Prurigo nodularis (PN) can cause uncomfortable skin rashes, blisters, nodules, and itchiness. Understanding the lifestyle choices that make symptoms better or worse can be essential to living well with the disease.

Like many chronic (ongoing) conditions, PN is linked to high levels of inflammation in the body. Your health care team will advise which treatments can help reduce your symptoms, which may include topical steroids, lotions, oral medications, corticosteroids, and injectable biologics (medications that come from living sources). But you may also choose to make changes in your diet that can help reduce symptoms.

Although you may not be able to identify specific foods that can trigger your PN to flare, avoiding certain inflammatory foods and ingredients you may be allergic or sensitive to can help keep your condition under control.

Foods That Increase Histamines

An overactive immune system may be responsible for itchiness and rashes in people with PN. Compounds in the body called histamines can trigger those immune responses. Therefore, doctors may prescribe antihistamines as a first-line treatment option to suppress those reactions. Studies show, however, that about 5 percent of total histamine levels come from gut bacteria and the foods you eat, which means dietary changes can be important when trying to control your histamine levels.

There are no established guidelines for a low-histamine diet, but you can get started by avoiding certain foods. For example, you can reduce histamine in your diet by eliminating aged or fermented foods, as well as:

• Chicken eggs
• Chocolate
• Fermented soy products
• Hard and semihard cheeses
• Mushrooms
• Oily fish
• Pickled vegetables and sauerkraut
• Sausage
• Shellfish
• Wine and beer

Any meat or fish should be consumed fresh. In addition, you should steer clear of fruits and vegetables that promote histamine release, such as:

• Avocados
• Bananas
• Citrus fruits
• Eggplant
• Kiwi
• Papayas
• Pineapples
• Plums
• Spinach
• Strawberries
• Tomatoes
• Citrus fruit (lemon, lime, orange)

Keep in mind that low-histamine diets are not necessarily proven to improve PN, but there have been documented dermatological benefits that may make it worth a try. If you suspect specific allergies are affecting your histamine levels and PN symptoms, you can make an appointment with an allergist to undergo allergy testing.

Pro-Inflammatory Foods

PN flare-ups (periods of worsening symptoms) can be associated with high levels of inflammation. That’s why dermatologists often prescribe immunosuppressants to keep inflammation down in people with PN. Fortunately, several lifestyle changes can help reduce inflammation, including avoiding certain foods. Cutting back on pro-inflammatory ingredients may improve the underlying causes of your skin symptoms, or at least help prevent your skin disease from getting worse.

People with other inflammatory skin conditions like atopic dermatitis and eczema have reported positive changes after avoiding white flour, gluten, nightshade vegetables (tomatoes, eggplant, potatoes, and peppers), dairy, alcohol, and junk food. Everyone reacts to food differently. The generally nutritious items on this list (like nightshades, gluten, and dairy) might not be a trigger for you. However, most people would benefit from reducing their intake of white flour, alcohol, and processed foods.

Consider cutting down on these items to start lowering inflammation:

• Alcoholic beverages
• Fast-food meals and fried foods
• Ice cream
• Pancakes, buns, and bagels
• Processed snacks (like pretzels and chips)
• Soda and other sugar-sweetened beverages
• Sugary breakfast cereals
• Sweet desserts and candy
• Refined carbohydrates (white bread)
• Red meat

Luckily, there are many anti-inflammatory foods you can consider:

• Berries and cherries
• Chia seeds
• Dark chocolate (more than 70 percent dark)
• Green tea
• Lentils
• Olive oil
• Nuts and nut butters
• Whole grains, like brown rice, millet, and quinoa
• Green, leafy vegetables

Many people find that adopting a Mediterranean-style diet that focuses on whole foods helps reduce inflammation and symptom prevalence in people with skin disorders. This diet includes fruits, nuts, whole grains, and healthy oils. Mediterranean diets aren’t just about the food but also influence the way you eat. Taking the time to slow down, cook meals from scratch, and enjoy dining with others in a relaxed environment can have a positive effect on your inflammation levels from a mental and physical perspective.

Stimulant Foods and Beverages

PN can lead to a cycle of itchy skin, and scratching promotes more lesions and skin damage. For some people, this can lead to a mental and emotional toll that can be just as strong as the physical symptoms. Many people with PN find that anxiety and stress can raise inflammation and increase the severity of the skin disease. If this sounds familiar, you may want to reconsider the role of stress-promoting ingredients (like caffeine) in your diet.

Caffeine can put your body in a constant state of stress that makes the urge to pick or scratch your skin even worse. Caffeine can also keep you up at night, giving your skin less time to heal and recover from PN flare-ups. Plus, it’s dehydrating and may lead to itchy, dry skin if you’re not drinking enough water. However, some older research suggests that topical caffeine may help reduce inflammation, especially when combined with topical steroids, but this has not been confirmed.

You can try switching from regular coffee to decaf or reducing the number of cups you drink per day to start reducing your caffeine intake. Also, be sure to watch out for caffeine in teas, chocolate, soda, and energy drinks. You may be surprised at the various ways caffeine is sneaking into your day.

Elimination Diets

Remember that although diet may play a role in your PN symptoms, it’s probably not the primary or sole cause of the condition. Making dietary changes can help, but consuming an overly restrictive diet can lead to malnutrition and a lower quality of life. To avoid unnecessary food restrictions, you can experiment with an elimination diet.

A registered dietitian can guide you through the process of avoiding potential triggers for a set period of time and reintroducing them one at a time. Monitor any changes or symptoms to determine what works best for you. In addition, keeping a food diary as you go will help you learn more about your triggers and safe foods, so you can include as much variety in your diet as possible. Remember, food is one of the joys of life. It’s important to search for helpful ways to modify your eating habits without feeling deprived.

Talk With Others Who Understand

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

Have you noticed a connection between what you eat and your PN symptoms? How has PN affected your eating habits and other lifestyle choices? Do you avoid certain foods or ingredients? Share your experiences in a comment below or on your Activities page.