What is the treatment for prurigo nodularis?

Question

Hey doctor,

These bumps on my skin are driving me insane. I have had them for about nine months now, and they have spread from my lower legs to my arms, back, and even my neck. The itching is unbearable, and I wake up with blood on my sheets from scratching at night. I even tried wearing cotton gloves, but I just took them off in my sleep. The nodules are hard, raised, and dark brown, some almost black and about the size of pencil erasers. My dermatologist prescribed Triamcinolone cream, which barely helps, and Hydroxyzine pills, which just make me a zombie at work. I teach high school, and my students keep asking what is wrong with my skin, which is embarrassing. The nodules that have healed left these dark spots that do not fade. I tried phototherapy twice weekly for a month but could not continue due to my work schedule. My sister has eczema and suggested Tacrolimus ointment, but my insurance would not cover it without prior authorization. When I scratch one bump, it triggers intense itching in others, like a chain reaction that I cannot control. My laboratory work showed slightly elevated IgE (290 IU/mL), but everything else was normal. My quality of life has plummeted because of constant itching and pain. Could this be related to my thyroid condition? I take Levothyroxine 88 mcg daily for hypothyroidism. What treatments work for prurigo nodularis? I am desperate for any relief.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

It would be better if you could share some pictures of the lesion. Also, all the treatment and investigations were done in the last nine months. Meanwhile, you can follow the instructions below for seven days and then follow up.

Calamine lotion for local application during the day.
Dermiford (Ketoconazole) ointment for local application at night.
Take a tablet of Chymoral forte plus twice daily.
Take a tablet of Bilastine 5 mg at night and Methylprednisolone 8 mg twice daily.
Take a tablet of multivitamins with antioxidants.
Review immediately if there is a fever or more intense itching.
Covering the affected area with an occlusive dressing and hydrocolloids generally adheres well.
Cooling the affected areas. Lying a cool flannel on the skin may reduce inflammation and help ease the itching. Some people keep flannels in the fridge for this purpose.
Keep rooms at a cool temperature.
Avoid sleeping with heavy or multiple bedclothes.
Avoid wearing clothes made of synthetic fibres and cotton is preferable.
Replace soaps or bath gels that may irritate the skin with an emollient.
Apply emollients at least twice a day, especially if you have dry skin.

I hope this information will help you.

Thanks.