All You Need To Know About Prurigo Nodularis 


Itchy skin is what we all experience in our lives from time to time, whether from an uncomfortable sweater, seasonal change, or maybe a reaction to some hygiene products. However, sometimes an itch lasts longer than normal which might be indicative of a skin condition called Prurigo Nodularis (PN). The itch in prurigo nodularis is so severe that it disturbs normal routine and also disrupts one’s sleep. Extreme itching results in scratching and bleeding from the itchy nodules, the characteristic feature of prurigo nodularis. The condition is rare and difficult to treat, however, various Clinical Research Organizations conduct Clinical Trials to find a potential treatment option. 

This blog focuses on discussing the causes, symptoms, and management of prurigo nodularis.

What Happens In Prurigo Nodularis?

Prurigo nodularis is a chronic skin condition characterize by itchy bumps, called nodules. The nodules are a result of intense itching that results in scratching and bleeding constantly. These itchy nodules appear in easily accessible areas of the body, like arms, legs, abdomen, and upper or lower back. It is not a contagious or hereditary condition. 

Itch-Scratch Cycle of Prurigo Nodularis

After the formation of nodules, it brings more itching that triggers a cycle of rubbing and scratching, leading to bleeding from those nodules. This results in more new nodules and more itching. The constant itch does not give enough time for nodules to heal and results in scarring. 

Risk Factors For Prurigo Nodularis

Prurigo nodularis is link with underly medical conditions that result in itching of the skin. These conditions include atopic dermatitis, insect bites, kidney failure, HIV, hepatitis C, thyroid disease and liver disease, etc.

Symptoms Of Prurigo Nodularis

The most prominent feature of prurigo nodularis is the presence of firm, itchy nodules on the skin, arms, legs, or abdomen. These nodules are extremely itchy and irritating. 

The size of nodules varies in size from 0.2 inches to 1.2 inches. They may be red, brown, or the same color as the skin. Once the nodules are form, they persist for months or years even, leaving behind a mark or scar.

Diagnosis Of Prurigo Nodularis

Diagnosis begins with a history and physical examination. The doctor will ask for symptoms and will assess the lesions. Mostly, a physical examination is sufficient to diagnose skin conditions but sometimes, a biopsy may be need to confirm the diagnosis. 

In case prurigo nodularis is diagnose, but the underly causative agent is not understood, your doctor may prescribe blood work for confirmation. 

Disorders Related to Prurigo Nodularis

Clinical symptoms are typically use to diagnose PN. Because of this, as well as symptom overlap with other conditions that cause severe, chronic pruritus, PN can be misdiagnose as other skin diseases and co-occur with some of them. These are some examples:

Pemphigoid nodularis:

it is a rare autoimmune disease and a variant of bullous pemphigoid in which fluid-filled blisters form on the skin of the arms and legs, most commonly in the elderly. Pemphigoid nodularis, unlike PN, may resolve on its own after several months to years.

Actinic prurigo:

is a skin condition that primarily affects girls and causes itchy papules and nodules to appear after sun exposure, usually on the upper extremities, face, and neck. It usually starts in the spring and lasts until the fall.

Epidermolysis bullosa:

is a genetic skin disorder that typically manifests in childhood and is clinically characterized by blister formation as a result of mechanical trauma or friction against the skin.

Lichen simplex chronicus (neurodermatitis):

is a type of eczema that affects one to two patches of skin and worsens with scratching.

Lichen amyloidosis:

is a form of primary localized cutaneous amyloidosis in which papules form on the shins and forearms as a result of abnormal protein deposits in the skin caused by altered protein metabolism.

Hypertrophic lichen planus:

is a rare autoimmune skin and mucous membrane disease that is chronic and inflammatory. Lichen planus (LP) most commonly manifests as itchy, shiny, reddish-purple skin spots (lesions) or as white-gray lesions in the mouth (cutaneous LP) or on the lips (oral LP).


is a mental disorder related to obsessive-compulsive disorder (OCD) in which lesions form as a result of chronic skin-picking, which can occur up to several hours per day.

Nodular scabies:

are skin nodules that appear following scabies infection and treatment. In some cases, nodular scabies is thought to be a persistent reaction to remaining mite parts in the skin. It is characterized by itchy nodules that are typically found in the groin and armpit and occur in approximately 7% of scabies infections.

Lupus erythematosus:

is an autoimmune disease that can affect many organs and systems, including the skin. Some lupus cases are skin-specific, most notably discoid lupus erythematosus (DLE), and some lupus rashes can resemble PN. These PN-like lupus rashes differ from the cardinal butterfly lupus-associate rash, which is characterize by thick and scaly patches that can itch.

Multiple keratoacanthomas:

are skin tumors that form from hair follicles and appear as nodules with blood vessels and a keratin plug. They may be linked to Muir-Torre syndrome, a rare inherited cancer syndrome characterize by a rash of many of these skin growths in addition to organ-specific cancer, most commonly colorectal cancer. Keratoacanthomas grow quickly and cause scarring within days to weeks.

Atopic dermatitis:

is the most common type of chronic eczema caused by an overactive immune system that damages the skin barrier, resulting in dryness, itching, rashes, and increased susceptibility to skin infections. It usually starts in child hood and is link to other allergic conditions such as asthma and hay fever.

Treatment Options Available

The goal of prurigo nodularis treatment is to eliminate or reduce itching. The goal is to break the itch-scratch cycle, allowing nodules and damaged skin to heal.

Lifestyle Changes:

Certain lifestyle changes and over-the-counter medications can aid in the reduction and relief of itchy skin. The following tips can be adopt:

  • Try not to scratch the itchy nodules.
  • When bathing, use gentle soaps or no soap at all.
  • Apply moisturizer to your skin several times per day.
  • To soothe skin and reduce itchiness, use over-the-counter lotions and ointments such as topical anesthetics, and products containing camphor, menthol, and phenol.
  • Maintain proper fingernail care.
  • Wear gloves or mittens while sleeping to prevent accidental scratching.

Medication on prescription:

Various prescription medications can help with symptom management.

  • Corticosteroids: These can help to alleviate inflammation and itchy skin. They can be applied topically (as a cream or ointment), or taken orally or intravenously.
  • Antihistamines: This medication can help with itching.
  • Phototherapy: Itchy skin and inflammation may be reduced by exposing affected areas of skin to specific wavelengths of ultraviolet (UV) light.
  • Immunomodulatory medications: These medications reduce inflammation and itchy skin by modulating the immune response. Immunosuppressive medications are typically reserved for more severe cases or itchy nodules that have failed to respond to other treatments.

Prognosis Of Prurigo Nodularis

Prurigo nodularis is a crippling condition that not only affects physical health but also significantly impacts mental health. It disrupts sleep and causes anxiety and depression. However, with lifestyle modifications and appropriate therapy, the symptoms can be manage. 

Bottom Line

Prurigo nodularis is an extremely debilitating condition that not affects physical health but has a significant impact on one’s self-esteem. It takes a toll on mental health because of the stigma associated with imperfect skin. However, appropriate and timely management can greatly alleviate the symptoms and make the affected individual feel better.

Revival Research Institute is conducting Prurigo Nodularis Clinical Trials that may be of help to people suffering from this condition. 

ALSO READ: Reasons for polysomnography

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