Prurigo nodularis (PN) is a chronic skin condition characterized by itchy nodules. While there’s no cure, various treatments can help manage symptoms and improve quality of life. In this article, we’ll explore the best treatment options for prurigo nodularis, as well as steps you can try at home to feel better.

Understanding Prurigo Nodularis

Prurigo nodularis causes symptoms including hard and intensely itchy bumps on the skin. The most important goal of treatment is usually to minimize itching and break the itch-scratch cycle, which can lead to subsequent scratching and cause even itchier nodules or hard lumps to form. If itching is controlled, the nodules may gradually go away.

The treatment plan that will work best for you will depend on how severe your PN is, how old you are, whether you have additional health problems, and how you feel about the side effects of different treatment options. It’s normal to try multiple types of therapies before you find a regimen that works for you. Some typical PN treatment options include:

1. Over-the-Counter Topicals

Treatment for PN may begin with topical itch relief medications, like creams or ointments, that you rub into your skin. There are a few over-the-counter options that may help calm itching. Look for lotions or creams that contain ingredients like menthol, phenol, camphor, pramoxine, or capsaicin. Calamine lotion may also relieve itching.

2. Topical Calcineurin Inhibitors

Sometimes, over-the-counter medications may not be effective enough to treat the severe itching that often comes with PN. In that case, your dermatologist may prescribe stronger prescription topical medications called calcineurin inhibitors. The most common are tacrolimus (Protopic) and pimecrolimus (Elidel), which can reduce immune system activity and potentially ease PN symptoms.

3. Prescription Forms of Vitamin D

Your health care provider may prescribe other prescription forms of vitamin D, including calcitriol (Rocaltrol) or calcipotriol (Dovonex). Studies have shown that using prescription vitamin D has helped clear up prurigo nodules in some people. This type of topical medication may help normalize skin cell growth and stop your immune system from attacking the skin.

4. Corticosteroids

Topical corticosteroids (also simply called steroids) are another common initial treatment option for PN. These medications help prevent your immune system from causing inflammation or other abnormal reactions. In some cases, you can cover your skin with medical tape or bandages that contain topical steroids. Stronger topical steroids may be necessary to reduce the itching from PN.

Sometimes, PN can lead to thick skin or stubborn nodules, making it difficult for topical medications to absorb into deeper skin layers. In this case, your doctor may inject a corticosteroid called triamcinolone acetonide (Kenalog-40) directly into the lesions (abnormal skin areas). Injecting the steroid directly into the nodules ensures that it’s delivered to the area where the inflammation is occuring.

The combination of topical corticosteroids and a form of vitamin D like in Dovobet (which contains ingredients used to treat psoriasis, like betamethasone and calcipotriol) can also be an excellent treatment option in PN.

5. Cryotherapy

Cryotherapy, also called cryosurgery, might be a treatment option for some if topical treatments or injections aren’t working. During this treatment, your doctor will use extremely cold liquid nitrogen to reduce inflammation or kill an area of skin tissue. Cryosurgery can help lessen itching and minimize nodules for people with PN.

While effective, this treatment option may not be right for some people, as it could cause scarring or hypopigmentation (patches of skin that are lighter than your natural skin color). This treatment also can be painful.

6. Phototherapy

Phototherapy, or light therapy, has been a treatment option for other types of skin diseases that cause inflammation and itchiness. During these treatments, you are exposed to ultraviolet (UV) light therapy, which can include narrowband UVB and PUVA (psoralen and UVA).

7. Oral Immunosuppressants

For some severe cases, doctors may prescribe oral medications that suppress the immune system and can help control inflammation throughout the body. These drugs, which are taken by mouth, may include:

• Azathioprine (Imuran)
• Cyclosporine (Gengraf, Neoral)
• Methotrexate (Trexall)

8. Biologics and Immunomodulatory Therapies

Unlike immunosuppressants, immunomodulatory medications can modify specific parts of the immune responses without suppressing the entire immune system. Some may block the nervous system signals between the brain and skin that contribute to itching.

Biologics are injected immunomodulatory drugs that have been developed for prurigo more recently:

• Dupilumab (Dupixent) became the first drug ever approved by the U.S. Food and Drug Administration (FDA) to treat PN in 2022.
• Nemolizumab (Nemluvio) was approved for PN in 2024.

Your doctor may recommend oral medications like thalidomide (Thalomid) and lenalidomide (Revlimid) if traditional therapies aren’t working.

9. Clinical Trials

Dermatology researchers are learning more about what causes PN and looking for better ways to treat it. For individuals who don’t respond to standard treatments, participating in clinical trials may also provide access to new, experimental therapies. You can talk to your doctor whether or not joining a clinical trial may be beneficial for you.

Other Potential Treatment Options

Many people notice that their PN gets worse in the evening or at night, making it difficult to get good quality sleep. If this is the case for you, your doctor may suggest taking a sedating antihistamine (an anti-allergy drug that makes you feel very sleepy). This could include diphenhydramine (Benadryl) or hydroxyzine (Vistaril). These drugs may fight immune cells that cause abnormal reactions in your skin while also helping you get a better night’s rest.

Your doctor may also recommend other therapy options to treat your PN, such as gabapentin (Neurontin) or pregabalin (Lyrica). These medications may stop nerve cells from activating, which could help stop the skin’s itch and pain signals from reaching the brain. In addition, some research has found that opioid receptor antagonists like naltrexone (ReVia) and NK1r antagonists such as aprepitant (Emed) may help some people with PN. However, additional studies are still needed to learn more about these drugs.

Tips for Prurigo Nodularis Self-Care

While medical treatments are essential, self-care can play a crucial role in managing PN. Some lifestyle changes may help control itching regardless of other PN medications and treatments you are taking.

Prevent Scratching

The more you scratch, the more new nodules may form. Try not to touch your skin so it can heal. In the long run, this can relieve some symptoms.

Cover up the affected areas of skin as much as possible. Wearing long pants and long-sleeved shirts may help you avoid directly scratching your skin and could help prevent skin damage. Wearing a bandage over itchy skin areas may also help.

You may also want to cover your fingernails so that any itching is gentler for your skin. Try wearing gloves or keeping your nails cut very short.

Avoid Triggers

Factors that can trigger your PN and make itching worse include:

• Heat or humidity
• Sweat
• High stress levels
• Dry air
• Clothes made from certain materials, such as polyester or wool
• Skin care products that contain certain irritating ingredients

Keeping yourself cool and staying away from products that worsen your skin condition may help boost your quality of life while living with PN.

Practice Good Skin Care

Take care of your skin using a gentle cleansing routine. Use water that is warm but not hot when bathing, and use your fingers to apply any skin products — loofahs, washcloths, and other tools may cause more irritation or inflammation. You may also want to avoid soap altogether or try using a mild soap. Shorter baths and showers may also help reduce itching.

Dry skin can lead to extra itchiness. It may help to regularly apply lotion or emollients to moisturize your skin.

Make sure that any skin products you use — lotions, body washes, facial cleansers, and other products — are designed to be used on sensitive skin. Fragrance-free and dye-free products may also help prevent additional skin irritation.

Treating Other Health Conditions

PN is often associated with other health issues like hepatitis C, psoriasis, eczema, atopic dermatitis, and other skin disorders. Sometimes, treating these underlying conditions can significantly improve PN symptoms.

If your PN causes other problems, you may also need additional treatment. Many people with PN have skin infections that require treatment with antibiotics. Additionally, antidepressants or therapy may help people with PN who are experiencing anxiety or depression. Mental health treatments may also reduce stress, and reducing stress can improve PN symptoms.

Talk to Your Health Care Provider

Prurigo nodularis can be challenging to treat, and it may require a combination of treatment options and self-care strategies to manage symptoms. Sometimes initial PN treatments don’t work well for some people, and some may take a long time to become effective. If you try these treatments and find that they aren’t controlling your PN symptoms very well, your health care provider may suggest other options.

Always remember to talk to your doctor or dermatologist before making any changes to your treatment plan.

Find Your Team

MyPrurigoTeam is the social network for people with prurigo nodularis and their loved ones. On MyPrurigoTeam, more than 4,000 members come together to ask questions, give advice, and share their stories with others who understand life with prurigo nodularis.

Are you living with prurigo nodularis? Which prurigo nodularis treatment options have you explored? Share your experience in the comments below, or start a conversation by posting on your Activities page.