What Is Prurigo Nodularis? Pictures, Causes, Treatment

There is no cure for prurigo nodularis, but several treatments can help break the itch-scratch-itch cycle, says Feldman. These include:

• Corticosteroids: If there are just a few nodules, steroid creams or ointments can help reduce inflammation and itching, says Feldman. Oral or injectable corticosteroids may be used for more severe PN, according to Yale Medicine.
• Antihistamines: These medications can help reduce itching.
• Phototherapy: Exposure to ultraviolet (UV) light can help reduce inflammation and itching, says Feldman.
• Cryosurgery: This method, which uses extreme cold to destroy abnormal tissue, is an option if other treatments don’t help with itch and pain. But it’s often not a first or second choice in people with darker skin because it can cause noticeable light spots, scarring, or both.
• Immunomodulatory drugs: In more severe cases or when nodules don’t respond to other therapies, dermatologists may prescribe immunosuppressive drugs like methotrexate or cyclosporin to try to control inflammation, says Feldman. But these medications have negative health consequences in the long term, he adds.
• Other medications: Some dermatologists may prescribe oral naltrexone, antidepressants, gabapentin, or pregabalin.

Dupixent (dupilumab) injection is the first treatment approved by the U.S. Food and Drug Administration (FDA) for prurigo nodularis. “Dupilumab is highly effective; it’s already been approved for atopic dermatitis,” says Feldman.

Dupixent is administered via subcutaneous injection: a 300 milligram dose administered via pre-filled syringe or pre-filled pen every two weeks after an initial loading dose. In clinical trials, the drug resulted in significant improvements in itch and in reducing/clearing of nodules, per the FDA.

Lifestyle Changes and Complementary Therapies

Although it is very difficult, try to avoid scratching nodules, says Feldman. “If you just have a few spots, placing a Band-Aid over them can help,” he says.

Other tips to help with the itch-scratch cycle, from Yale Medicine:

• Use mild soaps or even no soap at all when bathing.
• Apply moisturizer several times a day.
• Spread on over-the-counter lotions and ointments to calm skin and reduce itchiness including capsaicin cream, pramoxine hydrochloride (a topical anesthetic), and products that contain camphor, menthol, and phenol.
• Keep fingernails trimmed.
• Wear gloves or mittens while sleeping to avoid unintentional scratching.

Although the findings need to be confirmed in larger studies, a case study published in November 2021 in Clinical, Cosmetic and Investigational Dermatology found that four months of acupuncture treatment significantly decreased itch and improved sleep.

Prevention of Prurigo Nodularis

Because the root cause of PN is often unknown and it’s not clear why some people get it and others don’t, there’s no tried-and-true way to prevent it.

But there are ways to prevent the itch-scratch cycle from starting, according to the AAD. Avoiding common triggers including stress, heat, humidity, sweating, dryness, scented personal care products, and clothing made of wool, polyester, or any rough fabric may help minimize symptoms.