Picker Nodule, (Prurigo Nodularis) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

Picker nodule (PN) is a skin disease featured by pruritic (itchy) nodules which normally occur on the arms or legs.
Patients often manifest with multiple ulcerated swollen lesions caused by scratching (skin picking).
PN is also known as Hyde prurigo nodularis, lichen corneus obtusus, prurigo nodularis.
Patients are often tormented by their symptoms which often prove difficult to control with conventional therapy
The most prominent symptom is the excessive itchiness of the skin lesion which makes the patient scratch or picks at the lesion hence the name Picker nodule.
Causes:
Atopy or allergy
Neurological
Psychological
Infection
The exact cause of Picker nodule is still unknown.
Symptoms:
Picker nodule patients are most often middle-aged to elderly.
Patients with Picker nodule normally have symptoms of a long-standing history of severe, continual pruritus.
Patients can reveal specific locations where they start feeling itchy and where dark-colored nodules develop soon after.
Mature nodules seldom enlarge or reduce in size.
Picker nodule is normally bilaterally symmetrical, with nodules that are either stable or rising in number.
The patient's medical history may be important for several disorders:
1. Hepatic or renal dysfunction
2. Local injury or insult to the skin
3. Infection
4. HIV/immunodeficiency
5. Hypothyroidism
6. Hematological malignancies
7. Anxiety or other psychiatric conditions
The patient's history often shows a long list of prescribed medicines (topical and oral) which normally have caused little or no relief of symptoms.
80% of patients have a personal or family history of atopic (allergic) dermatitis, asthma, or hay fever (compared with about 25% of the normal population).
In a true Picker nodule, a nodule forms before any itching begins.
Normally, these nodules are extremely itchy (pruritic) and are alleviated only by steroids.
Picker nodule lesions may show signs of picking of skin with flat, umbilicated, or crusted top.
Skin Nodules or papules are:
1. ≤2 cm in diameter.
2. Discrete.
3. Scaly.
4. Symmetrical distribution.
5. Firm.
6. Hyper-pigmented or occasionally purpuric (blue black or blood clot).
Lesions may number from 1-2 to hundreds.
When entering the examination room and while patients are describing the locations of the lesions, patients may scratch or rub the lesions rather than pointing to them.
Many Picker nodule patients seem very anxious, worried, or even obsessed with the nodules.
The diagnosis is based on the doctor’s observation and the presence of itching.
Often a skin biopsy is done to confirm the diagnosis.
Biopsy of the lesions is advised to rule out abnormal or atypical presentations of other disease such as squamous cell carcinoma, mycobacterial infections, fungal infections and cutaneous lymphoma.
A culture of at least one skin nodule will exclude staphylococcus infection, which has been considerably linked to atopic dermatitis
Lesion biopsies will normally show a high level of eosinophils (cause of allergy) in PN.
Treatment
Present available treatments of Picker nodule have had mild-to-moderate success at best.
Topical, oral, and intra-lesional corticosteroids have all been given to reduce inflammation and sense of itching and to soften and smooth out firm nodules.
Pulsed dye laser may decrease the vascularity of individual lesions
Cryotherapy with liquid nitrogen helps to decrease pruritus and flatten lesions
Cognitive behavioural therapy
Habit reversal therapy
Medicines used:
Antihistamines
Thalidomide
Lenalidomide
Opiate-receptor antagonists
Systemic retinoids
Psoralen combined with ultraviolet A (PUVA) treatment
The immunomodulators tacrolimus and pimecrolimus
Anxiolytic drugs

TABLE OF CONTENT
Introduction
Chapter 1 Picker Nod

• Language: English
• Publisher: Kenneth Kee
• Release date: Sep 8, 2017
• ISBN: 9781370130351

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Picker Nodule,

(Prurigo Nodularis)

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2017 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Picker Nodule, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What The patient Need to Treat Picker Nodule)

This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If the patient would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 amazon kindle books and 200 into Smashwords.com eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.