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Nodular prurigo

What are the aims of this leaflet?

This leaflet has been written to help you understand more about nodular prurigo (NP).  It tells you what it is, what causes it, what can be done about it, and where you can find out more about it.

What is nodular prurigo?

‘Pruritus’ is the medical term for itching.  ‘Prurigo’ is a related word, which describes the changes that appear in the skin after it has itched and been scratched for a long time.  In nodular prurigo, these changes take the form of firm very itchy bumps (nodules) on the skin surface.  These will go away if the scratching that caused them stops – but this is easier said than done. 

What causes NP?

It is not known what causes NP or makes the skin react in this way.  However, once the skin has become itchy, scratching and rubbing keep the problem going and make it worse. 

• If you are under stress of any sort, it is more likely that you will scratch and so stress can make nodular prurigo worse.
• NP starts after an insect bite in a few patients.
• More patients with NP are atopic (i.e. have asthma, eczema or hay fever) than would be expected by chance. 

Is NP hereditary?

No.

What are the symptoms of NP?

The itching can be very distressing - bad enough to wake you at night and disturb your daytime activities.  It is often very hard not to scratch the skin lumps, which may bleed and can become sore as well as itchy.

What does NP look like? 

The skin shows many lumpy, hard areas that are intensely uncomfortable.  They may be browner than the skin around them.  They have a rough rather warty surface and may have a scab or a scratch mark on top.  The lumps are usually less than 1cm in width.  They feel firm and can be tender as well as itchy.  The arms and legs are the most commonly affected areas, but the back, buttocks, shoulders and chest can be affected too.  NP is most common between the ages of 20 and 60. 

How is NP diagnosed?

The story of itch, and the look of the lumps, is usually enough to make the diagnosis of NP.  If there is any doubt, then a skin biopsy (cutting out one of the bumps under local anaesthetic to examine it under the microscope) can help to confirm the diagnosis. 

Can NP be cured?

No.  It is hard to clear nodular prurigo quickly, but it can usually be helped and can gradually improve.  If you could stop scratching or rubbing, the NP would slowly get better and disappear, but you would still be very itchy for some weeks.  However most people find it impossible not to scratch such an itchy skin without help. 

How can NP be treated?

NP is hard to live with and does not respond quickly to treatment.  Treatments are aimed at stopping the skin itching: 

• A steroid cream or ointment will usually be suggested first as an attempt to reduce the inflammation in the skin.  It should be applied once or twice a day.  The strength of the steroid used will depend on your age, on the sites of the bumps, and on the severity of the problem.  Injecting a small amount of a steroid into a particularly itchy nodule can sometimes help too.
• Covering the skin with a paste or a paste bandage can increase the effect of the steroid.  It also helps to reduce the itch and the damage to the skin caused by scratching or rubbing.
• An antihistamine tablet or syrup can help to reduce the feeling of itch.  Those that work best for NP can also make you feel a bit sleepy, so should not be taken if you are driving or using machinery.
• Ultraviolet light treatment, given in the hospital, can help.
• If NP is very severe and bothersome, treatments to reduce inflammation can be taken by mouth.  Tablets of steroids, or of other immune-suppressing treatments such as cyclosporin, can help but have more side effects than steroid creams.  Thalidomide can help severe NP, but must not be given to any female who might possibly become pregnant as it can damage the unborn baby. 

What can I do?

The most important but hardest thing to do is to stop scratching. 

·         Anything you can do to take your mind off the itching will help to reduce or stop the scratching.  Ask your family and friends to remind you gently if they notice that you are scratching – it is easy to get into the habit of scratching, and you can do it without being aware that you are.

• You may find that laying a cool damp flannel on the skin can take down the feeling of itch.  A cooled moisturiser may also help. 
• Keep your bedroom cool and do not sleep with too heavy or hot bedclothes.  If you are hot and itchy during the day, a fan can help to cool the skin down. 

Where can I get more information?

Website: www.dermnetnz.org 

(While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Your own doctor will be able to advise in greater detail)

BAD PATIENT INFORMATION LEAFLET

PRODUCED NOVEMBER 2004