What are the best treatments for prurigo nodularis?

Question

Hi doctor,

I have prurigo nodularis, and I often scratch my skin until it bleeds. As a result, I have noticeable bumps that make me feel self-conscious, especially when wearing shorts or short sleeves. Is there anything that can improve the appearance of these nodules, or is surgery my only option?

Additionally, can I use over-the-counter pain creams to relieve the discomfort, or could they potentially make it worse? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Prurigo nodularis (a chronic skin condition characterized by intensely itchy, hard nodules that develop on the skin), as you are experiencing it, can be quite frustrating due to the persistent itching on one hand and the slow healing process on the other.

I hope you are consulting an experienced dermatologist (skin doctor) for proper guidance. I mention this because you have referred to surgery—who suggested this as a treatment option?

You can discuss the following treatment approaches with your dermatologist:

Managing nodule discomfort and appearance: There are topical creams available that can help reduce itching and improve the appearance of the nodules. Since I am not your consulting physician, I am not specifying particular medications. If you were referring to pain-relief creams, please provide the specific name, as typical pain-relief creams used for joint pain or sprains are not suitable for prurigo nodularis.
Phototherapy (light therapy): Discuss with your dermatologist whether narrowband ultraviolet B (NB-UVB) therapy or psoralen plus ultraviolet A (PUVA) therapy may be beneficial for your condition. These treatments help reduce itching and inflammation.
Antihistamine medication for itching: Request a prescription for an antihistamine (anti-allergy medication) to be taken at night. This will help reduce itching and prevent excessive scratching, which can worsen the nodules and lead to scarring.
Protecting the skin from scratching: During episodes of intense itching, consider using transparent polyurethane film dressings (such as Sunwrap film sheets) to temporarily cover the affected areas. This will prevent direct scratching and help reduce the risk of scarring.

There are effective symptomatic treatments available for prurigo nodularis, so do not lose hope. Additionally, I recommend undergoing screening with your primary care physician (PCP) to check for any underlying conditions such as liver disease, kidney disease, thyroid disorders (such as hypothyroidism or hyperthyroidism), and diabetes mellitus (a chronic metabolic disorder characterized by high blood sugar), as these may contribute to your symptoms.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.