Bay Biosciences provides high quality, clinical grade, fresh frozen biopsy bio-specimens, cryogenically preserved sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluid samples from patients diagnosed with Prurigo nodularis (PN) disease.
The sera (serum), plasma and PBMC biofluid specimens are processed from patient’s peripheral whole-blood using customized collection and processing protocols. The Prurigo nodularis (PN) biofluid samples are collected from unique patients diagnosed with Prurigo nodularis and are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Detailed clinical data, Prurigo nodularis patients history, symptoms, complete blood count (CBC), biopsy tissue, elevated biomarker levels, genetic and metabolic information, histopathological findings, annotations associated with Prurigo nodularis specimens is provided to a valued customer for research, development and drug discovery.
The Prurigo nodularis sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluid are processed from patients peripheral whole-blood using customized collection and processing protocols.
Prurigo Nodularis (PN) Overview
Prurigo nodularis (PN) also known as nodular prurigo is a chronic inflammatory skin disease characterized by symmetrically distributed, severely pruritic nodules, very itchy firm lumps. It is the most severe form of prurigo. Prurigo nodularis (PN) is a skin disease that causes hard, itchy lumps (nodules) to form on the skin. The itching ( pruritus) can be intense, causing patients to scratch themselves to the point of bleeding or pain. Scratching can cause more skin lesions to appear Prurigo nodularis (PN) is an intensely itchy skin rash. PN bumps on the skin can range in size from very small to about half inch in diameter. The number of nodules can vary from 2 to 200. Nodular prurigo, It is not known why these lumps appear. and it is very difficult to treat effectively.
The itching is worsened by heat, sweating, or irritation from clothing. In some cases, people with PN have a history of other diseases including eczema (atopic dermatitis), lymphoma, HIV infection, severe anemia or kidney disease. The exact cause of Prurigo nodularis (PN) is unknown. Although scratching is known to cause more nodules to appear, it is unclear what causes the itching to develop in the first place. Diagnosis of the disease is based on observing signs such as extremely itchy skin with the formation of nodules. In some cases, a skin biopsy is used to confirm the diagnosis. Treatment may include corticosteroid creams, oral medications, cryotherapy, or photochemotherapy.
Signs and Symptoms of Prurigo Nodularis (PN)
The main symptom of prurigo nodularis (PN) is the formation of hard, very itchy lumps (nodules) on the skin. The nodules can range in size from very small to about half an inch in diameter. The nodules often have a rough, dry top and can range in number from a few to hundreds. Nodules most commonly form on the outer arms, shoulders, and legs. Nodules can also form on the neck and trunk, and they rarely form on the face and palms. They may be lighter or darker in color than the surrounding skin. Scarring may occur after nodules begin to heal.
Prurigo nodularis (PN) can start as a small, red itchy bump. It occurs as a result of scratching the skin. The bumps usually start on your arms or legs but can also appear on the rest of the body, wherever you scratch.
The nodules can be intensely itchy. The bumps may be:
- Hard
- Crusty and scaly
- Range in color from flesh tones to pink, brown, or black
- Scabby
- Wart looking
The skin between bumps can be dry. Some people with PN also experience burning, stinging, and temperature variations in the bumps, according to a 2019 review. The bumps can develop secondary infections from frequent scratching. The intense itching can be debilitating, preventing restful sleep and disrupting your daily routine. This in turn can make people with PN feel distressed and depressed. The bumps may resolve if the person stops scratching them. They may leave scars in some instances.
Causes of Prurigo Nodularis (PN)
The exact cause of prurigo nodularis (PN) is not well-understood. It is thought that nodules are more likely to form when skin has been scratched or irritated in some way. Therefore, the act of a person scratching skin can cause the nodules to form. However, the cause of the skin to originally become intensely itchy is unclear. Many people with PN have a history of eczema (atopic dermatitis), other skin conditions, or allergies.
When people with PN have a skin biopsy, it can be seen that the nerves in the skin are thickened. It is thought that these thickened nerves may send stronger signals to the brain that the skin is itchy. This can cause a person to scratch the skin, which causes more nodules to form and the nerves to become even more thickened. This cycle, called the itch-scratch cycle, is thought to cause an increase in the number of nodules associated with PN. However, exactly why the skin becomes itchy in the first place is unclear and may vary from person to person.
Diagnosis of Prurigo Nodularis (PN)
Prurigo nodularis may be suspected when a person has signs and symptoms of the disease including intensely itchy skin and the development of nodules on the skin. In some cases, a doctor may wish to perform a skin biopsy to look for signs of the disease such as thickened nerves in the skin. After the diagnosis has been confirmed, other tests such as a blood test and tests of liver and kidney function may be recommended to rule out underlying causes of the disease.
Treatment of Prurigo Nodularis (PN)
Prurigo nodularis (PN) can be challenging to treat because people with the PN disease may respond to treatments differently. Due to the intensity of the itch, people with PN may try several different treatments without receiving much relief. In some patients, there’s no identifiable cause for the itching. For these people, there’s no single effective treatment. Some patients may try all current treatments available without receiving complete relief. For most patients, a combination of series of different therapies may be tried to achieve the right treatment to be effective. Currently, the U.S. Food and Drug Administration (FDA) has not approved any therapies to treat PN. However, there are many drugs under investigation that could possibly be used off-label to treat the condition.
Topical Drugs for Prurigo Nodularis (PN)
Some over the counter (OTC) or prescription topical medicines to relieve itching and to cool the skin may be prescribed.
Following are the common treatments used to treat Prurigo nodularis (PN) disease:
- Topical steroid creams such as Clobetasol or calcineurin inhibitors such as such as Pimecrolimus. (These may be covered to help them work more effectively.)
- Topical coal tar
- Topical vitamin D-3 ointment (Calcipotriol)
- Capsaicin cream
- Menthol
Injections for Prurigo Nodularis (PN)
Corticosteroid (Kenalog) injections for some nodules may be used to manage the disease.
Systemic Medications for Prurigo Nodularis (PN)
Overt the counter antihistamines may be suggested to help prurigo nodularis (PN) patients sleep at night. Some medications that are typically used as antidepressants may be prescribed by the doctors to help you stop scratching. Paroxetine and amitriptyline have had success in helping PN nodules to improve.
Other Therapies for Prurigo Nodularis (PN)
Therapies that may help shrink the nodules and relieve itching include:
- Cryotherapy: Cryotherapy is the use of ultra-cold temperatures on the lesion.
- Phototherapy: Phototherapy uses ultraviolet light (UV) for treatment.
- Psoralen used in combination with UV: Psoralen and UVA used together is known as PUVA.
- Pulsed dye laser: Pulsed dye laser is a treatment method used to kill diseased cells.
- Excimer laser treatment: An excimer laser at 308 nanometers has successfully treated PN that didn’t respond to other treatments.
Newer Available Treatments for Prurigo Nodularis (PN)
Some trials involving using recent drugs have shown promise in reducing itching.
- Naloxone intravenous and naltrexone oral mu-opioid receptor antagonists, which may have initial side effects
- Immunosuppressants, which include cyclosporine and methotrexate
- Gabapentinoids, which are used for people who don’t respond to other treatments or who have painful neuropathies
- Thalidomide, which has been shown to be effective, but is considered as a last resort because of possible side effects
- Nalbuphine and Nemolizumab, which are now undergoing testing
- Isoquercetin which is a derivative of plant quercetin
- Dupilumab which is an injectable treatment
If the above treatments for prurigo nodularis (PN) disease are not effective, other procedures may be used. These include cryotherapy, which uses very cold temperatures to try to reduce the size of the nodules, or laser therapy. Some people have used photochemotherapy, which combines the use of a medication that increases the skin’s sensitivity to ultraviolet (UV) rays with special light therapy. In some cases, immunosuppressants have been used to treat PN. If the lesions become infected, antibiotics or antibiotic ointment may be prescribed.
All treatments are typically used in combination with habit reversal therapy, which aims to reduce the frequency of scratching the skin. This can be helpful in slowing down or stopping the cycle of itching and scratching that is associated with PN. Some people wear gloves while they sleep to reduce scratching.
Although treatment options can help relieve itching and reduce the number of nodules, most people with prurigo nodularis (PN) do not have a complete resolution of the nodules even with treatment. The itching associated with the disease can be very intense, and it may affect the person’s ability to sleep at night or to enjoy everyday activities. This can result in increased stress and depression. It is important to speak with your doctor if you are having signs or symptoms of depression.
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