Prurigo nodularis / Nodular prurigo
- These are extremely pruritic firm lumps about 1– mm in diameter that erupt on the arms, legs and trunk. They can affect all ages and may manifest in late pregnancy.
- Scratching leads to:
- Enlargement resulting in a nodular, raised, warty surface
- Nodules tend to be firm and small but can measure up to 3 cm in diameter
- Older nodules are normally darker and are surrounded by paler, dry skin
- Nodules are grouped and follow a symmetrical distribution
- Some may ulcerate increasing infection risk
- Healed lesions can leave a scar or discolouration
- Definite diagnosis is with skin biopsy.
- They tend to run a long course and are difficult to treat.
DDx
- Atopic dermatitis
- Pemphigoid nodularis
- Nodular scabies
- Multiple keratoacanthomas
- Reactive perforating collagenosis
Mx
- Topical steroid cream or ointment
- stops scratching the lesions, as this can make the condition worse.
- Strategies that can help include:
- Keeping your mind busy
- Cooling the affected areas: Laying a cool flannel on the skin may reduce inflammation and help ease the itching
- some people keep flannels in the fridge for this purpose
