How to manage prurigo nodularis?

Question

Hello doctor,

I have been dealing with severe eczema since childhood, but recently, I have developed these extremely itchy hard bumps that my doctor says are prurigo nodularis. Is this connected to my eczema? Will steroid creams make the nodules worse? Can diet changes help with this condition? The itching is so intense that I cannot focus on anything else. I have tried cold showers, antihistamines, and every cream I could find, but nothing stops the itching for more than an hour. I have had to take time off work because I cannot concentrate because of the constant need to scratch.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Prurigo nodularis (PN) often develops in people with long-term eczema, allergies, or other chronic skin conditions. It is a nerve-related itch disorder, meaning your skin’s itch-scratch cycle is overactive. Scratching thickens the skin, causing the hard, raised nodules that won’t heal.

Will steroid creams help or make it worse?

Regarding steroid creams,

Mild benefit: Topical steroids reduce inflammation but do not fully stop the itch.
Not enough: Long-term use can thin the skin and make PN more stubborn over time.

Stronger options: Your doctor may suggest: These include:

Topical calcineurin inhibitors (immunosuppressants) (Tacrolimus, Pimecrolimus) – Less skin thinning, safer for long-term use.
Pramoxine (local anesthetic) lotion – Helps with nerve-related itching.
Biologic treatments (Dupixent (interleukin inhibitors), Nemolizumab (humanized monoclonal modified immunoglobulin 2 antibody), or JAK (Janus kinase) inhibitors like Upadacitinib (targeted synthetic disease-modifying antirheumatic drugs)) – Most effective for severe PN.

There is no direct cure through diet, but some people find relief by:

Eliminating common eczema triggers (dairy, gluten, processed sugars, alcohol).
Eating anti-inflammatory foods – Omega-3 fatty acids (salmon, walnuts), turmeric, and vitamin D may help.
Avoiding histamine-releasing foods (tomatoes, spinach, fermented foods) if your histamine intolerance worsens your itching.

Other itch-relief strategies include:

Capsaicin cream (analgesic agent) – It blocks itch signals.
Menthol or cooling lotions – They help numb the itch temporarily.
Oral medications – Naltrexone (Opiate antagonist), Gabapentin (anticonvulsants), or Mirtazapine (Tetracyclic antidepressants) may help with nerve-driven itch.

Kindly consult a specialist doctor, talk with them, and take medications with their consent.

I hope this helps.

Thank you.