Itch & Neuropathic
Prurigo Nodularis
WHAT IS IT
Very itchy, firm bumps from chronic scratching
HOW COMMON
Uncommon but under-recognized
CONTAGIOUS?
No — you cannot catch it or spread it
CURABLE?
Manageable; newer treatments help greatly
What Is It?
Prurigo nodularis causes firm, intensely itchy bumps (nodules), usually on the arms, legs, and trunk. The severe itch leads to scratching, which creates and thickens the nodules in a self-perpetuating cycle. It can be very distressing, but newer treatments have improved control significantly.
Signs & Symptoms
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Firm, raised, intensely itchy bumps (nodules)
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Often symmetric on the arms, legs, and trunk
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Scratched, crusted, or scarred tops
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Itch that is severe and hard to ignore
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Areas that are hard to reach may be spared
Why Does It Happen?
It arises from an intense itch that is often neuropathic (nerve-related) and immune-driven. Persistent scratching thickens the skin and inflames nerves, worsening the itch. It can be linked with other conditions such as eczema, kidney or liver disease, thyroid problems, or nerve issues, so a workup is often helpful. It is NOT contagious.
Treatment Options
Treatment targets the itch and the immune response, and protects the skin from scratching. Newer targeted therapies have notably improved outcomes for stubborn cases.
TOPICAL / INJECTED STEROIDS
Calm inflammation and itch in the nodules.
NERVE-CALMING MEDICINES
Gabapentinoids or certain antidepressants for neuropathic itch.
BIOLOGICS / SYSTEMICS
Dupilumab and other options for moderate-to-severe disease.
WORKUP
Checking for underlying causes (skin, kidney, liver, thyroid, nerve).
Tips for Managing It at Home
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Protect the skin from scratching (covering, short nails)
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Moisturize and use cool compresses for relief
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Treat any underlying condition contributing to the itch
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Seek support — the itch burden and its impact are significant
When to Call Your Provider
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Severe itch disrupting sleep or daily life
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Signs of skin infection in scratched areas
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Symptoms suggesting kidney, liver, or thyroid issues
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Poor response to current treatment (ask about newer options)
Sources & further reading
The information in this handout is based on general dermatology guidance from the reputable organizations below. These links are provided for patients who wish to read more from trusted sources.
American Academy of Dermatology (AAD). Prurigo Nodularis. https://www.aad.org/public/diseases/a-z/prurigo-nodularis-overview
DermNet. Prurigo Nodularis. https://dermnetnz.org/topics/nodular-prurigo
MSD/Merck Manual. Pruritus. https://www.msdmanuals.com/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/pruritus
This handout is for general education and does not replace advice from your own provider. Always follow your provider’s specific instructions.
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