An Atypical Manifestation: Linear Hyperkeratotic Prurigo Nodularis

We present the case of a 42-year-old Indian male with prurigo nodularis, exhibiting multiple verrucous, brownish-black nodules on the left lower and right upper extremities, with milder involvement of the right lower extremity. The lesions were asymmetrically distributed in a near-linear pattern, with prominent white hyperkeratosis and associated moderate pruritus and paresthesia. Differential diagnoses included pemphigoid nodularis, verruca vulgaris, and hypertrophic lichen planus, with a biopsy confirming prurigo nodularis. While prurigo nodularis typically presents with symmetric dome-shaped nodules on extensor surfaces, the asymmetric distribution, near-linear arrangement, and verrucous texture observed here are unusual and underscore the importance of recognizing prurigo nodularis variants to ensure accurate diagnosis and effective management.