Prurigo nodularis and acquired perforating dermatosis in chronic kidney disease: Are they the same entity?

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