Prurigo Nodularis

Prurigo Nodularis

Overview

Prurigo nodularis is a chronic skin condition characterized by intensely itchy, firm nodules that develop as a result of repeated scratching or picking. The itch-scratch cycle perpetuates the condition, with nodules becoming thickened and hard over time. It can be extremely debilitating and is often associated with underlying conditions such as atopic dermatitis, kidney disease, or liver disease.

Key Symptoms

  • Multiple firm, dome-shaped nodules on the skin
  • Intense, often unbearable itching
  • Nodules typically 1-3 cm in diameter, hard and well-defined
  • Hyperpigmented or skin-colored with a rough, excoriated surface
  • Distributed symmetrically on arms, legs, and trunk
  • Central back often spared (butterfly sign — areas the patient cannot reach)

Affected Areas

Arms, Legs, Trunk, Upper back, Buttocks

Care Instructions

  1. See a dermatologist for evaluation and to rule out underlying systemic causes of itching.
  2. Break the itch-scratch cycle with potent topical corticosteroids or topical calcineurin inhibitors.
  3. Intralesional corticosteroid injections can flatten individual nodules.
  4. Oral medications such as gabapentin, pregabalin, or dupilumab may be prescribed for itch control.
  5. Keep nails trimmed short and consider wearing cotton gloves at night.
  6. Phototherapy (narrowband UVB) may be effective for widespread disease.

Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult a qualified dermatologist for diagnosis and treatment.

Prevalence: Uncommon but increasingly recognized; more common in middle-aged and older adults