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Prurigo: what is it?
What is prurigo?
Prurigo is defined by the presence of red or even purplish pimples, sometimes vesicular, quite firm and creating intense itching.
Acute, subacute, and chronic prurigos are classically distinguished by their sudden onset and duration.
Acute prurigo
The basic lesion is a red swelling of the skin a few millimeters in size, often vesicular in the center and oozing, very itchy. Pimples can even become bullous. Then, by dint of scratching, the lesions become crusty and become superinfected, taking on the appearance of honey crusts (“like crystallized honey”) or even pustular. They are therefore often associated with scratching streaks, crusts and skin excoriations at their top.
The prurigo strophulus
It is the most common form, occurring especially in children from 2 to 7 years old, often atopic. It is linked to a hypersensitivity to insect bites and arthropods from the environment (house dust mites such as Dermatophagoides pteronyssinus, mites or even fleas from cats and dogs, chiggers in summer). The lesions sit on the legs and the points of friction.
The doctor prescribes antihistamines and local corticosteroids
When there are domestic animals, they must be shown to the veterinarian.
Other acute prurigos
The other acute forms may be due to skin drug allergies, forms of lymphoma, HIV infection, etc.
The prurigo subaigu
The lesions are swollen and vesicular, small in size and very quickly excoriated, so that we see mainly scabs and sores, predominantly on areas easily accessible by scratching the upper back, face, scalp, neck, lower back and buttocks, most commonly in women in their fifties. A particular psychological context is often discussed, since patients seem to have a tendency to “manage their stress badly” but subacute prurigo is not considered only as a psychodermatosis.
The treatment is symptomatic, again associating antihistamines and topical corticosteroids, and sometimes healing dressings, in particular to limit scratching and promote healing.
Chronic lumpy prurigo
It is a form similar to the subacute form but tending to become chronic over years.
The lesions therefore take on a nodular and thickened (we say lichenified) and / or excoriated appearance, measuring 1 to 3 cm in diameter and are particularly common on the posterior surfaces of the forearms, arms, upper back and legs. . The lesions leave pigmented and depigmented scars.
If the treatment identical to subacute prurigo is ineffective, the doctor can prescribe molecules such as thalidomide, ciclosporin, etc.
Our doctor’s opinion
Prurigo is encountered quite frequently in consultation. If the acute form has a well-known cause, the doctor often looks for a cause for subacute and chronic prurigos, by means of blood tests, x-rays, etc., looking in particular for infections (toxocariasis, HIV, hepatitis, strongyloidosis, etc.) allowing him to treat an underlying disease. Dr. Ludovic Rousseau, dermatologist |
Landmarks
Dermatonet.com, information site on skin, hair and beauty by a dermatologist
www.dermatonet.com
https://www.dermnetnz.org/topics/prurigo
Redaction: Dr. Ludovic Rousseau, dermatologist April 2017 |