Pruritus (itchy skin) with bumps or rashes is a distressing symptom that can sometimes occur with heart disease. But can heart problems cause a rash? Or can a rash be related to heart problems?

MyHeartDiseaseTeam members have frequently discussed itchy skin and rashes and the frustration of not knowing what the cause is. “I have a rash and can’t figure out why. I got a prednisone shot, got some pills, and supposedly this is taking away the itch. But it isn’t, so I’m just struggling,” a member wrote.

Someone else shared their experience: “I’ve got these blasted itchy bumps all over my body. I’m ending up itching them until they bleed. Big question is … what’s causing it?”

Edema (swelling), blocked arteries, very high cholesterol, diabetes, or medication side effects are all factors linked to heart disease that can cause itchiness or a rash. But an intensely itchy rash may be a sign of prurigo nodularis (PN), a chronic inflammatory skin condition that can sometimes affect people with heart disease.

If you have itchy bumps or skin lesions with heart disease, be sure to discuss these symptoms with your doctor. You may have prurigo nodularis. Although PN can sometimes be challenging to both diagnose and treat, a variety of treatment options have been shown to help reduce symptoms, and newer therapies are showing promising results.

What Is Prurigo Nodularis?

Prurigo nodularis — also known as nodular prurigo — is a chronic inflammatory condition that starts as an intense itch. Rubbing, scratching, and picking itchy skin with PN cause nodules (bumps) to develop in the skin. PN symptoms can appear in any area of the body that can be scratched or rubbed, but itchy bumps more commonly develop on arms, legs, torso, and buttocks.

Early symptoms of PN can be either short episodes of itching or itching that persists over time. The condition can also cause other sensations early on other than itching, such as stinging, burning, or a feeling of insects crawling on your skin.

Scratching an itch area can result in hard or pebbly bumps appearing, usually in around six weeks. These itchy bumps typically develop on both sides of the body. They may or may not be discolored and can range in size from very tiny to approximately 1 inch in diameter. Some people develop just a few nodules, or bumps, while others may have more than 100. People with prurigo nodularis can also develop patches of raised itchy skin.

Scratching can aggravate PN and cause it to spread. Scratching and picking can also cause sores to open and bleed. In more serious cases, spots or scars can develop on skin, which may linger for months or years.

Prurigo nodularis can have a serious impact on quality of life and may affect self-esteem, sleep, and mental health. You can find more information at MyPrurigoTeam and find support from others who are living with PN.

Risk Factors and Causes of Prurigo Nodularis

Researchers do not fully understand the causes of prurigo nodularis. Current thinking is that the condition is linked to dysfunction in the immune system and abnormalities in the nervous system that affect nerve fibers in the skin.

Dermatology studies indicate that people with other health conditions that cause itchy skin — such as allergies, atopic dermatitis (the most common form of eczema), contact dermatitis, and psoriasis — have a higher risk of developing prurigo nodularis.

Other conditions that are associated with prurigo nodularis include:

• Infections such as tuberculosis, herpes zoster (shingles), hepatitis C, and parasites
• Systemic and chronic diseases such as some skin cancer, HIV, lymphoma, kidney or liver disease, and cardiovascular disease
• Psychological disorders such as anxiety or depression, and use of antidepressants

People of any age can develop PN, but it most commonly appears between the ages of 40 and 69. According to NORD, PN is 3.4 times more common among African Americans.

Links Between Heart Disease Itch and Prurigo Nodularis

Researchers have found links between heart disease and prurigo nodularis, although there is still limited data on how these conditions are related. One study found that between 7.5 percent and 11 percent of people with PN had congestive heart failure.

One contributing factor may be key is the presence of elevated levels of interleukin-22 (IL-22), a protein in the immune system that promotes wound healing and tissue function in skin and organs throughout the body, including the heart and blood vessels. Abnormally high levels of IL-22 are associated with dysregulation in the immune system and chronic inflammatory diseases such as PN, psoriasis, and coronary artery disease. Chronic inflammation in psoriasis is also linked to cardiovascular disease. Coronary artery disease causes arteries to become narrowed and blocked and is linked to other heart conditions such as hypertension (high blood pressure), arrhythmia (irregular heartbeat), and heart failure.

One small study found a correlation between congestive heart failure and unspecified itch — or itch of an unknown cause. The study indicated that itch with acute heart failure corresponded to more severe cardiovascular symptoms and worse disease activity.

Diagnosis and Treatment of Prurigo Nodularis

PN is generally diagnosed by a dermatologist with a physical examination and a review of family and medical history. However, the condition can be difficult to recognize because its symptoms resemble those of other skin disorders. PN can also look different across various cases, which can also make it difficult to identify. Sometimes a skin biopsy is done — in which the skin is scraped in order to examine skin cells — to help with diagnosis by ruling out other skin diseases.

“I was told of my diagnosis with prurigo nodularis in 2023. I first broke out in 2018, and no doctors in my area had a clue,” a MyPrurgioTeam member wrote. “Suddenly, after two years with no new sores, all hell broke loose. My arms are covered, some on my neck, chin, around my waist. Same thing from doctors. Four doctors in a row said they’ve never seen it. I went to an ER out of my area, and they were great. I’m about to start new meds.”

Managing Prurigo Nodularis

PN is managed with a combination of behavior modifications and medications. It may take time to find effective relief of PN symptoms.

Treatment plans may include a combination of therapies, including:

• Topical treatments such as corticosteroids and calcineurin inhibitors
• Ultraviolet phototherapy (light therapy)
• Immunosuppressive medications such as tacrolimus, methotrexate, thalidomide, and lenalidomide
• The biologic drug dupilumab (Dupixent)
• Neuropathy (nerve disorder) treatments such as gabapentin and capsaicin
• Cryotherapy (extreme cold)

You should discuss potential side effects from PN treatment in detail with your doctor.

Self-Care With PN

If you’re living with PN, it’s essential that you protect your skin from scratching and keep your fingernails short in order to break the itch-scratch cycle — that is, scratching can break your skin, resulting in more itching and a greater desire to scratch. Wearing gloves or mittens may help if you have difficulty resisting the urge to scratch.

You may also consider wearing loose, soft clothing that covers affected areas. When bumps are inflamed or especially itchy, they may need to be bandaged.

Skin care may also include using anti-itch cream with menthol or camphor and sedating antihistamines before bedtime to help with sleeping. People with PN should consistently use moisturizer to avoid dry skin. You should use only gentle, fragrance-free skin care products for sensitive skin if you have PN.

Find Your Team

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 57,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Have you had itchy skin and bumps with heart disease? Were you diagnosed with prurigo nodularis? Share your experience in the comments below, or connect with other people living with prurigo nodularis on MyPrurigoTeam.