Based on a psychodynamic interpretation of two case reports, prurigo nodularis is defined as multicausal skin disorder of the elderly. We consider this disease a semi-artifact. Specific neurotic conflicts, generally with depressive symptomatology, center on an altruistic conception of life. From a psychoeconomic perspective this entails self-sacrifice, insufficient self-actualization, and repression and inhibition of aggressive impulses. Psychotherapeutic exploration frequently does not occur until decades after the onset of the illness. Our discussion addresses ‘specificity’ in psychosomatic medicine. We encourage dermatologists interested in psychosomatic phenomena to pay attention specifically to early experiences of loss and separation, as well as strain and excessive demands in the life of patients suffering from prurigo nodularis. Such experiences tend to be minimized due to the altruistic orientation of these patients. The primary manifestation and the actual conflict can be utilized to reconfigure the history of neurotic conflicts.

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