Clinical, Histopathological, and Direct Immunofluorescence Characteristics of Prurigo-Nodularis-Like Lesions and Pruritus: A Retrospective Study of Patients Admitted to a Tertiary Dermatology Hospital Publisher



S Rezaeemanesh SAJEDEH ; M Fathikazerouni MEHRDAD ; N Tootoonchi NASIM ; Ar Ghannadan Alireza R ; Sm Vahabi Seyed MOHAMMAD ; S Montazeri SAHAR ; H Memari HURIA ; I Etesami IFA
Source: Dermatologic Therapy Published:2025

Abstract

Background: Prurigo nodularis (PN) is a chronic skin condition characterized by intensely itchy nodules. Accurate identification and treatment of PN-like lesions are crucial due to their association with various dermatoses. Direct immunofluorescence (DIF) assays play a significant role in distinguishing PN from similar conditions. Methods: We conducted a retrospective analysis on patients referred to a tertiary dermatology hospital between 2017 and 2022. These patients presented with pruritus and PN-like lesions and underwent skin biopsies. PN diagnosis relied on clinical evidence, laboratory results, and histopathology, ruling out other differentials. Collected data included demographics, clinical manifestations, histology, and final diagnoses. Statistical analysis employed SPSS Version 26, using mean, standard deviation, frequency, and percentage. Significance was set at p < 0.05. Results: Our study included 746 individuals (mean age 45.34 ± 22.05; 423 females and 323 males) with pruritus and PN-like lesions. Clinical evidence and laboratory findings established final diagnoses: PN (51.1%), dermatitis (17.6%), lichen planus (8.4%), perforating disease (7.0%), and bite reaction (3.1%). DIF assays were performed on 177 patients, with 26 (19.2%) yielding positive results. Bullous pemphigoid (50%) and dermatitis herpetiformis (11.5%) were the most common diagnoses. Conclusion: Our study emphasizes the need for comprehensive diagnostic approaches, including DIF, to accurately diagnose PN-related conditions. The high PN confirmation rate validates initial clinical suspicion and expert judgment. Considering the potential confusion with dermatitis and immunobullous disorders, targeted health policies and resource allocation are essential for improved diagnostic capabilities and treatment outcomes in patients with PN-like lesions. © 2025 Elsevier B.V., All rights reserved.