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Prurigo nodularis as a sweat gland/duct-related disorder: resolution associated with restoration of sweating disturbance

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Abstract

Little attention has been given to the involvement of sweat glands/ducts in the pathogenesis of prurigo nodularis (PN). According to recent studies, PN is likely to develop under conditions characterized by dry skin, such as atopic dermatitis (AD), suggesting a strong impact of skin dryness on PN development. No therapeutic modalities produced complete resolution of PN without exacerbations. We previously reported that increases in skin dryness by sweating disturbance could initiate the development of AD. We investigated whether sweating responses were impaired in refractory PN lesions; and, if so, we asked whether the PN lesions could resolve by restoring sweating disturbance. Using the impression mold technique, which allows an accurate quantification of individual sweat gland/duct activity, we examined basal sweating under quiescent conditions and inducible sweating responses to thermal stimulus in PN lesions and normal-appearing skin in the same patients before and after treatment with a moisturizer or topical corticosteroids. Sweating disturbance, either basal or inducible, was most profoundly detected in the “hub” structure corresponding to the center of PN papule before the treatment. This sweating disturbance was immunohistochemically associated with the leakage of sweat into the dermis. This disturbance was restored by treatment with a moisturizer. Our limitations include a relatively small patient cohort and lack of blinding. Sweating disturbance could be one of the aggravating factors of PN development. Refractory PN with low skin hydration may resolve by restoring sweating disturbance.

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Abbreviations

AD:

Atopic dermatitis

DCD:

Dermcidin

HC:

Healthy controls

IMT:

Impression mold technique

LA:

Lichen amyloidosis

LP:

Lichen planus

PN:

Prurigo nodularis

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Funding

This work was supported by a grant from the Ministry of Education, Culture, Sports, Science and Technology (17K10220).

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Authors and Affiliations

  1. Department of Dermatology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan

    Chieko Katayama, Yuki Hayashida, Seiko Sugiyama & Yumi Aoyama

  2. Department of Dermatology, Kawasaki General Medical Center, Kawasaki Medical School, Okayama, Okayama, Japan

    Seiko Sugiyama

  3. Department of Dermatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Tetsuo Shiohara

Authors
  1. Chieko Katayama
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  2. Yuki Hayashida
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  3. Seiko Sugiyama
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  4. Tetsuo Shiohara
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  5. Yumi Aoyama
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Contributions

All authors (CK, YH, SS, TS and YA) have read and approved the final manuscript.

Corresponding author

Correspondence to Yumi Aoyama.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board at Kawasaki Medical University and followed the guidelines for the ethical conduct of human research (2238-4).

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Katayama, C., Hayashida, Y., Sugiyama, S. et al. Prurigo nodularis as a sweat gland/duct-related disorder: resolution associated with restoration of sweating disturbance. Arch Dermatol Res 311, 555–562 (2019). https://doi.org/10.1007/s00403-019-01937-6

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  • DOI: https://doi.org/10.1007/s00403-019-01937-6

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