How to manage prurigo nodularis during a chickenpox outbreak?

Question

Hello doctor,

I have been managing prurigo nodularis for over two years, with persistent, intensely itchy nodules on my arms and legs. Despite using topical steroids and antihistamines, I continue to experience flare-ups. Recently, I developed a rash of fluid-filled vesicles on my torso, and my pediatrician diagnosed it as varicella (chickenpox).

I am concerned about how this viral infection might affect my existing skin condition. Specifically, could the increased itching or inflammation from varicella worsen my prurigo nodularis lesions or increase the risk of scarring? I would also like to know whether systemic antivirals like Acyclovir are safe to take alongside my current treatments for prurigo nodularis.

Should I pause or adjust any immunomodulatory creams or phototherapy during this time to avoid complications? What measures can I take to reduce itching and prevent secondary infections in chickenpox lesions and the prurigo nodules?

Would you recommend any additional treatments, topical or systemic, to better manage pruritus during this period? Are there specific warning signs of bacterial superinfection I should watch for? Finally, once I have recovered from varicella, when would it be safe to resume my regular treatment regimen for prurigo nodularis? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

You are currently experiencing a flare of prurigo nodularis, a long-term skin condition that causes very itchy, hard bumps (nodules) to appear on the skin, most often on the arms and legs. These bumps are caused by constant scratching, which makes the skin thick and irritated over time. The itching can be very intense, and scratching only makes it worse, creating a cycle of itching and scratching. An active varicella (chickenpox) infection is a contagious infection caused by the varicella-zoster virus. It usually affects children, but can occur at any age. The viral illness appears to have intensified the patient’s underlying pruritus (condition with itching, a sensation that causes the urge to scratch), contributing to further aggravation of the nodular lesions. This overlap raises concerns about increased skin damage and potential scarring from persistent scratching and inflammation.

The following tests are recommended to help guide treatment:

A PCR (Polymerase chain reaction) test for varicella is recommended to determine the extent of the chickenpox infection. A complete blood count (CBC) should be done to check for any secondary bacterial infections. Liver and kidney function tests are necessary to ensure the safe use of Acyclovir. Additionally, a skin culture is advised to rule out bacterial infections in the prurigo nodularis or varicella lesions.

In light of the active infection, existing therapies, such as topical corticosteroids, antihistamines, and immunomodulatory agents, may require temporary adjustment to avoid complications. Antiviral treatment with Acyclovir is recommended to manage the varicella infection.

Given the dual dermatologic conditions, it may be advisable to temporarily suspend phototherapy, which is a medical treatment that uses specific wavelengths of light to treat various skin conditions, as well as certain topical treatments during the acute phase of the viral illness. Supportive care with calamine lotion, cool compresses, and rigorous skin hygiene can help reduce pruritus and prevent further trauma.

Close monitoring is essential to detect signs of secondary bacterial infection. Once the varicella infection has resolved, the prurigo nodularis treatment plan should be reassessed and resumed as appropriate.

I hope this helps.

Please revert in case of further queries.

Thank you.