Prurigo nodularis (in atopic dermatitis)
- produced by chronic, repetitive scratching or picking of the skin that leads to hypertrophy and increased density of substance P-positive nerves within affected skin, leading to perpetuation of the itch-scratch cycle
- classically sparing of the mid upper back ("butterfly sign") - often an underlying etiology can be found (xerosis, atopy, stasis, OCD, systemic disease)
- pramoxine and menthol
- high potency topical steroids under occlusion or ILK
- NBUVB
- hydroxyzine, doxepin (10mg qHS), SSRIs
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