Prurigo nodularis: Signs and symptoms

Where does prurigo nodularis develop on the body?

Prurigo nodularis causes itchy bumps on the skin, which appear when someone repeatedly scratches, picks at, or rubs their skin. These itchy bumps, which dermatologists call "nodules," can develop anywhere on skin that you can scratch, pick, or rub.

While the itchy bumps can develop anywhere, most appear on one or more of these areas:

• Arms

• Legs

• Upper back

• Lower back

• Buttocks

• Abdomen

What are the signs and symptoms of prurigo nodularis?

The following describes what you may experience if you have prurigo nodularis.

Itchy skin

Before the itchy bumps of prurigo nodularis appear, the skin often itches. This itch can be long-lasting or come in short bursts. Either way, it's often intense. Some people have a few itchy areas. For others, the itch covers much of their skin.

Skin may burn or sting

Instead of feeling itchy, some people say that their skin burns or stings. While rare, patients have said they experience other sensations, like the feeling that bugs are crawling on their skin.

Itchy bumps (nodules) develop

The repeated scratching, picking, or rubbing leads to itchy bumps. The itchy bumps usually appear about six weeks after your skin starts to itch, burn, or sting. Often, the bumps develop evenly on both sides of the body.

Itchy bumps vary in color, size, and number

The bumps can be the color of your skin, pink, red, or brownish black. The size may vary from that of a pinhead to larger than a U.S. quarter. It’s possible to have a few bumps or more than 100 on your skin. For most people, this number falls somewhere in between.

Raised, itchy patches can also develop on the skin.

Scratching can change the skin

Frequently scratching can cause more bumps and raised patches of itchy skin. The more you scratch, the itchier your skin may feel. Some people scratch until the itchy bumps or patches break open and bleed or the skin feels too painful to touch. All this scratching can cause changes. Dark spots may appear. The skin can feel pebbly or hard and thick.

Dark spots, light spots, or scars can appear as the bumps clear

Without treatment, the itch and bumps can last for months or years (A). As the bumps clear, you may see flat dark spots (B), spots that are lighter than your natural skin color, or scars where the bumps once were.

Prurigo nodularis can affect a person’s quality of life

Living with severe and frequent itch can affect your quality of life. Patients have told their dermatologist that the itch causes them to:

• Have trouble sleeping

• Miss days from work (or school)

• Feel sad, shameful, or helpless

• Limit social activities

• Retire early

Some people have a greater risk of developing prurigo nodularis. Find out if you do, at: Prurigo nodularis: Causes.

Images
Images 1-2: Getty Images

Images 3–6: Used with permission of the Journal of the American Academy of Dermatology and JAAD Case Reports:

• J Am Acad Dermatol; 2001;44:471-8.

• J Am Acad Dermatol; 2013;69:426-30.

• J Am Acad Dermatol; 2020;83:1559-65.

• JAAD Case Reports; 2019;5:471-3.

References
Elmariah S, Kim B, et al. “Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus.” J Am Acad Dermatol. 2021;84(3):747-60.

Huang AH, Williams KA, et al. “Prurigo nodularis: Epidemiology and clinical features.” J Am Acad Dermatol. 2020;83(6):1559-65.

Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Mosby Elsevier, China, 2018: 115-6.

Leis M, Fleming P, et al. “Prurigo nodularis: Review and emerging treatments.” Skin Therapy Lett. 2021;26(3):5-8.

Mullins TB, Sharma P, et al. “Prurigo Nodularis.” [Updated 2020 Sep 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

Qureshi AA, Abate LE, et al. “A systematic review of evidence-based treatments for prurigo nodularis.” J Am Acad Dermatol. 2019;80(3):756-64.

Silverberg JI. “Nummular eczema, lichen simplex chronicus, and prurigo nodularis.” In: Kang S, et al. Fitzpatrick’s Dermatology. (9th edition) McGraw Hill Education, United States of America, 2019:388-92.

Whang KA, Le TK, et al. “Health-related quality of life and economic burden of prurigo nodularis.” J Am Acad Dermatol. 2021;28:S0190-9622(21)01028-8.

Yosipovitch G and Kwatra SG. “Itch associated with systemic disorders.” In: Living with itch: A patient’s guide. The Johns Hopkins University Press. United States, 2013:75."

Written by:
Paula Ludmann, MS

Reviewed by:
Shari Lipner, MD, PhD, FAAD
J. Klint Peebles, MD, FAAD
Caroline Robinson, MD, FAAD

Last updated: 9/14/21