How to manage prurigo nodularis?

Question

Hi doctor,

I have been dealing with these crazy, itchy nodules for about eight months now. They started on my forearms but now spread to my back, stomach, and legs. The itch is so bad at night that I barely sleep and scratch till they bleed, which seems to make more appear. My dermatologist diagnosed prurigo nodularis after a biopsy, but the treatments are not working. I tried Clobetasol cream, antihistamines, and even Gabapentin 300 mg with minimal relief. I had phototherapy three times weekly for two months, which helped a little bit, but insurance stopped covering it. The nodules are getting bigger and darker, and some are turning into scars. I recently noticed my TSH was 6.2 and wonder if thyroid problems could be related. My anxiety is getting worse because of all this - I lost my job last month because I looked unprofessional with all these sores. What treatments work for severe cases? I am desperate enough to try anything at this point.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

This is distressing and challenging. It must be done to deal with prurigo nodularis and the associated symptoms.

Thyroid connection: Elevated TSH (thyroid stimulating hormone) levels can indicate hypothyroidism, which might contribute to skin issues and itching. It is important to address this with your healthcare provider to see if thyroid treatment could help.
Treatment options: For severe prurigo nodularis, treatments that might be considered include:
Systemic therapies: Medications like Cyclosporine, Methotrexate, or Thalidomide can be effective but require close monitoring.
Biologics: Newer treatments like Dupilumab have shown promise in managing severe cases.
Behavioral therapy: Cognitive-behavioral therapy (CBT) can help manage the itch-scratch cycle and associated anxiety.
Consultation: It is crucial to work closely with your dermatologist and possibly seek a second opinion to explore these options.

Please book a consultation with me if you would like more detailed information on any of these points, or if you have other questions.

I hope this information will help you.

Thanks.