SUCCESSFUL MULTIMODAL THERAPY IN REFRACTORY PRURIGO NODULARIS: A CASE REPORT FROM A TROPICAL SETTING

Abstract

Prurigo nodularis is a chronic skin condition characterized by numerous papules, plaques, and nodules, primarily found on the extensor surfaces of the limbs. It is one of the most intensely pruritic dermatological conditions and can significantly impact quality of life. The environmental factors such as heat, humidity, and exposure to insect bites or parasitic infestations can exacerbate or trigger the condition. Various treatments have been proposed for prurigo nodularis, including topical or intralesional corticosteroid and gabapentin. We present a case of a 71-year-old woman who has experienced this condition for two years. She had previously undergone various treatments, including antihistamines and topical and oral corticosteroids. Upon examination, she exhibited multiple erythematous papulonodular lesions with varying degrees of excoriation. The dermatology life quality index (DLQI) questionnaire indicated a score of 12, reflecting a very large effect on her quality of life. The visual analogue scale (VAS) for pruritus was 9 out of 10. Histopathological examination confirmed the diagnosis of prurigo nodularis. The patient was treated with clobetasol propionate 0.05%, gabapentin at a dose of 300 mg daily, and also intralesional triamcinolone acetonide 2.5 mg/ml was administered every 4 weeks, along with antihistamine and moisturizer. After two months, there was a marked reduction in pruritus reflected by reduction of VAS for pruritus to 3/10, flattening of the nodules, and an improvement in the DLQI score to 3. Intralesional corticosteroid along with gabapentin showed good effectiveness for PN. Its anti-inflammatory and immunomodulator properties effectively reduce inflammation and mitigate pruritus, making it a valuable option for managing this condition.