Treatment

This disorder is typically resistant to treatment (1).

• local treatments used in this condition include:
  • emollients - cooling applications such as 0.5% menthol in aqueous cream
  • oral antihistamines taken at night to reduce pruritus and allow sleep
  • topical steroid creams - may be applied occlusion
  • coal tar ointment as steroid alternative
  • other local treatments that have been used in this condition include:
    • calcipotriol ointment
    • capsaicin cream
    • pulsed dye laser
    • topical tacrolimus 0.1% has been shown to be effective in a case report (1)
    • cryotherapy - thought to cause destruction of sensory nerves and impairment of nerve regeneration
• systemic treatments used in this condition include:
  • ciclosporin has been reported to be successful in managing nodular prurigo when administered orally (2)
  • thalidomide
  • phototherapy (UVB and PUVA)
  • naltrexone has been reported to have a high antipruritic effect in patients with prurigo nodularis (4)

Reference:

1. Edmonds EV et al. Nodular prurigo responding to topical tacrolimus. Br J Dermatol. 2004 Jun;150(6):1216-7
2. Woo PN et al. Br J Dermatol. 2000 Jul;143(1):215-6.
3. Berth-Jones J, Smith SG, Graham-Brown RAC. Nodular prurigo responds to cyclosporin. Br J Dermatol 1995; 132: 795–9.
4. Lee MR, Shumack S. Prurigo nodularis: a review. Australas J Dermatol. 2005 Nov;46(4):211-18