Prurigo simplex subacuta

Last Updated: 2019-08-27

Author(s): Anzengruber F., Navarini A.

ICD11: -

Hebra (1854)

Strophulus adultorum, Lichen urticatus.

Polyätiological disease characterized by a strong, punctiform itching. 

  • Women > Men
  • Women: Peak age 20 to 30 years.
  • Men: Peaks age > 60 years

  • Polyätiological events.
    • Triggering 
      • Disturbances of the
        • Hormonal balance
        • GI tract
        • Liver function
        • Kidney function (dialysis patients)
      • Focal infections
      • Allergic diathesis
      • Nerve root irritations 

  • Primary afflorescence: "Seropapel", a urticarial nodule > 5 mm, partly with a felt central vesicle and reddening of the surrounding tissue. In fact, the disease begins without a specific primary efflorescence.

  • At first, the patient reports an extremely strong, piercing, punctiform itching, the seropapula is scratched. As soon as blood is visible, the pruritus stops. In the case of dermatological presentation, often only the residual excoriation or a crust is visible. 

  • Medical history
  • Clinical picture
  • Scratching behavior: localized itching (no extensive scratching)
  • Lab 
  • Blood count, ESR, Blood sugar level daily profile, kidney and liver values, uric acid
  • focus search
  • Biopsy with DIF
  • Anti-BP180/230 are used to exclude a prebullous bullous pemphigoid 

Arm extension sides, upper back, thighs and chest region. Skin changes in the face rarely occur. 

Feeling of relief as soon as the "felt" bubble is scratched. 

Often over years. 

Topical Therapy

  • Dermocorticoids: Class III (highly effective): mometasone furoate (mometasone 17 furoas (e.g. Elocom® cream / ointment / solution) or Class IV (very highly effective) clobetasol (clobetasoli 17 propionas) (Dermovate®) cream / ointment
  • Calcineurin inhibitors: Tacrolimus (Protopic® ointment 0.1%) 2x daily for 2 weeks
  • Menthol 2% in cream / Lipolotio base (e.g. Excipial® Lipolotio) Magistral prescription
  • Polidocanol 5% in cream base
  • Steroid injections: Triamcinolone acetonide (mixed with a local anaesthetic 3:1, Kenacort-A® 10/40mg).

Phototherapy: UVB / PUVA therapy / balneo-phototherapy

Baths: Saline baths / oil baths with Polidocanol additive / climate therapy: North Sea / high mountains (Davos) / Dead Sea

Systemic therapy:

  • Prednisolone (Spiricort®) p.o. 60-80 mg 1x daily
  • Methylprednisolone (Medrol®) p.o. 60 mg 1x daily

Antihistamines

  • H1 blocker
  • Levocetirizine (Xyzal®) p.o. 5 mg 1x daily
  • Desloratadine (Aerius®) p.o. 5 mg 1x daily
  • Fexofenadine (Telfast®) p.o. 180 mg 1x daily
  • For pruritus-induced sleep difficulties: Hydroxyzin (Atarax®) 25 mg 1x daily

Atypical neuroleptics

  • Olanzapine (Olanpax®) p.o. Initial: 5 mg 1x daily; course: 10 mg 1x daily 

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