Diagnosing & Treating Mild Prurigo Nodularis

Prurigo nodularis is a chronic skin condition characterized by itchiness and hard bumps or nodules, which form a symmetrical rash. Prurigo can be anywhere on the body but is often concentrated on the arms, legs, back, or abdomen. Symptoms can range from mild to severe. Mild prurigo may look like just a few itchy bumps, whereas severe prurigo can bring several hundred. The bumps can be the color of your skin, pink, red, or brownish-black. 

This article will cover what causes prurigo, symptoms, diagnosis, and available treatments. 

Prurigo Causes

The exact cause of prurigo is unknown, but it is associated with nerve cell and immune system dysfunction. The skin of people with prurigo tends to have more immune cells and dense nerve fibers causing itchiness than people without prurigo. Prurigo can occur independently or alongside other skin conditions.

 Mild Prurigo Symptoms

Skin itching may begin up to six months before prurigo nodules (itchy bumps) appear on the skin. The discomfort associated with this condition leads to scratching and creates skin changes which may increase the risk of infection. Other symptoms of prurigo include:

• Burning or stinging
  
• Skin changes, like discoloration or scarring from scratching

Mild prurigo can disrupt daily functioning. The American Academy of Dermatology says the following are all possible effects of having prurigo.

• Sleeping troubles (due to itching or discomfort)
• Missed days from school or work 
• Feelings of shame, sadness
• Limiting social activities
• Changing life plans (like retiring early)

Diagnosing Prurigo

Diagnosing prurigo involves an examination by a healthcare provider or skin specialist like a dermatologist. This exam can include a visual assessment of the size, color, and spread of skin nodules or skin biopsy, allowing your healthcare provider to look closely at the nodules under a microscope.  

It can be helpful to your healthcare provider to know when symptoms began and what types of treatment you have tried. Consider keeping a journal of symptoms to discuss with your healthcare provider.

If a skin biopsy confirms prurigo, you can expect follow-up tests to determine the possible cause. Tests may include:

• Complete blood cell count (CBC) for assessing overall health status, infection, and how well the immune system is functioning 
• Comprehensive metabolic panel (CMP) that includes liver and kidney function tests
• Thyroid hormone panel for diagnosing systemic diseases
• Stool sample to test for parasites
• HIV testing, if deemed necessary

Treatment

Even mild cases of prurigo require clinical treatment since it’s unlikely to go away on its own. Treatment will depend upon the underlying cause. For example, if you have prurigo due to a bacterial infection, treatment will focus on resolving the infection. 

Dupixent (dupilumab) is the first and only Food and Drug Administration (FDA) approved medication for the treatment of adults with prurigo nodularis. In addition, there are options used off-label to treat other skin and immune system disorders that your healthcare provider may recommend, including:

• Elidel (pimecrolimus)
• Protopic (tacrolimus)
• Dovonex (calcipotriol)

Anti-itch cream can be applied to the skin to reduce the urge to scratch. Topical medications may include corticosteroid creams. In some cases, corticosteroids may be injected directly into the skin.

Your healthcare provider might recommend alternative treatments such as cryosurgery or light therapy (phototherapy).

Behavioral adjustments are another option that can help reduce skin dryness and scratching. Treatments include:

• Keeping fingernails trimmed
• Wearing long sleeves 
• Covering fingers with gloves
• Bandaging bumps
• Cleaning skin with gentle cleansers
• Keeping skin moisturized
• Avoiding warm environments to reduce sweating

Summary

Mild prurigo is a chronic skin condition that causes itchiness, and skin bumps called nodules. Causes are associated with nerve cell and immune system dysfunction. Diagnosis will depend upon the results of an examination and skin biopsy. Treatment varies depending on the underlying cause but may include medications or behavioral changes to help reduce the itchiness and ability to scratch.

A Word From Verywell 

Skin conditions can be mentally and physically troubling. The itching and the skin bumps may feel out of control or unmanageable to cope with. Following a self-care plan can improve how well a treatment works and how well you feel. If you’re experiencing embarrassment, shame, frustration, anger, or feeling like hiding yourself from others, you may want to consider reaching out to a mental health professional. They can help you process these feelings and develop coping strategies.