Itchy Skin Disease Linked to Higher Rates of Erectile Dysfunction in Large US Study

Men with prurigo nodularis, a chronic and often debilitating itchy skin condition, may face a substantially higher risk of erectile dysfunction, according to a new cross-sectional study drawing on one of the largest and most diverse health databases in the United States. The research, published in the Archives of Dermatological Research, found that erectile dysfunction was significantly more common among men with prurigo nodularis than among carefully matched controls, and that the association persisted even after accounting for a long list of confounding health conditions. The finding adds prurigo nodularis to a growing roster of inflammatory skin diseases, including psoriasis and atopic dermatitis, that appear to exert effects far beyond the skin itself.

Prurigo nodularis is characterized by firm, hyperkeratotic nodules that develop on the skin of people caught in a relentless itch-scratch cycle. The condition is driven by a complex neuroimmune process in which T helper 2-skewed inflammation takes center stage, with cytokines such as interleukin-31 implicated in both the intense pruritus and the neural changes that accompany chronic scratching. Until recently, the disease was often dismissed as merely a dermatological nuisance, but accumulating evidence has reframed it as a systemic disorder. A global cohort study published in EBioMedicine in 2024 reported increased cardiovascular risks and mortality among patients with prurigo nodularis, raising the question of what other systemic manifestations might be hiding in plain sight.

Erectile dysfunction, meanwhile, has emerged as far more than a quality-of-life issue. The physiology of erection depends on intact vascular endothelium and healthy penile nerves, and the small arteries of the penis are narrower than the coronary arteries, which means endothelial dysfunction can manifest there first. Systematic reviews and meta-analyses have shown that erectile dysfunction predicts cardiovascular events as an independent risk factor, often preceding chest pain or a heart attack by years. In this sense, erectile dysfunction functions as an early warning light on the dashboard of male cardiovascular health, and identifying conditions associated with it may offer clinicians a valuable window for intervention.

To investigate whether prurigo nodularis shares this vascular and neurologic burden, a team led by researchers at NYU Grossman School of Medicine and Rosalind Franklin University of Medicine and Science turned to the NIH All of Us Research Program, using the Registered Tier Dataset version 7. The All of Us program, which aims to gather health data from one million or more Americans with deliberate attention to populations historically underrepresented in biomedical research, offered the scale and diversity needed to study a relatively uncommon skin disease. The investigators designed a nested, propensity score-matched cross-sectional study, a design that attempts to mimic the balance of a randomized experiment by matching cases and controls on key characteristics.

The study population consisted of male participants with at least three documented visits and complete data, while men with Parkinson’s disease or Alzheimer’s disease were excluded because these neurodegenerative conditions independently affect sexual function and could muddy the analysis. From a pool of 54,604 eligible participants, the researchers identified 204 men with prurigo nodularis, whose median age was 66 years. Each case was matched to three controls by age and race and ethnicity, yielding 612 controls. This 1:3 matching strategy strengthened the study’s statistical power while controlling for two of the most important demographic determinants of erectile dysfunction.

The baseline characteristics of the two groups revealed that men with prurigo nodularis carried a heavier burden of comorbid disease across the board. They had higher rates of depression, alcohol use disorder, hypertension, hyperlipidemia, obesity, and type 2 diabetes than their matched counterparts. This pattern is consistent with the emerging picture of prurigo nodularis as a disease entangled with metabolic and psychiatric morbidity, and it posed an analytical challenge: any apparent link between the skin disease and erectile dysfunction could simply reflect this shared burden of vascular risk factors rather than a direct relationship.

The headline result, however, survived that scrutiny. Erectile dysfunction was present in 35.3 percent of the men with prurigo nodularis compared with 20.6 percent of controls, a striking absolute difference of nearly 15 percentage points. In univariable conditional logistic regression, prurigo nodularis was associated with roughly a doubling of the odds of erectile dysfunction, with an odds ratio of 2.1 and a 95 percent confidence interval of 1.5 to 3.1, corresponding to a p value below 0.001. When the researchers adjusted for the relevant comorbidities in a multivariable model, the association attenuated but remained statistically significant, with an odds ratio of 1.7 and a 95 percent confidence interval of 1.2 to 2.5 and a p value of 0.008. In other words, even after stripping away the contribution of hypertension, diabetes, obesity, and the rest, prurigo nodularis itself was still independently associated with erectile dysfunction.

What mechanistic story could explain such a link? The authors point to shared inflammatory and neurogenic pathways. Chronic Th2-skewed inflammation in prurigo nodularis floods the circulation with cytokines, including interleukin-31, which has been hypothesized to influence both neural and vascular function. Interleukin-31 is best known as an itch-inducing cytokine acting on sensory neurons, but inflammatory cytokines more broadly have been implicated in erectile dysfunction through effects on endothelial cells and autonomic nerves, and a 2024 Mendelian randomization analysis published in Frontiers in Immunology examined inflammatory cytokine profiles in erectile dysfunction precisely because of these suspected causal links. Erectile function also depends on small-nerve integrity, and research on the neuropathy of erectile dysfunction has long shown that peripheral nerve damage is a major contributor. A disease that combines chronic systemic inflammation with neuroimmune dysregulation could plausibly damage both the vascular and the neural machinery of erection.

The findings also fit into a broader research program by the same group. In 2025, overlapping members of the team published a similar analysis showing erectile dysfunction in patients with seborrhoeic dermatitis, and a 2019 systematic review in JAMA Dermatology had already established an association between psoriasis and sexual and erectile dysfunction across epidemiologic studies. Treatment may matter as well: the German G-EPOSS study reported in 2025 that the biologic guselkumab improved sexuality and reduced perceived stigmatization in patients with psoriasis, and other work has explored whether biologics can reduce cardiovascular risk in psoriasis patients. Together, these strands suggest that controlling skin inflammation might conceivably benefit systemic and sexual health, although interventional evidence for prurigo nodularis specifically does not yet exist.

The clinical takeaway is straightforward. Because erectile dysfunction can serve as an early marker of cardiovascular disease and mortality, the authors argue that clinicians caring for men with prurigo nodularis should consider screening for sexual dysfunction rather than waiting for patients to volunteer such complaints, which stigma often suppresses. A positive screen could identify patients who warrant further cardiovascular risk assessment, potentially years before a cardiac event. The study’s limitations are those inherent to its design: it is cross-sectional, so it cannot prove that prurigo nodularis causes erectile dysfunction or clarify the direction of the relationship, and the number of cases, though adequate for the analysis, was modest at 204. Coding of diagnoses in electronic health records may also miss milder disease. Still, within a cohort of more than 54,000 men, the signal was robust, statistically significant, and independent of the usual suspects. For a disease long defined by the surface of the skin, prurigo nodularis is increasingly looking like a window into the blood vessels and nerves beneath it.

Subject of Research: The association between prurigo nodularis and erectile dysfunction in a large US cohort

Article Title: Erectile dysfunction in patients with prurigo nodularis in the all of us research program

Article References: Khodadad, K., Rabbin-Birnbaum, C., Shah, J. T., & Zampella, J. G. (2026). Erectile dysfunction in patients with prurigo nodularis in the all of us research program. Archives of Dermatological Research, 318(1), Article 431. https://doi.org/10.1007/s00403-026-04947-3

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04947-3

Keywords: prurigo nodularis, erectile dysfunction, All of Us Research Program, chronic itch, interleukin-31, cardiovascular risk, inflammatory skin disease, cross-sectional study, endothelial dysfunction, neuroimmune, dermatology, comorbidities