Woman showing her arm to a doctor

Prurigo nodularis (PN) is an intensely itchy skin rash. PN bumps on the skin can range in size from very small to about a half inch in diameter. The number of nodules can vary from 2 to 200.

It is thought that it happens because of scratching the skin. There are a number of reasons for itchy skin.

  • Dry skin.
  • The thyroid is a problem.
  • Chronic kidneys disease.

The itching of PN can be very bad. It is thought to have the highest itch intensity.

It can make the itching worse and cause more bumps to appear.

“It is difficult to treat PN. Let’s look at symptoms and how to manage them.”

A small red itchy bumps can start the PN. It happens when you scratch the skin. The bumps can start on your arms or legs, but can also start on the rest of your body.

The nodules can be very itchy. The bumps may be bigger than they are.

  • It was hard.
  • It was flaky and scaly.
  • There are different colors from flesh tones to pink, brown, or black.
  • There is a person named scabby.
  • Warty looking.

The skin between bumps can be dry. Some people with PN also experience burning, stinging, and temperature variations in the bumps, according to a 2019 review.

Secondary infections can be developed from frequent scratching.

The intense itching can be debilitating, preventing restful sleep and disrupting your daily routine. This in turn can make people with PN feel distressed and depressed.

The person may stop scratching the bumps. Some scars may be left.

The aim of the treatment is to break the itch-scratch cycle.

Your healthcare provider will need to treat any underlying condition that is causing itching and scratching.

The usual treatment for itch relief is systemic drugs.

You may have to try a number of different therapies to find the best one for you.

PN is an understudied disease.

There is no identifiable cause for the itching in some individuals. There is no single effective treatment for these people.

Currently, the U.S. Food and Drug Administration (FDA) hasn’t approved any therapies to treat PN. However, there are many drugs under investigation that could possibly be used off-label to treat the condition.

Discuss possible side effects of your medication with your healthcare provider.

Topical drugs

OTC or prescription remedies can be used to relieve itching and to cool your skin.

Examples can be included.


Your healthcare provider may suggest corticosteroid (Kenalog) injections for some nodules.

Systemic medications

Your healthcare provider may prescribe or suggest OTC antihistamines to help you sleep at night.

They may also prescribe medications that are typically used as antidepressants to help you stop scratching. Paroxetine and amitriptyline have had success in helping PN nodules to improve.

Other therapies

Treatments that can help shrink the nodules and relieve itching include:

  • Cryotherapy. Cryotherapy is the use of ultra-cold temperatures on the lesion
  • Phototherapy. Phototherapy uses ultraviolet light (UV).
  • Psoralen used in combination with UV. Psoralen and UVA used together is known as PUVA.
  • Pulsed dye laser. Pulsed dye laser is a treatment method used to kill diseased cells.
  • Excimer laser treatment. An excimer laser at 308 nanometers has successfully treated PN that didn’t respond to other treatments.

Your healthcare provider may also suggest habit reversal therapy to help you stop scratching.

Newer treatments

Some trials have shown that using drugs off-label can reduce itching.

  • Initial side effects of naltrexone and phine may be caused by the mu-opioid receptor antagonists.
  • The immunesuppressants include cyclosporine and methotrexate.
  • “Gabapenoids are used for people who don’t respond to other treatments or have painful neuropathies.”
  • Thalidomide is considered a last resort because of the possible side effects.
  • nalbuphine and nemolizumab are being tested.
  • isoquercetin, which is a derivative of plant quercetin
  • dupilumab, which is an injectable treatment

It may take some time to find a routine that helps your itching.

A combination of remedies may work well. It is important to break the itch-scratch cycle to prevent more nodules and allow the old ones to resolve.

In addition to OTC creams and prescribed medications.

  • Use an ice pack to cool itchy areas.
  • Take a lukewarm, short bath with colloidal oatmeal.
  • It is advisable to use a hypoallergenic cream or Vaseline.
  • Use fragrance-free soaps and other products for sensitive skin.


Contact Nodular Prurigo International for more information or to join its private Facebook group or open Facebook group.

Participating in a PN clinical trial is also an option.

The cause of the skin problems is not fully understood, but they are believed to be caused by an itch.

Several conditions have been associated with PN.

It is thought that PN occurs when other conditions cause persistent itching and scratching, resulting in the characteristic lesions.

Even when the underlying condition is resolved, PN is said to sometimes persist.

Also, a 2019 study notes that about 13 percent of people with PN have no predisposing illness or factors.

Researchers are looking at the underlying mechanisms involved in the project.

  • Changes in skin cells.
  • Nerve fibers.
  • The immune system and thepeptides change.

Researchers expect that better treatments will become available as the cause of the development becomes clearer.

Fast facts

  • PN is most common in people between ages 20 and 60.
  • PN affects men and women equally.
  • PN is rare. There are few studies of its prevalence or incidence. A 2018 study of 909 patients with PN found that African American patients were 3.4 times more likely to have PN than white patients.

It is difficult to prevent until the exact mechanism of PN is known. It may be the only way to not scratch the skin.

If you have a disease or genetics that make you prone to PN, watch your skin. If you have long-term itch, see a healthcare provider. Try to stop the cycle before it starts.

Many remedies can help relieve itching before it becomes difficult to manage.

There is a skin condition called PN that can be disabling. It is known to be associated with several other conditions, but its exact cause is not fully understood.

It may take a while to successfully manage your PN. It is likely that a combination of drugs and therapies will work for you.

Several new drugs and therapies are undergoing testing and are the good news. More targeted effective therapies will be developed as researchers learn more about the PN mechanism.