Condition

Prurigo Nodularis Treatment in Houston

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Medically reviewed by Harrison P. Nguyen, MD, MBA, MPH, FAAD — board-certified dermatologist
Last reviewed: September 2026

Understanding Prurigo Nodularis

What is Prurigo Nodularis?

Prurigo nodularis (PN), or nodular prurigo, is a chronic inflammatory skin condition characterized by lesions formed from nodular lichenification and hyperkeratosis. Produced by repetitive scratching or picking of the skin. Persistent scratching and picking of the skin cause additional inflammation of the skin, causing further pruritus and nodules.

Most commonly present in middle-aged adults, patients experience a significant impact from loss of physical function, increased pruritus, and diminished quality of life. Treatment options help achieve decrease in itch and improved skin clearance. Without proper treatment, symptoms can develop and persist. It is recommended to seek consult from a board-certified dermatologist upon symptom onset.

Before-treatment photo of lower legs affected by prurigo nodularis

Signs and Symptoms

Prurigo nodularis is characterized by multiple intensely itchy, burning, and stinging hyperkeratotic lesions with varying degrees of central scale-crust, erosion, or ulceration. These lesions will begin as normal skin that will be traumatized by itching until a dome-shaped papulonodule forms.

If symptoms persist for over two weeks, see a board-certified dermatologist.

Causes and Underlying Biology

Evidence has shown that prurigo nodularis is caused by a persistent itch-scratch cycle causing a cascade of inflammation and additional itching. More specifically, this cycle is perpetuated by neuroimmune and type-2 inflammation. Current treatments aim to calm and regulate inflammatory cytokines involved in prurigo nodularis pathogenesis.

Risk Factors

The cause of prurigo nodularis is not completely known, but many risk factors and underlying conditions have been identified to contribute to its pathogenesis. Prurigo nodularis has been linked to other skin conditions not limited to atopic dermatitis, contact dermatitis, and lichen planus. Prurigo nodularis is also associated with conditions outside the skin, including chronic kidney disease, thyroid disorders, diabetes, HIV and other chronic infections, and - less commonly - lymphoma. Because of these associations, your dermatologist may order bloodwork to screen for an underlying cause alongside treating the skin. It can also affect patients with no associated condition at all.

How it is diagnosed

It is advised to schedule a consult with your dermatologist to diagnose and treat prurigo nodularis. Your dermatologist will examine clinical features and histories to determine narrow differentials. They may perform a small scrape of your skin to examine under a microscope; a procedure called a skin biopsy. This allows your provider to confirm their diagnosis and pursue an optimal treatment plan.

Prurigo Nodularis Treatment Options

Currently, two FDA-approved therapies are available for the treatment of prurigo nodularis
  • Nemluvio is an FDA approved biologic therapy that is an IL-31 receptor antagonist that blocks IL-31 cytokines that is strongly associated with the nerve signals involved in the itch-scratch cycle. This is an effective treatment for moderate to severe prurigo nodularis by modulating drivers of itch and inflammation.
  • Dupixent is an FDA approved biologic therapy that is an antagonist blocker for IL-4 receptor-alpha that regulates IL-4 and IL-13 cytokines. This effectively inhibits the type-2 inflammation involved in prurigo nodularis reducing itch and lesion formation.
  • Corticosteroids applied topically can help lower inflammation in affected areas to decrease pruritus. Relieving pruritus, topical corticosteroids can interrupt the itch scratch cycle in localized areas. An important consideration for topical corticosteroids is skin atrophy so always use as advised by your provider.
  • Intralesional corticosteroids is a treatment option chosen for thick persistent nodules resistant to topical therapies. Intralesional injection provides more immediate symptom relief by calming inflammation.
  • Hydrocolloid bandages are effective in enhancing the application of topical corticosteroids. By protecting the skin from itching and delivering topical corticosteroids, these bandages calm inflammation and protect the skin from further trauma effective for disruption of itch-scratch.

Nemluvio vs. Dupixent for Prurigo Nodularis

Both are injectable biologics approved for prurigo nodularis, and both work by calming the inflammatory signals that drive chronic itch — but they target different pathways. Nemluvio (nemolizumab) blocks the IL-31 receptor, the signal most directly tied to the sensation of itch, which often means faster itch relief. Dupixent (dupilumab) blocks the IL-4 receptor alpha subunit, regulating the broader type-2 inflammation behind both the itch and the skin lesions. Which one fits depends on your symptom pattern, other conditions such as atopic dermatitis or asthma, and your insurance coverage. Your dermatologist will walk through both options at your consultation.

Prurigo Nodularis Treatment Outcomes

With adequate control of disease symptoms, significant reduction in itch severity and skin clearance are expected clinical outcomes. These reductions have downstream effects on patients, improving sleep, confidence, and quality of life.
Progress photo of lower legs affected by prurigo nodularis
After-treatment photo of lower legs affected by prurigo nodularis

Living with Chronic Itch

Patients living with prurigo nodularis experience physical function, mental distress, and diminished quality of life revolving around chronic itch. Chronic itch is an unpleasant sensation for patients with prurigo nodularis; the itch is exacerbated. The itch interferes with processes such as focus, while scratching causes further skin trauma perpetuating the itch-scratch cycle. It can cause patients to have increased emotional effects from: depression, anxiety, and distress because of chronic nature if prurigo nodularis.

Frequently Asked Questions

No. Prurigo nodularis is not contagious or infection and cannot be spread from person to person. It is a chronic inflammatory skin condition that develops due to the itch-scratch cycle, with no viral, bacterial, or fungal involvement.

There is no cure for prurigo nodularis; it is a chronic inflammatory condition. Current treatments are aimed at controlling symptoms. Current treatments aim to control pruritus to allow the skin to heal.

Discoloration from prurigo nodularis, known as post-inflammatory hyperpigmentation/hypopigmentation, results from trauma to lesions. It's important to control symptoms to prevent additional discoloration. Discoloration is expected to improve with adequate control of symptoms over time. However, intervention of prescriptions, procedures, and sun protection can be recommended by your dermatologist to treat discolorations.

Prurigo nodularis is not an autoimmune disease but instead is caused by dysregulated immune and inflammatory pathways. More specifically caused by type 2 inflammation and itch signaling.

Prurigo nodularis is considered an acquired inflammatory disease. Although there are genetic factors that can increase a patient’s susceptibility to the disease, they are not the reason a patient will develop PN.

Why Choose Harrison Dermatology?

With Harrison Dermatology, we offer patient-centered care with one thing in mind: you. Our team of providers delivers evidence-based, comprehensive dermatological care. We work closely with industry leaders with efforts in pursuing research and advancing medicine. Our promise to you is that we will deliver compassionate care tailored to each patient. At Harrison Dermatology we believe that you shouldn’t let your skin condition control your quality of life. Our goal is that every patient that walks through our doors will be able to regain their confidence and leave feeling better than they entered.
Dr. Harrison Nguyen eczema and chronic itch specialist in Houston

Dr. Harrison P. Nguyen, MD, MBA, MPH

Trishann Nguyen, PA-C, eczema care provider in Greater Houston.

Trishann T. Nguyen, MPAS, PA-C

Harrison Dermatology

Schedule your appointment with Harrison Dermatology today

References

  • Liao V, Cornman HL, Ma E, Kwatra SG. Prurigo nodularis: new insights into pathogenesis and novel therapeutics. Br J Dermatol. 2024;190(6):798-810. doi:10.1093/bjd/ljae052
  • Kwatra SG, Ständer S, Yosipovitch G, Kim BS, Levit NA, O'Malley JT. Pathophysiology of Prurigo Nodularis: Neuroimmune Dysregulation and the Role of Type 2 Inflammation. J Invest Dermatol. 2025;145(2):249-256. doi:10.1016/j.jid.2024.06.1276
  • Patrick MT, Wu Y, Zhong X, et al. IL31 identified as a key genetic risk factor for prurigo nodularis. J Allergy Clin Immunol. 2025;156(5):1410-1413. doi:10.1016/j.jaci.2025.06.031
  • Shawn G. Kwatra, Sonja Ständer, Gil Yosipovitch, Brian S. Kim, Noah A. Levit, John T. O’Malley, Pathophysiology of Prurigo Nodularis: Neuroimmune Dysregulation and the Role of Type 2 Inflammation, Journal of Investigative Dermatology, Volume 145, Issue 2, 2025,