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Patient Information Leaflet

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 may start 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 lumps, 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 scratch mark on top. The lumps are usually less than 1 cm 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. There may additionally be some pale scars in the affected areas from deep scratching. NP is most common between the ages of 20 and 60. The number of nodules may increase with time.

How is NP diagnosed?

Symptoms of itching 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 a local anaesthetic to examine 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 controlled and therefore gradually improve. Try to avoid scratching or rubbing and the NP will 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, or covering it with steroid tape, can sometimes help too. 
• Covering the skin with an ointment 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. Some tablets have both antihistamine and anti-stress effects, such as doxepin, and can be helpful taken at night.
  
• 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. Immune-suppressing treatments such as steroid tablets, or ciclosporin, can help but have more side effects than steroid creams. Thalidomide can help severe NP but it is usually not 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 reduce the feeling of itch. A cooled moisturiser (kept in the refrigerator or with added menthol) may also help.
  
• Keep your bedroom cool and do not sleep with 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?

Links to patient support groups:

Nodular Prurigo UK
136 Bedford Street South
Liverpool
L7 7DB
www.nodular-prurigo.org.uk
E-mail: info@nodular-prurigo.org.uk

Web links to detailed leaflets:

www.dermnetnz.org/dermatitis/prurigo-nodularis.html (includes photographs)

The British Skin Foundation fund vital research into all skin diseases. To find out how you can help, please visit the British Skin Foundation website here.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor. 

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED AUGUST 2004
UPDATED MAY 2010