Prurigo Nodularis HIV — SCE Infectious Diseases MCQ

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ModerateHIV MedicinePrurigo Nodularis HIVSCE Infectious Diseases

A 40-year-old man with HIV on ART (CD4 550, VL <50) develops chronic prurigo nodularis — multiple hyperpigmented pruritic nodules on his extremities. All infectious causes are excluded. What is this condition?

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Correct answer: B — Prurigo nodularis is a chronic itch-scratch cycle condition that is more common and severe in HIV; treatment includes potent topical corticosteroids, Gabapentin/Pregabalin for itch control, and UVB phototherapy

Prurigo nodularis (PN) is significantly more prevalent in PLWH than the general population. It results from chronic scratching creating a self-perpetuating itch-scratch cycle with nodule formation. After excluding infectious causes (scabies, fungal infection, Strongyloides, atopic dermatitis), management includes: (1) potent topical corticosteroids (Betamethasone valerate 0.1%) under occlusion, (2) neuromodulators for itch (Gabapentin, Pregabalin, Amitriptyline), (3) UVB phototherapy, (4) Dupilumab or Nemolizumab (anti-IL-31) for refractory cases. The condition may persist despite effective ART.

Reference: BHIVA 2022 – Dermatology; BAD 2023 – Prurigo nodularis; NICE 2024