Prurigo Nodularis and Fertility Management: No Direct Link
Prurigo nodularis (PN) does not have any established link to fertility management or oocyte freezing procedures, and there is no medical reason to delay or modify fertility preservation based solely on a PN diagnosis. 1, 2
What is Prurigo Nodularis?
Prurigo nodularis is a chronic inflammatory skin disease characterized by:
- Firm, hyperkeratotic nodular lesions that are intensely pruritic (itchy) 1
- Pruritus lasting at least 6 weeks with a history of repeated scratching, picking, or rubbing 1
- Distribution typically on the trunk and extensor surfaces of extremities 2
- A vicious itch-scratch cycle that perpetuates the condition 3
The disease has a neuropathic origin with alterations in dermal and epidermal small diameter nerve fibers, involving both neural and immunologic components 4, 5
Lack of Connection to Fertility
There is no evidence in the medical literature linking prurigo nodularis to fertility issues, ovarian function, or reproductive health. 1, 2, 4, 3, 5
The condition is associated with various comorbidities including:
- Diabetes, obesity, thyroid disease, kidney disease, chronic liver disease 3
- Mental health disorders (anxiety, depression) 3
- Atopic dermatitis in some patients 3
Notably absent from this list are any reproductive or fertility-related conditions.
Proceeding with Oocyte Freezing
Patients with prurigo nodularis can safely proceed with oocyte cryopreservation without any special modifications to standard fertility preservation protocols. 6
Standard Oocyte Freezing Protocol Applies:
- Ovarian stimulation with gonadotropins followed by follicle aspiration 6
- Random-start stimulation can be initiated at any point in the menstrual cycle 6
- Timing is crucial - the procedure must be completed before initiation of any gonadotoxic treatments if applicable 6
- Success rates are age-dependent, with cumulative live birth rates of 61.9% if 12 oocytes are cryopreserved in women ≤35 years 6
Important Clinical Considerations
Medication Review is Essential:
Review any systemic medications the patient is taking for PN treatment, as some immunosuppressive therapies could theoretically require discussion, though this is unrelated to PN itself as a disease entity. 1, 2
Common PN treatments include:
- Topical or intralesional corticosteroids 4, 5
- Phototherapy 4
- Gabapentin or pregabalin 4
- Cyclosporin or thalidomide (less common) 4, 5
If the patient is on thalidomide, this requires immediate discussion due to its teratogenic potential, though this relates to the medication, not the PN diagnosis itself. 4
Quality of Life Impact:
PN significantly impacts quality of life through intense itching, poor sleep, anxiety, and depression, which may affect the patient's overall well-being during the fertility preservation process. 3
Ensure adequate symptom control to optimize the patient's comfort during ovarian stimulation and retrieval procedures. 1, 3
Common Pitfalls to Avoid
- Do not delay fertility preservation based on the PN diagnosis alone - there is no medical justification for this 6
- Do not assume PN affects ovarian reserve or oocyte quality - no evidence supports this connection 1, 2, 4, 3, 5
- Do not overlook medication review - focus on what the patient is taking for PN treatment, not the PN itself 1, 4
- Do not dismiss the patient's quality of life concerns - PN causes significant distress that may need addressing during the fertility preservation process 3
Bottom Line
Proceed with standard oocyte cryopreservation protocols without modification. The presence of prurigo nodularis is incidental to fertility management and should not influence timing, technique, or expected outcomes of oocyte freezing. 6, 1, 2