Prurigo Nodularis and Acquired Perforating Dermatosis in Chronic Kidney Disease: Are They the Same Entity?

Prurigo nodularis (PN) has been reported in itchy chronic kidney disease (CKD) patients, in particular, in end-stage renal failure. Acquired perforating dermatitis (APD) associated with CKD and diabetes is a group of disorders where dermal materials are eliminated through the epidermis and is characterized by itchy papules and nodules. We focus on the relationship between PN and APD in CKD and provide data to support that both entities share many of the same clinical and histologic features. These cutaneous diseases often go underreported in this patient population, leading to inadequate treatment and suboptimal patient outcomes. Our review of the literature suggests a relationship between PN/APD and CKD, presumably driven by uremic pruritus, changes in the renin-angiotensin-aldosterone system, a predisposing immune dysregulation with increased IL-31 expression, and opioid system imbalances. A variety of pharmacologic therapies may be efficacious. The use of the new targeted biologics for PN and whether they are also helpful for CKD and APD are welcome..