What Is Prurigo Nodularis – Symptoms, Causes And Treatment

What Is Prurigo Nodularis – Symptoms, Causes And Treatment


What Is Prurigo Nodularis – Prurigo Nodularis (PN) is a very itchy rash. Skin lumps in PN can vary in size from very small to about half an inch in diameter. The number of nodes can vary from 2 to 200.

It is widely believed that this occurs as a result of scratching the skin. Itchy skin can be caused by a number of reasons, such as:

  • Dry skin
  • Thyroid dysfunction
  • Chronic kidney disease

Moreover, Itching PN can ease its severity. It is believed to have the highest itching intensity of all itchy skin conditions.

Because scratching conditions may increases the itching and can lead to new bumps and worsening of the existing bumps.

PN is difficult to treat. Let’s look at the symptoms and how to manage Prurigo Nodularis.

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Symptoms Of Prurigo Nodularis

Prurigo Nodularis may start as small itchy red bumps. Occurs as a result of scratching the skin. The bumps usually start on the arms or legs, but they can also appear all over the body, wherever it has been scratched.

The nodules can itch a lot. These bumps can be:

  • Hard
  • Crusty and scaly
  • Scabby
  • Color varies from flesh to pink, brown or black
  • Warty Appearance

The skin between the bumps may be dry. According to a 2019 review, some people with PN also experience variations in burning, stinging, and temperature in the lump.

The bumps can cause a secondary infection due to frequent scratching.

Furthermore, Severe itching can be debilitating, interfere with good sleep, and disrupt your daily routine. This, in turn, can cause anxiety and depression in a person with PN.

The swelling may disappear if the person stops itching. Also in some cases, it has been seen that they can leave scars.

Treatment Of Prurigo Nodularis

The goal of treatment for Prurigo Nodularis is to break the itch cycle by relieving itching. Your doctor will need to treat any underlying conditions that cause itching and scratching.

Common treatments for Prurigo Nodularis include topical creams and systemic medications to relieve itching.

Because itching is so intense and each case is different, you may need to try several different treatments to find the one that works best for you.

PN is a poorly understood disease. In some people, the cause of itching is unknown. For these people, no treatment works.

At present, the US Food and Drug Administration (FDA) has not approved any therapy for the treatment of PN. However, there are many investigational drugs that can be used off-label to treat this condition.

Be sure to talk to your doctor about possible side effects of medications and off-label use of medications.

Local Treatment Or Topical Drugs

Your doctor may recommend some prescription or over-the-counter topical medications to help relieve itching and cool your skin.

Examples may include:

  • Topical Steroid Creams i.e clobetasol or calcineurin inhibitors like as pimecrolimus. (This can be protected to help them work more efficiently.)
  • Topical Coal Tar
  • Topical Vitamin D-3 Ointment (calcipotriol)
  • Capsaicin cream
  • Menthol

Your doctor may recommend corticosteroid injections (Kenalog) to treat certain tumors.

Systemic Drugs Or Medications

Your doctor may prescribe or recommend over-the-counter antihistamines to help you sleep at night.

They may also prescribe commonly used medications, such as antidepressants, to help you stop itching. Paroxetine and amitriptyline successfully improve PN nodules.

Other Therapies

Therapies that can help relieve lumps and reduce itching include:

  • Cryotherapy: Cryotherapy is the effect of ultra-cold temperatures on the lesions.
  • Phototherapy: Phototherapy uses ultraviolet (UV) radiation.
  • Psoralen is used in combination with UV: Psoralen and UVA used together are known as PUVA.
  • Pulsed Dye Laser: A pulsed dye laser is a type of treatment, this method may be used to kill the diseased cells.
  • Excimer Laser Treatment: The 308 nm excimer laser has successfully treated Prurigo Nodularis that are not amenable to other treatments.

Your doctor may also suggest habit reversal therapy to help you stop itching.

New Treatments

Several trials with unapproved drugs have shown promising results in reducing itching.

  • Intravenous naloxone and the oral mu-opioid receptor antagonist naltrexone which may have early side effects۔
  • Immunosuppressants, including cyclosporine and methotrexate.
  • Gabapentinoids, which are used for people who have not responded to other treatments or who have painful neuropathy
  • Thalidomide, which has been shown to be effective, but is considered a last resort due to possible side effects.
  • Nalbuphine and nemolizumab, which are being tested.
  • Isoquercetin, which is a plant derivative of quercetin.
  • Dupilumab injection

More Ways For Managing Your PN

Everyone’s skin is different, and it may take some time to find a procedure that helps control itching.

A combination of funds can work well. It is important to try to break the cycle of itching to prevent new bumps from forming and allow the old ones to dissolve.

In addition to prescription drugs and over-the-counter creams:

  • Use an ice pack to cool the itchy area.
  • Take a short bath in hot water with colloid oatmeal.
  • Moisturize your skin regularly with Vaseline or a hypoallergenic cream.
  • Use unscented soaps and other products for sensitive skin.

Causes Of PN

The exact cause of Prurigo Nodularis is not fully understood, but the lesions are thought to be a direct result of itching, which can be caused by a variety of reasons.

PN has been linked to several conditions, including:

  • Atopic dermatitis (eczema)
  • Diabetes
  • Chronic kidney failure
  • Chronic hepatitis C
  • Neurological disorders
  • Psychiatric disorders
  • Post-herpetic neuralgia
  • Lymphoma
  • Lichen planus
  • Congestive heart failure
  • Chronic obstructive pulmonary disease (COPD)
  • HIV
  • Certain therapeutic drugs for cancer (pembrolizumab, paclitaxel, and carboplatin)

Prurigo Nodularis is thought to occur when other conditions cause persistent itching and scratching (the itch-scratch cycle), resulting in characteristic lesions. It is said that even when the soil condition is removed, the PN is sometimes preserved.

Additionally, a 2019 study indicated that approximately 13% of people with Prurigo Nodularis do not have a disease or predisposing factor.

Researchers are studying the underlying mechanisms involved in PN, including:

  • Skin cell changes
  • Nerve fibers
  • Neuropeptides and changes in the Neuroimmune system

As the causes of PN become clearer, researchers hope that more effective treatments may become possible.

Quick Facts
  • PN most often occurs in people between the ages of 20 and 60.
  • PN affects men and women equally.
  • PN is rare. There are few studies on its prevalence or incidence. A 2018 study of 909 PN patients found that African Americans were 3.4 times more likely to develop PN than white patients.


Until the exact causal mechanism of Prurigo Nodularis is known, it is difficult to prevent it. Not scratching your skin may be the only way.

If you’re prone to Prurigo Nodularis due to genetics or an underlying medical condition, pay attention to your skin. See your doctor for treatment of any persistent itching. Try to stop any cycle of itching before it starts.

Many medications can help reduce itching before it becomes uncontrollable.

The Conclusion

Prurigo Nodularis is a skin condition that is very itchy and can be disfiguring. Its exact cause is not fully understood, but it is known to be associated with several other conditions.

Many treatments are possible, but it can take some time to successfully control PN. A combination of topical, medical, and other treatments may work for you.

The good news is that some new drugs and treatments are being developed and tested. As researchers learn more about the mechanisms of Prurigo Nodularis, more effective targeted treatments will be developed.

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