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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

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)

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

 

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?

 

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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Copyright © 2000 - 2025    K. Kerr

Most recent revision April 15, 2025 09:45:38 AM