What is prurigo nodularis? This is a skin disease that usually begins with intensely itchy skin. Scratching and rubbing the itchy skin cause hard, itchy bumps to appear on the skin.
Is it contagious? No
Prurigo nodularis on a patient’s leg
This disease causes hard, itchy bumps on the skin. You may see bumps that are red, pink, the color of your skin, or brownish-black.
Before you see the bumps of prurigo nodularis, the skin is often intensely itchy. You may have one or two small areas of itchy skin, or the itch may be widespread. The itch may come in short, intense bursts or be present most of the time.
When the skin itches, it causes an uncontrollable urge to scratch and rub. After about six weeks, hard bumps called nodules to appear where you’ve been scratching and rubbing.
The bumps are also intensely itchy. The frequent scratching can cause scrapes and tears on the skin. Some people scratch until the itchy bumps break open and bleed or the skin feels too painful to touch. The open and injured skin can become infected.
The uncontrollable itch caused this patient to scratch so intensely that some of the bumps broke open and bled.
The scratching can cause more bumps and thick, scaly raised patches. The skin tends to feel extremely dry and inflamed. This dry, inflamed skin also itches, which leads to more scratching.
Why some people develop prurigo nodularis isn’t fully understood. Many who get this disease already have another condition that causes extremely itchy skin like atopic dermatitis, stasis dermatitis, scabies, extremely dry skin, or bullous pemphigoid. All of these conditions can cause repeated itching and scratching, which dermatologists call the itch-scratch-itch cycle.
Treatment for prurigo nodularis focuses on breaking this itch-scratch-itch cycle. If scratching has become something that you do without thinking about it, breaking this cycle can take time.
When dermatologists create a treatment plan for prurigo nodularis, the plan often includes medication, skin care, and tips to help you stop scratching.
Treatment takes time, and no one treatment works for everyone.
Researchers continue to study the itch-scratch-itch cycle and prurigo nodularis so that they can develop more effective and long-lasting treatments for both.
To get the best outcome from treatment, dermatologists recommend starting treatment soon after the itchy bumps appear. You can see how prurigo nodularis can progress without treatment and the different ways that it may appear on the skin at: Prurigo nodularis: Signs and symptoms.
Images Image 1: Used with permission of the Journal of the American Academy of Dermatology:
J Am Acad Dermatol; 2001;44:471-8.
Image 2: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
References Elmariah S, Kim B, et al. “Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus.” J Am Acad Dermatol. 2021;84(3):747-60.
Huang AH, Williams KA, et al. “Prurigo nodularis: Epidemiology and clinical features.” J Am Acad Dermatol. 2020;83(6):1559-65.
LeCourt AP, “Prurigo nodularis.” In: Medscape (Elston DM., Ed.) Last updated 11/13/2020. Last accessed 7/23/2021.
Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Mosby Elsevier, China, 2018: 115-6.
Leis M, Fleming P, et al. Prurigo nodularis: Review and emerging treatments. Skin Therapy Lett. 2021 May;26(3):5-8.
Mullins TB, Sharma P, et al. “Prurigo nodularis.” In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2021 Jan.
Rinaldi G. “The itch-scratch cycle: A review of the mechanisms.” Dermatol Pract Concept. 2019;9(2):90-7.
Silverberg JI. “Nummular eczema, lichen simplex chronicus, and prurigo nodularis.” In: Kang S, et al. Fitzpatrick’s Dermatology. (9th edition) McGraw Hill Education, United States of America, 2019:388-92.
Ständer S, Luger T, et al. “Treatment of prurigo nodularis with topical capsaicin.” J Am Acad Dermatol. 2001;44(3):471-8.
Yosipovitch G and Kwatra SG. “Itch associated with systemic disorders.” In: Living with itch: A patient’s guide. The Johns Hopkins University Press. The United States, 2013:75.
All content solely developed by the American Academy of Dermatology
Prurigo nodularis: Signs and symptoms
Where does prurigo nodularis develop on the body?
Prurigo nodularis causes itchy bumps on the skin, which appear when someone repeatedly scratches, picks at, or rubs their skin. These itchy bumps, which dermatologists call "nodules," can develop anywhere on skin that you can scratch, pick, or rub.
While the itchy bumps can develop anywhere, most appear on one or more of these areas:
Arms
Legs
Upper back
Lower back
Buttocks
Abdomen
What are the signs and symptoms of prurigo nodularis?
The following describes what you may experience if you have prurigo nodularis.
Itchy skin
Before the itchy bumps of prurigo nodularis appear, the skin often itches. This itch can be long-lasting or come in short bursts. Either way, it's often intense. Some people have a few itchy areas. For others, the itch covers much of their skin.
Skin may burn or sting
Instead of feeling itchy, some people say that their skin burns or stings. While rare, patients have said they experience other sensations, like the feeling that bugs are crawling on their skin.
Itchy bumps (nodules) develop
The repeated scratching, picking, or rubbing leads to itchy bumps. The itchy bumps usually appear about six weeks after your skin starts to itch, burn, or sting. Often, the bumps develop evenly on both sides of the body.
Itchy bumps vary in color, size, and number
The bumps can be the color of your skin, pink, red, or brownish black. The size may vary from that of a pinhead to larger than a U.S. quarter. It’s possible to have a few bumps or more than 100 on your skin. For most people, this number falls somewhere in between.
Raised, itchy patches can also develop on the skin.
Scratching can change the skin
Frequently scratching can cause more bumps and raised patches of itchy skin. The more you scratch, the itchier your skin may feel. Some people scratch until the itchy bumps or patches break open and bleed or the skin feels too painful to touch. All this scratching can cause changes. Dark spots may appear. The skin can feel pebbly or hard and thick.
Dark spots, light spots, or scars can appear as the bumps clear
Without treatment, the itch and bumps can last for months or years (A). As the bumps clear, you may see flat dark spots (B), spots that are lighter than your natural skin color, or scars where the bumps once were.
Prurigo nodularis can affect a person’s quality of life
Living with severe and frequent itch can affect your quality of life. Patients have told their dermatologist that the itch causes them to:
Have trouble sleeping
Miss days from work (or school)
Feel sad, shameful, or helpless
Limit social activities
Retire early
Some people have a greater risk of developing prurigo nodularis. Find out if you do, at: Prurigo nodularis: Causes.
Images Images 1-2: Getty Images
Images 3–6: Used with permission of the Journal of the American Academy of Dermatology and JAAD Case Reports:
J Am Acad Dermatol; 2001;44:471-8.
J Am Acad Dermatol; 2013;69:426-30.
J Am Acad Dermatol; 2020;83:1559-65.
JAAD Case Reports; 2019;5:471-3.
References Elmariah S, Kim B, et al. “Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus.” J Am Acad Dermatol. 2021;84(3):747-60.
Huang AH, Williams KA, et al. “Prurigo nodularis: Epidemiology and clinical features.” J Am Acad Dermatol. 2020;83(6):1559-65.
Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Mosby Elsevier, China, 2018: 115-6.
Leis M, Fleming P, et al. “Prurigo nodularis: Review and emerging treatments.” Skin Therapy Lett. 2021;26(3):5-8.
Qureshi AA, Abate LE, et al. “A systematic review of evidence-based treatments for prurigo nodularis.” J Am Acad Dermatol. 2019;80(3):756-64.
Silverberg JI. “Nummular eczema, lichen simplex chronicus, and prurigo nodularis.” In: Kang S, et al. Fitzpatrick’s Dermatology. (9th edition) McGraw Hill Education, United States of America, 2019:388-92.
Whang KA, Le TK, et al. “Health-related quality of life and economic burden of prurigo nodularis.” J Am Acad Dermatol. 2021;28:S0190-9622(21)01028-8.
Yosipovitch G and Kwatra SG. “Itch associated with systemic disorders.” In: Living with itch: A patient’s guide. The Johns Hopkins University Press. United States, 2013:75."
All content solely developed by the American Academy of Dermatology
Prurigo nodularis: Causes
What causes prurigo nodularis?
This disease starts with intensely itchy skin. Scratching, picking, or rubbing the intensely itchy skin causes itchy bumps and patches on the skin. It usually takes six or more weeks of frequent scratching, picking, or rubbing before the bumps and patches appear.
Black people are more likely than white people to develop prurigo nodularis
A study at Johns Hopkins Hospital found that Black patients with prurigo nodularis were also likely to have a condition like kidney disease, hepatitis C, atopic dermatitis, or depression.
Researchers are trying to understand exactly why the itchy skin develops. Many people who develop prurigo nodularis have a condition that makes their skin intensely itchy. These conditions include atopic dermatitis, an allergy, and end-stage kidney disease.
What complicates matters is the following:
Some people who develop prurigo nodularis do not have another condition that causes itchy skin.
Many people who have intensely itchy skin never get prurigo nodularis.
This makes it unclear what causes prurigo nodularis. It’s likely that no one thing causes this disease.
It’s possible that when conditions are just right inside the body, these bumps appear. What makes conditions just right may be intense inflammation inside the body, thickened (and more excitable) nerves due to scratching, and changes in the person’s immune system. More research is needed to find out.
Some people have an increased risk for prurigo nodularis
While studying this disease, researchers have learned that some people have a higher risk of developing prurigo nodularis.
This disease is more common in people who are:
50 years of age or older, usually between 51 and 65 years of age
Black, especially if they have atopic dermatitis that flares often
Living with certain long-term diseases
The long-term diseases that have been linked to a higher risk of developing prurigo nodularis include:
Mental health conditions, including anxiety or depression
While some people have a higher risk of getting prurigo nodularis, it’s important to know that this disease can occur at any age. If you have itchy bumps on your skin that last for more than two weeks, see a dermatologist.
If you have prurigo nodularis, an early diagnosis and treatment can relieve the itch and clear the bumps. When the itchy bumps could be a sign that you have another disease like one listed above, your dermatologist can help you get the care you need.
References Boozalis E, Tang O, et al. “Ethnic differences and comorbidities of 909 prurigo nodularis patients.” J Am Acad Dermatol. 2018;79(4):714-9.
Elmariah S, Kim B, et al. “Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus.” J Am Acad Dermatol. 2021;84(3):747-60.
Huang AH, Williams KA, et al. “Prurigo nodularis: Epidemiology and clinical features.” J Am Acad Dermatol. 2020;83(6):1559-65.
Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Mosby Elsevier, China, 2018: 115-6.
Leis M, Fleming P, et al. “Prurigo nodularis: Review and emerging treatments.” Skin Therapy Lett. 2021;26(3):5-8.
Qureshi AA, Abate LE, et al. “A systematic review of evidence-based treatments for prurigo nodularis.” J Am Acad Dermatol. 2019;80(3):756-64.
Whang KA, Le TK, et al. “Health-related quality of life and economic burden of prurigo nodularis.” J Am Acad Dermatol. 2021;28:S0190-9622(21)01028-8.
Williams KA, Huang AH, et al. “Prurigo nodularis: Pathogenesis and management.” J Am Acad Dermatol. 2020;83(6):1567-1575.
All content solely developed by the American Academy of Dermatology
Prurigo nodularis: Diagnosis and treatment
How do dermatologists diagnose prurigo nodularis?
Your dermatologist can often diagnose prurigo nodularis by examining the itchy bumps and patches on your skin.
If you have more than one skin condition, your dermatologist may need to scrape off a bit of skin or perform a skin biopsy. The skin your dermatologist removes will be examined under a microscope. This close-up view helps your dermatologist give you an accurate diagnosis.
Both a skin scraping and a skin biopsy can be performed during your appointment while you remain awake. A scraping is exactly what it sounds like. Your dermatologist scrapes off a bit of skin. During a skin biopsy, your dermatologist numbs the area and then removes a small amount of skin.
During your appointment, your dermatologist will also ask questions. This helps your dermatologist learn how the itch and bumps affect your life, whether you may have another condition, and important information that can affect your treatment plan.
Because people who develop prurigo nodularis may have another disease, including diabetes, hepatitis C, and untreated HIV, you may need blood tests.
If you have prurigo nodularis, your dermatologist will create a treatment plan tailored to your needs.
Prurigo nodularis may be the first noticeable sign of another disease like lymphoma or untreated HIV
That’s why dermatologists give patients who have prurigo nodularis a thorough exam, order medical tests, and sometimes refer a patient to another medical doctor.
How do dermatologists treat prurigo nodularis?
Treatment often begins before you have the results of your tests. That’s because prurigo nodularis is often treated separately from other conditions — even when another condition causes intensely itchy skin.
If you have lymphoma (a type of cancer) or untreated HIV and prurigo nodularis, treating the cancer or HIV often relieves the itch and clears the bumps.
The goal in treating prurigo nodularis is to stop the itch, so that your skin can heal. To do this, a treatment plan may include one or more of the following.
Anti-itch emollient: Applied to the skin, this can reduce the urge to scratch. It also helps to soften and flatten the bumps and patches.
Itch relief medication (apply to your skin): Your dermatologist may recommend applying menthol, phenol, pramoxine, or capsaicin cream to help relieve the itch. These are available without a prescription. If you need a stronger medication, your dermatologist may prescribe calcipotriol or another medication.
Medication to control inflammation (apply to your skin): Your dermatologist may prescribe one or more of these medications, which you can apply at home: Corticosteroid, pimecrolimus, tacrolimus, or calcipotriol.
Medical tape coated with a corticosteroid: Covering itchy bumps and patches with this tape can help your skin absorb more of the medication. The tape has two more advantages. It can help flatten the bumps and patches. Wearing the tape also puts a protective layer between your nails and your skin, so you cannot directly scratch the bumps and patches.
Cryosurgery: If other treatments fail to relieve the itch and pain, cryosurgery may be an option. However, if you have a dark skin tone, cryosurgery is not a first or second option for treating prurigo nodularis. On darker skin tones, cryosurgery can cause noticeable light spots, scaring, or both. Should the prurigo nodularis fail to go away with other treatments, your dermatologist may talk with you about whether cryosurgery is an option for you.
When cryosurgery is part of your treatment plan, your dermatologist can perform this procedure during an office visit. You remain awake the entire time.
During cryosurgery, your dermatologist will apply a very cold substance like liquid nitrogen to the bumps and patches. Freezing helps to reduce the itch and flatten the prurigo nodularis.
When cryosurgery is used to treat prurigo nodularis, most patients need between two and four treatments. After each cryosurgery treatment, you may see crusting or a blister on your treated skin. This is normal and expected.
Injections of a corticosteroid: If you have a bump or patch that isn’t going away with treatment, your dermatologist may inject the area with a corticosteroid. This injection can relieve the itch and flatten the bump or raised patch.
This type of treatment can only be used on a few bumps or patches.
Phototherapy (also known as light therapy): Studies have shown that this type of treatment can effectively treat prurigo nodularis. Your dermatologist may prescribe phototherapy if you need stronger treatment than you can get from applying medications to your skin — or you have bumps and plaques on large areas of your skin.
Phototherapy is typically prescribed by a dermatologist
This non-invasive treatment exposes you to a prescribed amount of ultraviolet (UV) light for a precise amount of time.
If your dermatologist recommends phototherapy, you must be able to go to your dermatologist’s office or a phototherapy treatment center two to three times per week for a number of weeks.
The excimer laser is a type of phototherapy. For some patients, this laser can effectively treat a stubborn bump or patch of prurigo nodularis that just won’t go away. Research shows that it can work when other treatments fail.
Medication that works throughout your body: If you have widespread or severe prurigo nodularis, your dermatologist may include this in your treatment plan.
One medication that has been used for years to treat prurigo nodularis is an antihistamine that makes you sleepy. It can help prevent itching while you’re asleep.
Taking an antidepressant medication can help relieve the itch while you’re awake.
The medications methotrexate and thalidomide have also been used for years to help heal the skin.
Newer medications that can be effective include dupilumab, nemolizumab (a newer medication designed to break the itch-scratch-itch cycle), gabapentin, or aprepitant.
All medications that work throughout your body are powerful and come with possible side effects.
Help dealing with anxiety, depression, and other feelings: Having prurigo nodularis can be tough. Some people say that the frequent itch and scratching can take an emotional toll on their lives. They may feel less confident, stop getting together with people, or miss time from work or school.
Getting psychological counseling can be helpful if this disease is taking an emotional toll.
Self-care is an essential part of treatment
Following a self-care plan can improve how well treatment works and how well you feel. You’ll find the self-care that dermatologists recommend at: Prurigo nodularis: Self-care.
Images Getty Images
References Elmariah S, Kim B, et al. “Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus.” J Am Acad Dermatol. 2021;84(3):747-60.
Huang AH, Williams KA, et al. “Prurigo nodularis: Epidemiology and clinical features.” J Am Acad Dermatol. 2020;83(6):1559-65.
LeCourt AP, “Prurigo nodularis.” In: Medscape (Elston DM., Ed.) Last updated 11/13/2020. Last accessed 7/23/2021.
Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Mosby Elsevier, China, 2018: 115-6.
Leis M, Fleming P, et al. “Prurigo nodularis: Review and emerging treatments.” Skin Therapy Lett. 2021;26(3):5-8.
Qureshi AA, Abate LE, et al. “A systematic review of evidence-based treatments for prurigo nodularis.” J Am Acad Dermatol. 2019;80(3):756-64.
Williams KA, Huang AH, et al. “Prurigo nodularis: Pathogenesis and management.” J Am Acad Dermatol. 2020;83(6):1567-1575.
Yosipovitch G. “Prurigo nodularis: New treatments on the horizon.” J Am Acad Dermatol. 2020;82(4):1035-6.
All content solely developed by the American Academy of Dermatology
Prurigo nodularis: Self-care
9 tips that can improve treatment for prurigo nodularis
Prurigo nodularis can be difficult to treat. Self-care plays an important role in helping you get the best results from treatment. Here’s the self-care advice that dermatologists give their patients who have prurigo nodularis.
Understand that treatment takes time, and you may need to try different treatments before you find the combination that works for you. Many patients become frustrated and give up too quickly because they don’t see results. Continue to follow your treatment plan. Tell your dermatologist if you have problems following the plan.
Try to stop scratching, rubbing, picking, and touching the skin with prurigo nodularis. Treatment cannot work if you keep scratching. Also, if you continue to scratch, rub, pick, or touch the skin with prurigo nodularis, new bumps can develop, and old ones may not clear.
Dermatologists understand how difficult it can be to stop scratching. Here are a few self-care tips that can help:
Cover the bumps and patches. Covering bumps with clothing like pants, long sleeves, and socks adds a layer of protection between your nails and the bumps. If the area is intensely itchy or inflamed, dermatologists recommend that you bandage the area.
If you are still scratching the bumps through your clothes or bandages, tell your dermatologist. A medicated tape may be an option for you. The medication reduces the itch, and the tape adds a protective layer between your nails and your skin.
Keep your nails short. Fingernails and toenails do less damage when they’re short.
Consider wearing lightweight gloves or mittens. If you can prevent overheating, try wearing gloves or mittens until you can stop scratching. You want to make sure that you don’t overheat, as that can cause your skin to itch.
Be prepared to calm the itch. Prurigo nodularis can cause uncontrollably itchy skin. Here’s what you can do instead of scratching.
Sudden itch? Apply calamine lotion or an anti-itch cream that contains camphor or menthol.
Skin becomes extra itchy at bedtime. Prurigo nodularis often itches when you’re relaxed or in bed. Taking a sedating (can cause drowsiness) antihistamine can relieve bedtime itch. Take this medication only as directed.
Soothe and soften your skin. Apply a fragrance-free emollient throughout the day.
Dermatologists recommend gently applying a fragrance-free emollient several times a day
An emollient can soften and soothe your skin, which may help relieve the itch.
Use gentle skin care products. Any skin care product — soap, cleanser, or emollient — that will touch skin with prurigo nodularis should be:
Made for sensitive skin
Fragrance-free
Make sure the label says, “fragrance free” rather than “unscented”
Unscented means the product contains fragrance, but the fragrance has been covered up.
Be gentle with your skin and use warm water when bathing and showering. Rubbing or scrubbing your skin can make it itchier. To avoid this, gently apply your cleanser and other products that your dermatologist recommends.
Skip the washcloths and buff puffs. You want to apply your skin care products gently with your fingertips. Then rinse well with lukewarm water.
Find out what triggers your itch and figure out how to avoid these triggers. Common triggers for itch are:
Stress
Heat
Sweating
Extreme humidity
Dryness
Personal care products
Clothing made of wool, polyester, or any rough-feeling fabric
If you have trouble avoiding any of your triggers, tell your dermatologist. These are common triggers for many skin conditions. Your dermatologist can offer solutions that can help.
Look for signs of a skin infection. While the goal of treatment is to heal the skin, treatment takes time. It can also take time to stop scratching. During this time, you can develop a skin infection.
If skin with prurigo nodularis develops any of the following signs of infection, call your dermatologist or primary care doctor right away:
Swelling
Discoloration
A warm (or hot) feeling
Pus leaking from open skin
Pain
If you have an infection, you may also have a fever.
Keep your medical appointments. Patients who have prurigo nodularis often see a dermatologist, primary care doctor, and other health care providers. To get the best results from treatment, keep all medical appointments. Doing so will help:
Make sure you know what to do.
Know whether your treatment plan is working or needs to be changed.
Find an infection, which can be serious, early.
Spot a possible side effect early.
Learn the possible side effects of the medications in your treatment plan. A dermatologist tailors each treatment plan to a patient’s unique needs, which helps to reduce the risk of developing side effects. Still, it’s helpful to know what you should watch for. Your dermatologist or pharmacist can tell you.
These self-care tips can help you cope while you’re treating prurigo nodularis – and help the disease from flaring after it clears.
Image Getty Images
References Elmariah S, Kim B, et al. “Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus.” J Am Acad Dermatol. 2021;84(3):747-60.
Mullins TB, Sharma P, et al. “Prurigo nodularis.” In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2021 Jan.
Silverberg JI. “Nummular eczema, lichen simplex chronicus, and prurigo nodularis.” In: Kang S, et al. Fitzpatrick’s Dermatology. (9th edition) McGraw Hill Education, United States of America, 2019:388-92.
