How to manage itchy bumps on the skin?

Question

Hello Doctor,

These itchy bumps are ruining my life. I have been dealing with them for almost a year now. They started on my lower legs but have since spread to my arms, torso, and even my neck. The itching is unbearable, I scratch until I bleed every night, and often wake up to find bloodstains on my sheets.

The bumps are hard, dark brown, and about the size of pencil erasers. Some develop a thick crust on top, which bleeds when scratched off. My skin in these areas has become thick and leathery. I have tried many treatments, including Hydrocortisone, Cetirizine, Gabapentin, and even expensive creams that claim to stop itching.

A dermatologist administered Triamcinolone injections directly into some of the bumps, which helped those specific ones, but unfortunately, new ones keep appearing. The itching intensifies significantly at night and during stressful situations.

My job as a bus driver is becoming increasingly difficult because the constant itching distracts me while driving. I even tried covering my hands with socks at night, but I ended up removing them in my sleep.

I had a skin biopsy done, which showed hypertrophic lichen simplex chronicus versus prurigo nodularis, but the doctor was not definitive. My blood work showed a slightly elevated Immunoglobulin E (IgE) level at 275 IU/mL, but all other parameters were normal.

I am wondering if this could be related to my Lisinopril, which I have been taking for hypertension for the past five years.

The itching feels like bugs crawling under my skin, and scratching one spot often triggers itching elsewhere on my body.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Prurigo nodularis is a related condition, likely a more prominent manifestation. In this disorder, skin lesions (nodules) are thicker and typically multiple. Lichen simplex chronicus is a thickening of the skin in response to repetitive scratching or rubbing. This affected skin becomes lichenified, scaling, and crusted.

Lisinopril tablet(angiotensin-converting enzyme (ACE) inhibitors) can cause itching as a side effect, but it is unlikely to be the sole cause of your symptoms.

The more you scratch, the more bumps form, creating an itch-scratch cycle that can be difficult to break. In 2024, the FDA(food and drug administration) approved Nemolizumab (Nemluvio) (monoclonal antibody) for adults with moderate-to-severe prurigo nodularis.

I suggest the following treatment plan:

Dupilumab (interleukin-4 [IL-4] and interleukin-13 [IL-13] inhibitor).

I hope this helps. Please follow up if there are any concerns.

Thank you.