Antihistamines and steroid creams can help you combat prurigo nodularis itching. Personal-care products include fragrance-free detergents and cleaning bars.
Prurigo nodularis (PN) is a chronic skin inflammatory condition characterized by nodules (firm, itchy bumps) that are often painful. It usually begins with intense itching, which may be generalized or restricted to one part of the skin.
The urge to scratch or rub itchy skin leads to increased itchiness, inflammation, and sometimes hard nodules. These are usually found on the arms and legs.
Atopic (eczema) is more common than prurigo nodular.
PN can significantly reduce a person’s life quality. The itching associated with prurigo nodular may be debilitating, says Dr. Cohen. Some patients cannot sleep or do the things they want or need to do because of their itching.
According to the American Academy of Dermatology, the Treatment for prurigo is focused on three areas:
- Daily skincare practices that reduce skin irritation.
- Medications that can reduce itching directly.
- Topical or systemic therapies (oral or injections) aimed at stopping itch-scratch cycles and flattening skin lesions.
Prurigo Nodularis Skin Care
Cohen says skin care can be a crucial component in managing prurigo nodularis. The following strategies can be used:
- Mild soaps
- Showers and baths that are short but not too hot
- Apply moisturizer throughout the day
- Lotions and ointments that relieve itching are available over-the-counter
- Wearing gloves or mittens to bed at night or trimming your fingernails regularly
- Laundry detergent without fragrance
Shower or bathe with mild soap. Use mild soaps for showering or bathing.
Showers and baths should be a manageable length and cool. Cohen says to limit your shower or bath to 10 to 15 minutes and to dry your skin immediately (using gentle patting rather than rubbing).
Cohen recommends that you avoid scalding baths and showers. “Sometimes, people with prurigo nodularis or other itchy conditions find temporary relief by taking a hot shower. It turns out, however, that you can lose a great deal of moisture from your body, which can lead to irritation and itching.
Apply moisturizer at least three times per day. According to the AAD, using an emollient daily can soothe skin and reduce itching. Cohen recommends using a fragrance-free moisturizing lotion immediately after toweling yourself from the shower or bath.
Apply a topical itch reliever, such as calamine lotion, capsaicin cream, or pramoxine hydrochloride (an anesthetic). The AAD recommends calamine cream, capsaicin lotion, pramoxine chloride (drug), or products that contain camphor, menthol, or phenol.
Avoid unintentional scratching by trimming your fingernails and wearing gloves or mittens when sleeping. Yale Medicine says covering itchy skin with bandages and dressings will help prevent scratching.
Use fragrance-free detergent. Cohen says that people with prurigo nodular need to avoid perfumes. Laundry detergent is one of the places where fragrances can cause problems.
Prurigo nodularis Treatments
There are two main treatments options for prurigo Nodularis:
- Topical corticosteroids
- Topical nonsteroidal medications
- Antihistamines
- Steroid injections
- Phototherapy
- Systemic therapies, such as injectable biologicals
- Cryosurgery is a procedure that uses extreme cold to destroy unwanted tissues.
- Antidepressants
Topical corticosteroidsA staple of prurigo Nodularis Treatment. Cohen says these can effectively reduce itching and even help remove some nodules.
According to the AAD, medical tape coated with corticosteroid relieves itching, serves as a barrier that prevents scratching, and helps flatten bumps.
Cohen says that topical steroids should not be used long-term. They may cause the skin to be thin or turn discolored.
Nonsteroidal Topical Medications Topical TCIs can relieve symptoms of prurigo nodularis. Pimecrolimus, tacrolimus and Protopic are also in this class. Dermatologists can also prescribe a Vitamin D derivate, Calcipotriene.
AntihistaminesAccording to StatPearls, nonsedating antihistamines during the day and sedating ones at night can calm prurigo.
Steroid Treatment “Sometimes, people with a few very annoying spots who don’t respond to topical treatment will respond to steroid injections directly into the lesion,” Cohen says. This can be repeated multiple times, usually once a week. It can help.
Phototherapy Exposure to ultraviolet light (UV) can be the next step in treating prurigo nodularis if topical treatments are insufficient to control inflammation and itching.
Cohen says that people with prurigo nodularis who undergo phototherapy in an office setting are exposed to UV lights in a controlled environment. It’s not the same as going to a sunbed. It’s medical-grade UV light, which is effective and well-tolerated.
Phototherapy requires repeated visits. According to the AAD, patients usually receive phototherapy two to three days a week over several weeks.
Systemic Therapy When topicals and phototherapy are not enough to relieve symptoms, doctors can turn to systemic Therapy, according to the AAD. There are several options:
- Dupilumab Dupilumab injection (Dupixent) is the only treatment for prurigo nodularis approved by the U.S. Food and Drug Administration. Food and Drug Administration. It is a biological drug administered subcutaneously (below the skin). Typically, 300 milligrams are administered every two weeks via prefilled syringes or pens after an initial “loading dose.” The drug was effective in clinical trials such as the study in NatureMedicine. It also reduced or cleared nodules. Cohen describes the medication as “new and highly-effective.”
- Nemolizumab While the FDA hasn’t yet approved this monoclonal antibody for prurigo nodularis, recent research in The New England Journal of Medicine shows that it is effective but associated with gastrointestinal symptoms.
- Immunosuppressants Medicines such as methotrexate and Cyclosporine may help reduce inflammation or itch but can also cause serious side effects.
StatPearls states that Thalidomide, and lenalidomide can be used to treat prurigo nodularis.
Cryosurgery The AAD recommends this Treatment if other treatments do not relieve the pain and itch of prurigo nodular. It’s not the first or second choice for people with darker skin because it can result in light spots or scarring.
AntidepressantsAntidepressants can help reduce itching, according to AAD.
Cohen says that natural and complementary therapies are ineffective in treating prurigo nodularis. Cohen says that some people have tried natural remedies like apple vinegar, but this is not well-researched.
Prurigo Nodularis – Mental Health
Prurigo can have a significant impact on the quality of life for people and their ability to function. Cohen says that treating this condition can help to restore the quality of life we all deserve. It will not only clear up the nodules but also reduce the itching.
Prurigo nodularis increases the risk of depression or anxiety. Cohen says that it’s crucial for doctors and patients with this condition to be aware and to address any possible issues.
The AAD suggests that those with this condition seek counseling or Therapy because of the emotional and mental impact.
Prurigo nodularis: Treatment and Prevention
The AAD says that without Treatment, prurigo nodularis itch and bumps can last for months or even years. After the bubbles have gone, you may see flat dark spots, or lighter spots, where there were once nodules. This is called post-inflammatory skin pigmentation change.
Cohen says that there are several ways to minimize the pigment changes caused by prurigo nodularis. They include:
- Early Treatment
- Sun protection
- Bleaching cream
Early Treatment Managing prurigo nodularis well and treating it early are essential steps to prevent permanent pigment changes, according to Cohen. He says the fewer nodules present, the less likely this will occur.
Sun protection Exposed skin spots and scars can be more visible and lasting longer. Cohen says it’s crucial to use sun protection on the affected areas, especially when they are more visible.
Bleaching cream If preventative measures do not work or pigment changes are not improving, in some cases, a doctor will recommend a bleaching cream, such as hydroquinone. Cohen says this would be done on a case-by-case basis and that the benefits and risks should be carefully considered.