Prurigo nodularis (PN) is a chronic skin inflammation that is which is characterized by itchy, challenging, and sometimes uncomfortable bumps (nodules) on the skin. It usually begins with an intense itchiness that may be widespread or restricted to a particular area within the human body.
The need to rub and scratch areas cause itching and inflammation, ultimately developing hard nodules in the areas that were repeatedly scratched. Typically, they are on the legs, arms, and trunk, says Jeffrey Cohen, MD, an associate professor of dermatology at the Yale School of Medicine in New Haven, Connecticut.
Although prurigo nodularin is not common, those suffering from the condition are likely to suffer from other, more frequent skin disorders that cause severe itching, such as Atopic skin dermatitis (eczema).
PN can significantly impact the quality of life of a person. “The itching associated with prurigo nodularis can be absolutely debilitating,” Dr. Cohen said. “Some patients can’t sleep at night or engage in activities that they need or want to engage in because they’re so itchy.”
Treatment for prurigo nodular centers on three major areas as per the American Academy of Dermatology (AAD): skincare and daily routines to lessen itching and irritation to the skin and itchiness; medicines that help reduce itching directly and also through topical (applied on your skin) as well as systemic (oral and injectable) treatments that aim to stop the scratch-itch cycle and reducing the lesions on the skin.
Common Questions & Answers
What is the most effective solution for prurigo? The best treatment for prurigo is determined by several aspects, such as the patient’s health and age and the seriousness of their issue. Most doctors use topical steroids for the first line of treatment and then move to other treatments when needed. What is the reason for prurigo nodularis? What creams work best for prurigo? Which medications are approved to treat prurigo nodularis?
Skincare for Prurigo Nodularis
Skincare products can play an essential role in assisting with the management of prurigo nodularis, according to Cohen. The strategies include:
- Mild soaps
- Showers that are short, not too hot, or baths
- A moisturizer that is applied throughout the day.
- Over-the-counter lotions, itch-relieving creams, and Ointments
- Regularly trimming your fingernails or wearing gloves or mittens at the night
- Fragrance-free laundry detergent
Make use of mild soaps when bathing or showering. Abrasive soaps, such as scent-free or liquid cleansers, may irritate the skin and aggravate itching.
Ensure baths and showers are short, and avoid making these too heated. Keep your shower or bath not more than 10 minutes or fifteen minutes and then dry the skin (gently patting but not rubbing) as soon as possible, suggests Cohen.
Cohen is also adamant about avoiding scalding baths and showers: “Sometimes people with these extremely itchy conditions such as prurigo nodularis experience temporary relief by taking the bath in a hot and steamy shower. But, it’s clear that if you take a hot shower you’ll likely lose a significant amount of the moisture your skin loses, which can cause inflammation and itching.”
Apply a moisturizer several times per every day. Applying an emollient daily can ease skin irritation and reduce itching, per the AAD. Applying a non-fragrance moisturizer after removing yourself after a shower or bath is a great idea, Cohen suggests. Cohen.
Dab over-the-counter products for reducing itch, such as ointments and lotions. In addition to regular moisturizers, topicals that relieve irritation can help soothe skin, claims Cohen. According to the AAD, there are calamine lotions, capsaicin cream, pramoxine hydrochloride (an anesthetic), and other products containing menthol, camphor, or phenol.
Keep your fingernails neat, and wear gloves or mittens during sleep to prevent accidental scratching. Also, covering the areas itchy with dressings or bandages may reduce scratching, per Yale Medicine.
Make sure you use a fragrance-free detergent. “People with prurigo nodularis should avoid fragrances, and one place where this can be a problem is laundry detergent,” Cohen explains. Cohen.
Treatments for Managing Prurigo nodularis
The primary treatment options for prurigo nodularis include:
- Topically corticosteroids
- Nonsteroidal topical medicines
- Antihistamines
- Steroid injections
- Phototherapy
- Systemic therapies like injectable biologics
- Cryosurgery (procedures that use extreme cold to eliminate unwanted tissue)
- Antidepressants
Topical corticosteroids are a significant component of prurigo nodularis treatment. “These can be very effective at reducing itch and can even actually help take away some of the nodules themselves,” Cohen declares.
According to the AAD, medical tape coated with a corticosteroid may relieve itching, act as a layer to stop scratching, and can help smooth bumps.
However, they aren’t an effective treatment for long-term use. They’re only available for two weeks or more for some time since they may cause a loss of volume or color to the skin, according to Cohen.
According to Cohen, nonsteroidal Topical Medicines Inhibitors of the calcineurin system (TCIs) are an excellent option for treating the symptoms of prurigo. Other drugs in this class are pimecrolimus (Elidel) and tacrolimus (Protopic). Dermatologists might also prescribe the vitamin D derivative called calcipotriene (Dovonex).
AntihistaminesNonsedating antihistamines to treat daytime allergies and sedating antihistamines before bed may help soothe prurigo nodularis itching, as StatPearls.
Steroid Injections “People who have a few very bothersome spots that don’t respond well to topical therapy sometimes do respond to steroid injection right into the lesion,” Cohen says. Cohen. “This can be done multiple times, generally once a month, and that can really help.”
Phototherapy exposure to UV (UV) light is an option for those suffering from prurigo nodularis if the topical treatments aren’t enough to control itching and inflammation.
“People with prurigo nodularis who do phototherapy get exposed to UV light in a very controlled setting in the office; it’s not like going to a tanning bed,” Cohen says. Cohen. “It’s a medical grade UV light that is very specific, effective, and well tolerated.”
One issue in phototherapy is the fact that it demands repeated sessions. Patients get it three to four times weekly for some weeks, as per the AAD.
Systemic Therapy If topicals and phototherapy aren’t effective enough in relieving symptoms, physicians might turn to systemic therapies as per the AAD. There are several options:
- Dupilumab Dupilumab (Dupixent) injection was the first treatment for prurigo nodularis approved by the U.S. Food and Drug Administration (FDA). It is a biological drug given via under cutaneous (below on the skin) injections: usually 300 milligrams given via a prefilled syringe or pen every two weeks after taking the first “loading” dose. In clinical trials like one published by the scientific journal NatureMedicine, The drug produced significant improvement in the itch of itch and in clearing or reducing nodules. Cohen says the treatment is “new and highly effective.”
- Nemolizumab While the FDA has yet to approve this monoclonal antibody to treat prurigo nodularis, studies published in The New England Journal of Medicine have proved that the treatment works. However, it comes with adverse stomach consequences.
- Immunosuppressants Medicines such as methotrexate or cyclosporine may weaken the immune system to lessen inflammation and reduce itching. However, they can also result in serious adverse side effects.
Thalidomide and lenalidomide are both immunomodulators (medications that alter the immunity system) that are often used to treat prurigo solubility, according to StatPearls.
Cryosurgery This procedure is utilized if other methods fail to assist with the pain and itch of prurigo nodularis. The AAD. However, it’s not usually an option first or last for people who have darker skin, as it could cause noticeable small spots, scarring, or both.
AntidepressantsAntidepressants can help reduce itching by the guidelines of the AAD.
No natural or alternative treatments for prurigo nodularis have been shown to aid, according to Cohen. “Some people have tried remedies such as apple cider vinegar, but that’s not something that’s been well researched,” Cohen declares.
Prurigo Nodularis and Mental Health
Prurigo nodularis has the potential to have a massive impact on the quality of life and life functions. “Treating this condition not only helps clear the nodules and reduce the itch, but it can also help restore quality of life, which we all deserve,” Cohen says. Cohen.
Prurigo nodularis is linked to an increased risk of anxiety or depression. It’s crucial for both doctors and those with the disorder to know about these possible issues to detect and treat the mood disorder, according to Cohen.
Due to this mental and emotional toll due to this mental and emotional burden, the AAD advises people suffering from the disease to seek Therapy or counseling.
Prurigo Nodularis Scarring: Prevention and Treatment
Without treatment, the itching and bumps from prurigo nodularis may last for several months or even for years, According to the AAD. If the bubbles disappear, the flat dark spots or spots lighter than the surrounding skin can remain where the nodules were, a condition known as post-inflammatory pigment changes.
According to Cohen, there are several key ways to limit the changes in pigment caused by prurigo nodularis. This includes:
- Early treatment
- Sun protection
- Bleaching cream
Early treatment The treatment of prurigo nodularis earlier and addressing it correctly is a crucial step to avoid permanent change in pigmentation, says Cohen. “The fewer nodules that develop, the lower the potential for this,” Cohen declares.
Sun Security The exposure of skin spots and marks to the sun makes the color changes more apparent, but it could also cause them to last longer. “It’s important to be careful and use sun protection, especially in those affected areas — this can help them fade over time,” Cohen says. Cohen.
Bleaching Cream In some instances, if preventative measures do not perform and the pigment changes don’t improve, a physician may suggest bleaching creams like hydroquinone. It’s the basis of a case-by-case origin and involves carefully taking into account the benefits and risks the doctor says. Cohen.