Quick Links
About MyPrurigoTeam
Powered By
Prurigo nodularis (PN) is a chronic skin condition that causes pruritus (intense itching) and the development of firm, itchy nodules (bumps). It often occurs alongside other health conditions and is linked to inflammation caused by the immune system’s response in the skin.
Also called nodular prurigo, PN is not very common, although health experts believe it may be underdiagnosed. Within the U.S., an estimated 72,000 to 100,000 new cases are diagnosed in adults ages 18 to 64 each year. Treatment usually focuses on medications that help relieve itching and reduce inflammation.
PN usually leads to pruritus, which may be constant or may come and go.
Scratching the itchy areas can eventually cause nodules and scaly skin patches to form. The bumps can make you itch even worse, which causes an itch-scratch cycle: The more you scratch, the more you itch, and you keep scratching.
PN nodules may:
PN nodules can develop anywhere on the body that can be easily scratched, such as the upper and lower back, abdomen, arms, or legs. The skin lesions are often symmetrical — for example, you may have bumps in a similar location on both arms.
People with PN may also experience other indirect symptoms because of their intense itching or skin appearance. Some people may have trouble sleeping, need to miss school or work, or have feelings of depression or low self-esteem.
Researchers don’t yet know the exact cause of PN. It may be linked to changes in the immune system. It may result from an increased number of nerve fibers in the skin or higher nerve sensitivity.
People with certain risk factors are more likely to develop the condition. While PN can occur at any age, it is most often diagnosed in people between the ages of 51 and 65. According to a 2018 study, PN is 3.4 times more common in African Americans than in white people.
People with certain chronic health conditions are also more likely to have PN.
PN may develop in people who have underlying skin disorders like:
PN can also be associated with other health conditions, including diabetes, anemia (low levels of red blood cells), gout, and diseases that affect the thyroid, liver, or kidneys. Cancer — including liver cancer, lung cancer, skin cancer, and blood cancers like leukemia and lymphoma — can also increase your risk of PN.
Certain types of medications, such as cancer drugs, antimalarial drugs, and opioids, can also cause itching as a side effect, which sometimes leads to the development of PN.
Having PN doesn’t necessarily mean that you have another serious disease. PN can occur in people who don’t have any other known health problems. However, it’s important to talk to your doctor about whether it might be a good idea to check for any other conditions, especially if you have other symptoms in addition to itchy skin and nodules.
PN can be diagnosed by a dermatologist (a specialist in skin conditions).
PN may appear similar to other conditions, such as pemphigoid nodularis or psoriasis. A dermatology provider can figure out what is wrong by asking what symptoms you have, how often you have them, and how they affect your life.
If you are experiencing itchy skin or nodules, your dermatologist may perform various tests. They may perform a skin scraping, in which they scrape off the top layer of skin cells to be studied under a microscope for the presence of fungus.
Your doctor may also recommend a skin biopsy, through which they remove a small piece of skin to analyze more closely under a microscope. A biopsy can help your dermatologist identify skin changes such as hyperkeratosis (thickened outer skin layer) and inflammation, which are common in PN.
PN is often linked to other medical conditions, so your doctor may also recommend that you undergo additional tests to check for any other health problems.
PN is typically treated by a dermatologist. If your PN is caused by another underlying health problem, a dermatologist may refer you to another specialist to treat that condition.
Treatment often involves a combination of medication and skin care strategies. Your dermatologist may also suggest ways to reduce scratching, which can help the skin heal and prevent new nodules.
Treatment of PN often includes topical creams or ointments that lessen the itching. Some of these creams, including treatments that contain pramoxine, menthol, phenol, or capsaicin, are available over the counter. If these don’t help, your doctor may prescribe stronger topical medications.
Other medications may also help. Corticosteroids can be given as an injection into the affected skin areas. Other injected medications, like biologic therapies, work throughout the body to treat PN.
PN is also sometimes treated with oral medications (drugs taken by mouth as a pill or tablet). These medications often work by calming your immune system or preventing nerve fibers from sending itch signals to your brain.
Cryosurgery, sometimes called cryotherapy, may be an option if other treatments aren’t effective. This treatment involves using extremely cold substances, such as liquid nitrogen, to freeze and remove the nodules or abnormal skin areas. You may need to go through multiple cryosurgery procedures to get relief. This treatment option may not be a good fit for everyone, as it can lead to pain, light spots, or scarring.
Some people manage their PN using phototherapy — treatments using ultraviolet (UV) light. This may be an effective treatment when topical drugs don’t work or when large parts of your body are affected by PN. Another type of light treatment involves using a laser to treat the skin.
Treating any underlying conditions may also help improve PN. Additionally, because many people with PN experience depression and anxiety, treatments such as counseling or taking antidepressants can help improve quality of life.
It can be very difficult to avoid scratching when you have PN. However, scratching at your nodules can lead to infection, cause new nodules to develop, and make treatment less effective.
You may find that certain triggers may worsen itching from PN. Common triggers include:
Identifying and avoiding triggering factors may help you better manage your PN.
It may help to wear long-sleeved shirts and pants or to cover the affected skin with special medicated tape or breathable dressings. You may also want to cut your fingernails very short or wear gloves to prevent deep scratches.
Staying active and busy may also help take your mind off the itching. Try to participate in work, hobbies, or activities to shift your focus.
To improve sleep, consider speaking with your doctor about taking a sedating antihistamine before bedtime. They can help you find the right dose and check for any potential interactions with other medications you may be taking.
Taking care of your skin with fragrance-free moisturizers and gentle, sensitive-skin soaps may also help.
PN may persist for several years. There are many potential treatment options, and it may take time — and trying different medications, therapies, or lifestyle changes — to find what works best for you and helps improve your quality of life.
On MyPrurigoTeam, the social network for people with prurigo nodularis and their loved ones, 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? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Get updates directly to your inbox.
Have Very Itchy Lumps In My Hair, What Can I Use To Calm Them
Sign up for free!
Continue with Facebook
Sign up with your email
Your privacy is our priority.
Become a member to get even more
Join
A MyPrurigoTeam Member
this list includes Leukemia, could PN be somehow related to MDS, which is a precursor to Leukemia?
We'd love to hear from you! Please share your name and email to post and read comments.
You'll also get the latest articles directly to your inbox.