• Multiple studies have found links between prurigo nodularis (PN) and depression, anxiety, and other mood disorders.
• There are many complex reasons, both psychosocial and biological, why PN is associated with emotional and mental health challenges.
• Treating your mental health can benefit your skin symptoms and improve your overall quality of life.

If you’re living with prurigo nodularis — also known as nodular prurigo — you may be coping with more than the physical symptoms of the chronic skin disorder. Although PN’s hallmark symptom is an intense itch originating from nodules on the skin, numerous scientific studies have linked the condition to disorders of mood, attention, and behavior. Although these associations are scientifically proven, why and how they’re connected remains unclear. We don’t even know for certain whether mood disorders lead to PN or if PN leads to mood disorders.

Here, we explain what the research so far shows about the relationship between PN and depression and anxiety. The good news is that treating your mental health along with your skin can improve both conditions and raise your overall quality of life.

It’s Not ‘All in Your Head’

Some people living with PN have negative associations with discussing mental health. Doctors can sometimes make matters worse by telling people with PN that their symptoms are all in their head.

MyPrurigoTeam spoke with Dr. Shawn Kwatra, associate professor of dermatology and director of the Johns Hopkins Itch Center in Baltimore, Maryland. Dr. Kwatra highlighted some of the challenges people with PN face as they seek treatment. “One of the biggest misconceptions of PN is that it’s all in people’s heads,” he said. “When I speak to other dermatologists, they often say, ‘If I have a PN patient, I send them to a psychologist or psychiatrist and tell them it’s in their head.’”

According to Dr. Kwatra, some health care providers don’t understand that psychological distress dysfunction can contribute to the development of PN. “These patients are incredibly itchy. They’re not sleeping well. And then they develop anxiety and depression,” he said. “That’s the truth of the matter. It can be especially damaging for patients to hear, ‘It’s all in your head’ and not to be validated that they actually have a skin disease.”

This misconception can be doubly harmful because it may cause people with PN to distrust dermatologists and mental health professionals. This, in turn, can make it more difficult for them to get effective treatment for PN, depression, and anxiety.

Prurigo Nodularis and Mental Health

Public health studies have shed light on the relationship between prurigo nodularis and psychiatric comorbidity (having a mental, emotional, or behavioral disorder as well as PN). One of the largest studies on the subject showed that people experiencing chronically itchy skin had a greater risk of having clinical depression, suicidal thoughts, and economic hardship than the general population.

Specifically, researchers have found that, compared to people without PN, those with the condition are at a higher risk of having:

• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Schizophrenia
• An impulse to inflict self-harm
• Mood disorders including depression and anxiety

Although proving exactly what causes a health problem is difficult, several research studies have discovered eye-opening connections between depression, anxiety, and prurigo nodularis.

Worse Prurigo Nodularis Symptoms Can Mean Worse Mental Health

The severity of your PN is associated with your mental health. One small study of people with chronic itching due to PN, psoriasis, or atopic dermatitis (also called eczema) found that those with insomnia or depression had significantly more severe itching compared with those who didn’t have mental health problems. The study also found that those with severely itchy skin were more likely to have depression than those with mild itching.

One theory about this connection is that the severity of PN on one’s quality of life — including systemic itchiness, pain, and poor self-esteem due to changes in appearance — leads to a lack of sleep and an increased rate of mental illness. Researchers have noticed links between sleep, itch, and depression.

Another theory is that PN is biologically linked to mental health issues. Some researchers have found that PN skin symptoms often arise in people after they’ve experienced ongoing mental health problems. Although studies have not yet proven which comes first, mental health challenges or PN, they do demonstrate that you are not alone if you’re also experiencing depression or anxiety while living with PN.

Side Effects of Prurigo Nodularis Treatment

Some medications for PN may include a combination of corticosteroids (also called steroids), antihistamines, and immunomodulatory drugs. Some of the side effects of these drugs can include changes in mood and energy levels.

For example, corticosteroids reduce the chemical serotonin in the brain, which may lead to mood swings and depressive symptoms that may mirror psychiatric disorders. Scientists also have found a link between steroid use and irritability, hyperactivity, anxiety, psychosis, and insomnia. If you’re taking high doses of steroids, they may contribute to mood problems. Antihistamines, meanwhile, tend to cause tiredness. Speak to your doctor if you experience these issues to find out if they may be related to medication.

Treating Mental Health May Improve Prurigo Nodularis

There is a silver lining to this connection. Since the links between your mind and skin can go both ways, treating mental health may actually help improve PN symptoms. Studies show that treating depression and anxiety — such as through social support, counseling, or antidepressants — can help improve skin lesions and itching. In other words, taking steps to improve your emotional health may improve your skin condition too.

Caring for the Whole Person

Given that mental health problems are more common among people living with PN, some researchers have called for a holistic (whole-person) approach to managing the condition. Undergoing treatment for depression and anxiety through cognitive, psychological, or mindfulness techniques can help you better manage the physical, emotional, and psychological symptoms of your condition. Recognizing that you are not alone in living with PN — and all of its symptoms, including depression and anxiety as well as itching — is the first step to improving your overall well-being.

Talk With Others Who Understand

MyPrurigoTeam is the social network for people with prurigo nodularis and their loved ones. On MyPrurigoTeam, members come together to ask questions, give advice, and share their stories with others who understand life with PN.

Are you living with depression or anxiety as well as prurigo nodularis? Have you noticed links between your PN symptoms and mental health? Share your experiences in a comment below or on your Activities page.