymphoma) and these should be excluded. Dupilumab is now NICE-approved for prurigo nodularis. Nodular scabies causes persistent post-treatment nodules but the clinical history and distribution differ. Dermatitis artefacta typically presents with bizarre-shaped lesions in accessible sites.

Reference: BAD 2023 Patient Information; NICE TA916 Dupilumab for PN