Prurigo nodularis is a skin condition that usually starts with feeling extremely itchy. Unfortunately, scratching, rubbing or picking at the skin can worsen the condition.
After about six weeks of scratching and rubbing the itchy spots, new and painfully itchy bumps, called nodules, usually show up.
Further scratching prevents the skin from healing and clearing existing bumps. It also can break the nodules open. This can be painful and increases the risk of bacterial infection.
Dermatologists recommend a combination of skin care and medication to treat the symptoms and reduce itchiness. Without treatment, the uncomfortable itch and bumps can remain for months or even years.
Of course, being told “don’t scratch” isn’t always easy advice to follow. You can try several self-care strategies and medications available without a prescription to help your skin heal from prurigo nodularis.
But it’s also important to see a healthcare professional. Prurigo nodularis can be linked to other conditions, like atopic dermatitis, HIV or hepatitis C. Your healthcare team can test for and treat other conditions, if needed. They can also offer prescription-strength medications for prurigo nodularis.
Your healthcare team might recommend the following care options for prurigo nodularis.
At-home treatment tips for prurigo nodularis
If you’re experiencing prurigo nodularis, try the following strategies.
Make it difficult to scratch. Consider cutting your fingernails short and wearing soft gloves to bed.
Cover your skin. Wear long-sleeved shirts and pants in a soft, comfortable fabric. Just be careful to wear light layers when it’s warm because heat can make skin itchier. You also can cover itchy spots with bandages. Your healthcare team might recommend a medicated tape. The tape delivers medication directly to impacted spots, and it helps protect the skin so it can heal.
Baby your skin in the shower. Use gentle cleansers and lukewarm water when bathing. Look for products labeled for sensitive skin. Make sure products are fragrance-free, not just unscented. Unscented products can still include fragrances. Wash your body gently, using your hands rather than rough washcloths or loofas that can further irritate your skin. Hot water also leads to itchy skin, so consider moving the temperature dial back a bit.
Moisturize. Apply a fragrance-free lotion or cream throughout the day to keep the skin moisturized. Many anti-itch creams and lotions are available without a prescription. They can help reduce itching and soften the skin. Look for calamine lotion or lotions with ingredients like menthol, phenol, pramoxine, camphor or capsaicin.
Don’t forget to apply lotion before bed when skin tends to be extra sensitive.
Try an antihistamine. Taking an allergy medicine like hydroxyzine (Vistaril) or diphenhydramine (Benadryl) can be helpful. These drugs may be particularly effective at bedtime since they can make you tired.
Be kind to yourself. While your skin heals, try to keep your environment as comfortable as possible. That means avoiding stress, heat, humidity, sweating and uncomfortable clothing.
Prescription treatment tips for prurigo nodularis
Your dermatologist might recommend prescription-strength medicines and treatments to help clear your condition. These include:
- Topical medicines: Corticosteroids or nonsteroid anti-inflammatory medicines can be applied to itchy spots.
- Injectable medications: Corticosteroids might be injected directly into the affected areas.
- Cryotherapy: Freezing temperatures applied to the skin may help reduce itching and nodules.
- Light therapy: Also called phototherapy, this treatment uses UVA or UVB rays to attempt to heal the skin.
- Antidepressants: These oral medications can help reduce pain and improve sleep.
- Dupilumab (Dupixent): An injectable medication can be given every two weeks to treat prurigo nodularis.
What to expect when treating prurigo nodularis
Be patient and understand that it can take time for your prurigo nodularis to clear. Don’t give up on the treatment if you don’t see immediate improvement. You might need to try a couple of different treatments to find one that works for you. Check in with your dermatology care team, especially if your care plan isn’t working for you or if you see the condition worsening. Your care team may be able to change your treatment.
As the prurigo nodularis bumps begin to clear and you feel less itching, you might notice that your skin changes. The bumps might become flat, dark-colored spots. This is called post inflammatory hyperpigmentation and will slowly fade over months to years. You also might have scars where the bumps were. The chance of developing scars is lessened by getting treatment for the condition and avoiding picking or scratching at the bumps as much as possible.
Prurigo nodularis is a stubborn condition that is likely to come back. But it is not dangerous. The condition often improves with medication and home-care strategies. New treatments also are being developed. Clinical trials are happening now.