There are a lot of treatments offered for prurigo nodularis. Here are some of the latest in the literature:
Author: Daniel J Hogan, MD, Affiliate Teaching Faculty, Sun Coast Hospital; Investigator, Hill Top Research, Florida Research Center
Coauthor(s): Siobahn M Bower, MD, Internal Medicine Resident, Creighton University; Sharron M Mason, MD, BS, Staff Physician, Department of Intrernal Medicine, University of Kansas School of Medicine; Stephen H Mason, MD, Assistant Professor of Dermatology, Medical College of Georgia
Current available treatments of PN have had mild-to-moderate success at best. Often, combinations of several medications or physical modalities may be used in an attempt to control this process.
•Topical, oral, and intralesional corticosteroids have all been used in attempts to decrease inflammation and sense of itching and to soften and smooth out firm nodules. The improvement with corticosteroids is variable, and corticosteroids are sometimes not helpful.
•Menthol, phenol, pramoxine, capsaicin cream,14 vitamin D
-3 ointment,15 and topical anesthetics are some other topical agents used to reduce pruritus. Treatment with DuoDerm or other occlusive therapies has been suggested to flatten lesions while at the same time preventing patients from directly scratching nodules.16
•UV light treatment using UV-B17 or UV-A plus psoralen may be beneficial for severe pruritus. Consider the adverse effects of prolonged UV exposure before such treatment. Monochromatic 308-nm therapy may be helpful for recalcitrant lesions.18 UV-A1 has also been reported to benefit lichen simplex chronicus and PN.19
, anxiolytics, opiate receptor antagonists, and (most recently) thalidomide are oral medications other than steroids used for PN. Thalidomide20,21 has been shown to aid in several severe dermatoses, including PN with or without associated HIV disease.17,22 Severe teratogenic effects are well known and documented, and all women of childbearing age should be on adequate birth control methods. Patients taking thalidomide have an increased risk of peripheral neuropathy
•For steroid unresponsive patients or those with lesions on thin skin, a few case reports and small studies have shown efficacy of the topical immunomodulators tacrolimus and pimecrolimus.
•Anecdotally, gabapentin has been reported to benefit PN.23 Sedation is the main problem with this generic medication.
•Habit reversal therapy for the itch-scratch cycle associated with PN may be helpful and can be administered by dermatology nurses trained in this therapy.24
•Cryotherapy with liquid nitrogen helps reduce pruritus and flatten lesions.25,26
?Thirty-second thaw cycles with 2-4 treatments are recommended, depending on the size of the lesion.
?Understanding the risks of scarring and change in pigmentation (especially in darker-skinned individuals) is important.
?Cryotherapy may be combined with other modalities (eg, intralesional corticosteroids).
•Pulsed dye laser therapy may help reduce the vascularity of individual lesions.
Please talk to you dermatologist about the above treatments to see which is best suited for your condition. Please review the article below: