Cutaneous neural proliferation in highly pruritic lesions of chronic prurigo

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Abstract
Nodular lesions of chronic prurigo correspond to highly sensitive pruritic areas of neural proliferation. This was shown by light microscopy and EM studies in 4 patients. Axons and Schwann cells participated in this process. Their ultrastructure appeared mostly normal; some disorganization, axonal swelling, and dystrophy were also observed. At places, newly formed nervous tissue imitated neuromas, surrounded by mononuclear cells and a peculiar cell type which was called spider cell. The noninvolved skin near the nodules showed no alterations. Occlusion with elastic bandages for 4 wk betters the clinical and histological picture. The neural proliferation in prurigo is apparently a secondary phenomenon due to chronic traumatization by scratching. The extreme pruritis in chronic lesions is related to the increased number of dermal nerves.

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