Prurigo nodularis (PN), also called nodular prurigo, is a chronic (long-term) inflammatory skin condition that causes severe itching. The intense itch often leads to scratching and picking, which can cause hard, raised bumps (called nodules or picker’s nodules). These nodules can become even itchier, leading to broken skin and sometimes infection.

Prurigo nodularis may occur alongside other systemic (whole-body) medical conditions, such as:

• Atopic dermatitis (the most common subtype of eczema)
• Bullous pemphigoid (a condition that causes skin blistering)
• Psoriasis
• Chronic kidney disease
• Thyroid problems
• HIV infection and AIDS
• Cancer

Many of these medical conditions also cause itchy skin, which can lead to scratching, nodule formation, and skin thickening. In this article, we’ll cover PN symptoms, show prurigo nodularis pictures, and explain what to look for if you think you might have this condition.

What Does Prurigo Nodularis Look Like?

People with prurigo nodularis often experience pruritus (intense itching), which leads to frequent picking and scratching at the skin. The skin thickens in response, resulting in prurigo nodularis symptoms like itchy bumps, nodules, and scarring.

Prurigo nodularis can appear anywhere you scratch or pick at your skin. However, the bumps tend to appear more often in certain areas, such as the:

• Arms
• Upper and lower back
• Abdomen
• Legs
• Buttocks
• Back of the scalp

Picker’s nodules are less common in the middle of the back, likely because that area is harder to reach and scratch.

Intense Itching and Crawling Sensation

PN skin symptoms often start with intense itching, burning, or stinging. Some people have described a rare sensation that feels like bugs are crawling across their skin.

These sensations can be triggered by:

• Stress
• Insect bites
• Other skin conditions, such as eczema or lichen planus (an inflammatory skin condition that causes flat, discolored bumps)
• Brachioradial pruritus (a nerve-related condition that causes itching and stinging on the forearms)

Once itching begins, scratching often follows. In prurigo nodularis, this leads to the formation of hard, itchy bumps called nodules. These nodules can worsen the itch, leading to the itch-scratch cycle. Dermatologists often recommend treatment options that focus on breaking this cycle to keep new nodules from developing.

Papules, Nodules, or Plaques

Prurigo nodularis skin lesions can range in size from 0.2 inches (0.5 centimeters) to 1.2 inches (about 3 centimeters). The lesions’ size and depth help determine how they’re classified:

• Papules are small, raised spots that are usually less than 0.4 inches (1 centimeter) in size.
• Nodules are typically larger than 0.4 inches and go deeper into the skin, affecting both the epidermis (outer layer) and the dermis (inner layer).
• Plaques are also wider than 0.4 inches, but they tend to spread across the surface of the skin rather than going deeper.

PN rashes and lesions tend to be symmetrical, meaning they appear on both sides of the body in the same place. Some people may have only a few nodules, whereas others may develop many more, even hundreds. Nodules can match your natural skin tone or be red, pink, purple, brown, or black, depending on your skin and how they heal.

Thickened Skin and Scarring

Ongoing scratching in prurigo nodularis can cause the skin to become thick, rough, and scarred. This thickening is called lichenification or hyperkeratosis — a process in which the skin produces too much keratin (a protective protein) in response to constant irritation. These areas may look and feel like calluses.

PN nodules may last for months to years, depending on how severe your condition is. Even after the bumps recede and fade, they may leave behind lasting signs, such as:

• Flat, dark spots where nodules once were
• Scars from repeated scratching
• Lighter areas of skin where pigment has been lost

Skin Infections

People with PN may develop secondary bacterial infections. Scratching or picking at nodules can break the skin and cause open wounds, allowing bacteria to enter and multiply. Symptoms and signs of an infected nodule or lesion include:

• Discoloration and swelling
• Pain or tenderness
• Crusting or oozing
• Warmth around the area
• Fever (in more serious cases)

If you notice signs of infection, it’s important to talk with your healthcare provider right away.

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Mental Health Symptoms of Prurigo Nodularis

Living with a skin disorder like prurigo nodularis can take a toll on mental health and overall quality of life. Because skin conditions are often visible, many people feel self-conscious, anxious, or stigmatized. Researchers have studied how PN affects mental health — and the emotional impact is significant.

Depression, Anxiety, and Other Mental Health Conditions

Depression and anxiety are common in people living with chronic skin conditions such as prurigo nodularis. One study found that out of 7,095 people with PN, 1,513 (about 21 percent) had anxiety, and 1,228 people (about 17 percent) were living with a mood disorder such as depression or bipolar disorder.

Constant itching and the urge to scratch can make it difficult to focus, work, or enjoy everyday life. According to the American Academy of Dermatology, people with PN have reported that the condition interferes with going to work or school, and it keeps them from participating in social events or activities.

Sleep Problems

Intense itching from prurigo nodularis can make it difficult to sleep, a symptom known as nocturnal pruritus (nighttime itching). Poor sleep can cause daytime fatigue, trouble concentrating, and low energy, which can further affect your mood and mental health.

Talk With Your Doctor

If you’re living with both physical and emotional symptoms of prurigo nodularis, know that support is available. Talk with your dermatologist or healthcare provider about ways to manage both your skin and your mental well-being — and boost your quality of life.

Find Your Team

On MyPrurigoTeam, the social network for people with prurigo nodularis and their loved ones, members from all over the world come together to ask questions, give advice, and share their experiences with others who understand life with prurigo nodularis.

Do you have prurigo nodularis? Share your experience in the comments below, or start a conversation by posting on your Activities page.