Prurigo nodularis is a skin condition that starts with extreme itchiness. Frustratingly, scratching or rubbing your itchy skin only makes it worse. After about six weeks, hard, itchy bumps, called nodules, can appear where you scratch.
The condition isn’t dangerous, but it can be painful and annoying. Some people report that the unbearable itching affects their sleep. They also might skip school, work or social activities because the condition makes them physically or mentally uncomfortable.
Here are the answers to five common questions about prurigo nodularis.
What are symptoms of prurigo nodularis?
Prurigo nodularis is characterized by intensely itchy skin. It can be a small spot or a large area. It can be itchy for a short while or itch constantly. It also can include a burning or stinging feeling.
After several weeks of this, bumps might start to appear. They’re most common on places where the skin was rubbed or scratched, such as arms, legs, upper back and abdomen. Parts of the back that are difficult to reach are usually clear of bumps. Prurigo nodularis doesn’t usually affect the face, neck or feet.
The bumps can be the color of your skin, red, pink or black. Some people have just a few bumps in a small area. For others, the bumps are widespread. The bumps often develop on both sides of the body.
When medical professionals have examined biopsies from people with prurigo nodularis, they have noticed some differences as compared to people who don’t have the condition. These included:
- Fewer nerve fibers in the epidermis, which is the outer layer of the skin, but more nerve fibers in the inner dermis layer.
- More immune cells that produce cytokines, which are chemicals associated with inflammation.
- More cells that contain histamine, which is a chemical associated with allergy symptoms and itching.
What are the effects of prurigo nodularis?
Prurigo nodularis is bothersome, but it doesn’t develop into more serious conditions. However, frequent scratching can affect the skin. Sometimes scratching rips open the bumps and makes them bleed. The open skin can then become infected with bacteria. The skin might become sensitive to touch. Even clothing that rubs on sensitive skin can be painful.
Keep in contact with your healthcare team while you’re managing prurigo nodularis. Your team might be able to make changes to your treatment plan if some parts aren’t working for you. It’s also important to let your healthcare team know about any signs of infection, such as worsening pain, swelling, skin discoloration, fever, or pus coming from open skin.
Skin conditions also can take an emotional toll. A mental healthcare professional might be able to help you process the feelings that come with having a health condition.
What causes prurigo nodularis?
There’s no known cause of prurigo nodularis. It seems to be related to the nervous and immune systems. The condition is most common among people over age 60 and people who are Black. It’s also common among people who have other skin conditions that cause itching, such as atopic dermatitis. It can be linked to health conditions that predispose to itchy skin, including HIV, hepatitis C and kidney failure. Your healthcare team can test for other conditions and recommend treatments for the itch.
What’s the treatment for prurigo nodularis?
Self-care strategies that ease itchiness also can help with condition management. Since prurigo nodularis varies by person, so does the treatment. Generally, the first step is to prevent scratching. Using gentle, fragrance-free skincare products and keeping your skin moisturized with lotion helps. Your healthcare team also might recommend anti-inflammatory medicines such as topical steroids or antihistamine pills. Sometimes, particularly itchy bumps that aren’t responding to topical treatments can be injected with steroids to help them go away. Light therapy and other systemic medicines are also options in people with severe disease. Learn more about treatments HERE.
The Food and Drug Administration (FDA) recently approved dupilumab, an injectable medication given every two weeks, to treat prurigo nodularis. And new therapies are being researched.
In addition, dermatologists recommend strategies to reduce stress and avoid heat and sweating, since these are common triggers for itchy skin.
Can prurigo nodularis be cured?
For most people, prurigo nodularis is a chronic condition that can come back. But new treatments are being tested. With medicine and home-care strategies, symptoms and the frequency of flare-ups can improve.
Your dermatologist or healthcare team can help tailor your treatment plan to fit your needs.