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Prurigo Nodularis

(PN)

Overview

What is prurigo nodularis?

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.

Prurigo nodularis can develop anywhere on your body, but it’s often on your:

Abdomen.

Arms.

Legs.

Scalp.

Shoulders.

Upper back.

This condition is chronic, which means that it often lasts a long time, or gets better and comes back again (recurs).

Who gets prurigo nodularis?

Anyone can get prurigo nodularis, though it’s more common in:

African Americans.

Adults between ages 40 and 69.

Women.

Certain skin diseases can increase your risk of PN, including:

Bullous pemphigoid.

Cutaneous T-cell lymphoma.

Eczema (atopic dermatitis).

Keratoacanthomas (skin tumor caused by sun exposure).

Lichen planus.

Other types of prurigo.

Psoriasis.

Severely dry skin (Xerosis cutis).

Other health conditions that may increase your risk of PN include:

Cancer.

Certain bacterial, viral and parasitic infections.

Diabetes.

Gout.

Human immunodeficiency virus (HIV).

Iron deficiency.

Kidney failure or chronic kidney disease.

Liver disease.

Lupus.

Nervous system disorders.

Some mental health disorders, like psychogenic pruritus (impulse to scratch at your skin due to a perceived itching sensation) or obsessive-compulsive disorder.

Thyroid disease.

How common is prurigo nodularis?

People around the world develop prurigo nodularis. While studying this disease, researchers have learned that some people have a higher risk of developing it.

It is more common in people who are:

50 years of age or older, usually between 51 and 65 years of age

Living with certain long-term diseases, including:

A skin disease that is often itchy, such as eczema/atopic dermatitis, contact dermatitis, cutaneous T-cell lymphoma, or lichen planus. About half of people who develop prurigo nodularis have (or had) eczema.

Diabetes

End-stage kidney disease

Hepatitis C

HIV (untreated)

Lymphoma (Hodgkin’s lymphoma or non-Hodgkin’s lymphoma)

Mental health conditions, including anxiety or depression

Taking certain medications, such as an antimalarial or opioid.

Receiving certain cancer medications. These include some chemotherapy medications and a few medications called immune checkpoint inhibitors, specifically pembrolizumab or nivolumab.

In the United States, Black people may be more likely than white people to develop prurigo nodularis. This finding comes from a study conducted at Johns Hopkins Hospital.

While some people have a higher risk of getting prurigo nodularis, it’s important to know that anyone can develop this disease.

If you have itchy bumps on your skin that last for more than 2 weeks, see a dermatologist. Should those itchy bumps turn out to be prurigo nodularis, early diagnosis and treatment can relieve the itch and clear the bumps.

When the itchy bumps could be a sign that you have another disease like one of those listed above, your dermatologist can treat the skin condition and help you get the care you need for other conditions.

What are the 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.

Prurigo nodularis symptoms include:

Raised bumps on your skin, usually topped by a thick, dry crust. The bumps might be the same color as your skin. They can also be light pink, dark red, brown or black. The bumps might vary in size and depth. Sometimes, they affect both your epidermis (top layer of skin) and dermis (middle layer of skin).

Intense itchiness.

Sometimes, burning or stinging.

PN bumps might be categorized as:

Nodules (larger than 1 centimeter in diameter and going into your epidermis).

Papules (less than 1 centimeter in diameter and only on the surface of your skin).

Plaques (shallow, scaly lesions that are more than 1 centimeter in diameter but don’t go beneath the surface of your skin).

What causes prurigo nodularis?

Prurigo nodularis isn’t contagious. It may result from too many nerve or immune cells in your skin. Other conditions may increase itchiness on your skin’s surface, so the bumps might appear from excessive scratching and irritation. Sometimes, medication — like certain types of chemotherapy — 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.
Dermatologists and other researchers are still studying what causes this disease.

From what researchers have found, we know that the following play a role in causing prurigo nodularis:

Nerves become more sensitive and overreact: This contributes to the itchy skin and inflammation (response in your body that harms healthy tissue).

An overly active immune system: When a person’s immune system overreacts, this also leads to inflammation. The increased inflammation contributes to the intensely itchy skin.

Diagnosis and Tests

How is prurigo nodularis diagnosed?

A healthcare provider examines your skin. They check the size, color and location of the bumps. They’ll also ask how itchy the bumps are and if certain triggers increase the itchiness.

Make sure your provider knows about any other skin or health conditions you have, including allergies. This information can help them distinguish between PN and other disorders.

Tests for prurigo nodularis may include:

Dermoscopy: Your provider uses a dermoscope (a handheld microscope with a light) to evaluate your skin. Dermoscopy provides a magnified view of your skin and doesn’t require any cuts.

Blood and urine tests: A complete blood count, basic metabolic panel and urinalysis can help your provider identify health conditions like liver, thyroid or kidney disease.

Biopsy: Your provider takes a skin sample using a razor, scalpel or other cutting tool. You receive a local anesthetic to numb your skin. The skin biopsy sample includes skin from your dermis and epidermis. They examine the sample in a lab under a microscope to check for abnormal cells or other signs of disease.

Management and Treatment

How is prurigo nodularis treated?

The most common treatments for mild prurigo nodularis include:

Injections: You may receive an injection of medication directly into the skin lesions. Injections of corticosteroids (anti-inflammatory drugs) reduce inflammation and can help relieve pain, redness and itching right away.

Topical treatments: You apply certain medications directly to your skin as creams or ointments. Calamine lotion is a common antihistamine (anti-itch medication). Your provider may also recommend topical corticosteroids, Vitamin D or calcineurin inhibitors (immune system suppressants).

If injections or topical treatments aren’t effective, your provider may recommend:

Cryotherapy: uses liquid nitrogen to freeze off large or especially itchy skin lesions. Most people receive cryotherapy in combination with corticosteroid injections.

Immunosuppressants: are drugs that prevent your immune system from overacting. You might receive this treatment if you have PN related to an autoimmune disorder, such as lupus or psoriasis.

Phototherapy: uses ultraviolet (UV) light to reduce itchiness and help skin lesions heal. It works by calming immune cells that release histamines. Most people need several treatments.

Proven Treatment Options

DUPIXENT® (dupilumab)

Dupilumab: This medication is FDA approved to treat adults who have prurigo nodularis. Dupilumab works by reducing inflammation thought to cause itchy skin. It can effectively reduce the itch and clear lesions on the skin when other treatments fail. For many patients, itch relief happens quickly.

This medication is given as an injection just beneath the skin. You will be taught how to inject this medication, so you can treat yourself at home. The first dose consists of 2 injections. After that, you inject yourself every other week. You can get this medication in a pre-filled syringe or self-injector pen.

In the studies that led to FDA approval of dupilumab for prurigo nodularis, the most common side effects were mild. They included inflamed (red and itchy) eyes and eyelids, cold symptoms like a stuffy nose, and diarrhea.

DUPIXENT® (dupilumab) for Adults with Prurigo Nodularis (PN)

NEMLUVIO® (nemolizumab-ilto)

Nemolizumab: This medication is FDA approved to treat adults who have prurigo nodularis. It can stop the itch-scratch cycle.

In studies, nemolizumab has significantly reduced the itch within 48 hours. It has also reduced the bumps and patches — and sometimes completely cleared the skin.

Nemolizumab comes in a prefilled self-injector pen. If this medication is prescribed, you would receive an initial dose. After learning how to inject it, you would give yourself another dose once every 4 weeks.

The most common possible side effects are headache and developing atopic dermatitis or nummular dermatitis (both types of eczema).

NEMLUVIO® (nemolizumab-ilto) for adults with 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.
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.

Prevention

How can I prevent prurigo nodularis?

There’s no way to prevent prurigo nodularis, but you can take steps to reduce itchiness, irritation and new PN flare-ups:

Avoid the sun or wear sunscreen with an SPF (sun protection factor) of at least 30.

Keep your fingernails trimmed short.

Stay out of hot environments and avoid activities that may cause sweating.

Use gentle cleansers and moisturizers on your skin.

Wear long sleeves and gloves.

If skin lesions break open or bleed, be sure to apply antibiotic ointment and cover the lesions with clean bandages.

Prognosis

Does prurigo nodularis go away?

Sometimes, prurigo nodularis goes away on its own, but it’s a chronic skin condition that can last for several months or longer. The skin rash may clear up for a while and then come back. Identifying what triggers your flare-ups may help you avoid them in the future.

Complications from PN are rare, but open lesions can get infected. Healed lesions may leave scars or cause skin discoloration.
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.

Living With PN

Prurigo Nodularis is a chronic skin condition that causes intense itching and hard, itchy bumps. It can greatly affect a person’s quality of life. The constant discomfort and visible skin lesions lead to physical, psychological, and social challenges.

The impact of Prurigo Nodularis on quality of life is wide-ranging. People with this condition often face:

Physical Discomfort and Pain

The main symptom of Prurigo Nodularis is intense itching. This itching can be hard to control and can damage the skin further. The itchy bumps can also be painful, making things worse.

This discomfort can disrupt sleep, causing fatigue and lowering overall well-being.

Psychological and Emotional Effects

Dealing with a chronic skin condition like Prurigo Nodularis can harm mental health. The itching, visible skin lesions, and sleep issues can lead to anxiety, frustration, and depression. People may feel self-conscious about their appearance, leading to social withdrawal.

The psychological effects of Prurigo Nodularis can be as bad as the physical symptoms.

Social and Occupational Challenges

Prurigo Nodularis also affects social and work life. The visible skin lesions and itching can make social interactions hard, causing people to avoid social events. Work performance may suffer due to discomfort, lack of sleep, and emotional distress.

In severe cases, Prurigo Nodularis can even cause disability and prevent people from working.

It’s important to understand the big impact of Prurigo Nodularis on quality of life. Providing care and support that addresses physical, psychological, and social aspects is key. This helps improve overall well-being and helps patients manage their challenges.

When should I contact my healthcare provider about prurigo nodularis?

Contact your healthcare provider if you notice any signs of infection, including:

Discharge or pus draining from a lesion.

Fever.

Pain, tenderness or swelling around a lesion.

Red or warm skin around a lesion.

Red streaks around lesions.

What questions should I ask my healthcare provider about prurigo nodularis?

If you have PN, you may want to ask:

Are there foods I should avoid with prurigo nodularis?

Are there home remedies for prurigo nodularis?

How can I reduce the risk of scarring?

How can I relieve itching, especially at night?

Is my prurigo nodularis the result of an underlying health condition?

Lifestyle Changes and Self-Care

Medical treatments are not the only way to manage Prurigo Nodularis. Lifestyle changes and self-care are also key. Gentle skincare, regular moisturizing, and stress management can help. These steps can ease symptoms and improve skin health.

Skincare Routines and Moisturization

For those with Prurigo Nodularis, a gentle skincare routine is vital. Use mild, fragrance-free cleansers to avoid irritation. Avoid harsh scrubbing and hot water, as they can make symptoms worse.

After washing, apply a rich moisturizer to soothe and protect the skin. Look for products with ceramides, glycerin, or hyaluronic acid. These ingredients help keep moisture in and reduce itching and swelling. Moisturizing often, after bathing or showering, keeps the skin hydrated and less irritated.

Stress Management Techniques

Stress can trigger Prurigo Nodularis. Managing stress is important for skin health and overall well-being. Try deep breathing, meditation, or yoga to calm your mind and body.

Regular exercise, like walking or swimming, can also reduce stress and boost mood. Prioritize sleep, eat well, and enjoy hobbies or social activities. These actions help lower stress and improve life quality.

By making these lifestyle changes and practicing self-care, people with Prurigo Nodularis can manage symptoms better. Remember, everyone’s experience is different. It might take time to find the right skincare, moisturizers, and stress management techniques. A dermatologist or healthcare provider can offer personalized advice and support.

Coping Strategies and Support

Living with Prurigo Nodularis can be tough, but there are ways to manage it. Seeking support from family, friends, and healthcare professionals is key. Talking about your feelings can offer comfort and help with the condition’s psychological effects.

Joining support groups or online forums can also help. These places are safe to share experiences and find encouragement. Organizations like the National Eczema Association and the American Academy of Dermatology offer support and resources.

Organization	Website
National Eczema Association	https://nationaleczema.org/
American Academy of Dermatology	https://www.aad.org/
International Skin Care Nursing Group	https://www.isng.co.uk/

Learning about Prurigo Nodularis is important. Knowing about its triggers and treatments can make you feel more in control. Working with a dermatologist can give you accurate information and personalized advice.

Stress management is also key. Practices like meditation, deep breathing exercises, and gentle yoga can help. They promote relaxation and may reduce flare-ups, improving your overall well-being.

Advances in Research and Future Treatments

Researchers are working hard to find new ways to treat Prurigo Nodularis. They are studying the causes of this condition and developing targeted therapies. They look at the immune system, nerve fibers, and other factors that may cause Prurigo Nodularis.

Current Research Initiatives

Several clinical trials are underway to test new treatments for Prurigo Nodularis. These trials are checking the effectiveness of various medications. They include topical creams, oral drugs, and biologic agents.

Researchers are also looking into light therapy and other non-pharmacological approaches. These methods aim to manage the symptoms of Prurigo Nodularis.

Promising New Therapies

Some promising therapies for Prurigo Nodularis include targeted biologics. These drugs target the immune system pathways involved in the condition. Early studies show they may offer better management of Prurigo Nodularis.

Novel drug delivery systems, like nanoparticle-based creams, are also being developed. These systems aim to improve the effectiveness and tolerability of topical treatments.

As research continues, we hope for new and more effective treatments for Prurigo Nodularis. With the hard work of scientists and the support of patients and healthcare providers, we can look forward to a future where this challenging condition can be better managed and controlled.

FAQ's

Q: What are the most common symptoms of Prurigo Nodularis?

A: Prurigo Nodularis causes intensely itchy, firm bumps on the skin. These bumps can also lead to skin inflammation and itching. This can make everyday life very uncomfortable.
Q: How is Prurigo Nodularis diagnosed?

A: Doctors diagnose Prurigo Nodularis by examining the skin and checking symptoms. They might also do a skin biopsy. This helps rule out other skin conditions that look similar.
Q: What causes Prurigo Nodularis?

A: The exact cause of Prurigo Nodularis is not known. It’s believed to involve genetics, immune system issues, and environmental factors. The itch-scratch cycle can make the condition worse.
Q: How does Prurigo Nodularis impact the quality of life?

A: Prurigo Nodularis can really affect a person’s life. It causes intense itching, discomfort, and pain. This can lead to sleep problems, anxiety, depression, and feeling isolated. It can also make it hard to work or socialize.
Q: What are the treatment options for Prurigo Nodularis?

A: Treatments for Prurigo Nodularis include creams and ointments, pills, and light therapy. The right treatment depends on how severe the condition is and the patient’s situation.
Q: Can lifestyle changes help manage Prurigo Nodularis?

A: Yes, making lifestyle changes can help manage Prurigo Nodularis. Using gentle skincare, moisturizing regularly, and managing stress can reduce its impact on daily life.
Q: Are there any support resources available for people with Prurigo Nodularis?

A: Yes, there are many resources for people with Prurigo Nodularis. Support from family, friends, and healthcare professionals is important. Joining support groups or organizations can also offer valuable information and emotional support.
Q: What advances are being made in Prurigo Nodularis research?

A: Researchers are working hard to understand Prurigo Nodularis better and find new treatments. They are exploring new therapies, like targeted biologics and drug delivery systems, to help manage this chronic condition.

One Final Note..

Prurigo nodularis can be difficult to treat. It often lasts several months or more and can come back after it gets better. It can be pretty frustrating to try one treatment after another, so be sure you have a dermatologist who listens to your concerns. In the meantime, you’ll want to keep your skin in the best condition possible, It’s hard not to scratch an itch, but scratching the bumps associated with prurigo nodularis can lead to infection and scarring. And more itchiness. Try to keep your skin cool and dry, and instead of scratching, try applying calamine lotion.

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Most recent revision June 29, 2025 08:52:44 PM

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