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Description:
Prurigo nodularis is a disease with multiple pruritic nodules. The individual lesions are approximately pea sized, firm and erythematous/copper-brown in color. Chronic lesions may appear fissured, crusted or verrucal. Prurigo nodularis is one of the disorders in which the pruritus is unbearably severe and relieved only by scratching to the point of damaging the skin, usually inducing bleeding and often scarring.

Location:
Prurigo nodularis most commonly occurs on the extremities, especially on the anterior surfaces of the thighs and legs. A linear arrangement is common.

Etiology:
The cause is unknown. Emotional stress, atopic dermatitis, anemia, HIV disease, pregnancy, renal failure, photodermatitis and insect bites have been considered as contributing factors.

Hallmark of the disease:
Hundreds of copper brown firm nodules that have superficial excoriations.

Treatment:
Treating prurigo nodularis is very difficult and challenging. Local measures include antipruritic lotions and emollients. The initial treatment of choice is topical steroids. Phototherapeutic measures combined with topical and oral medications have also been reported to be effective. Dr. Crutchfield will carefully evaluate and design a treatment program most appropriate for each individual case.

Normal course:
The course of the disease is chronic and the lesions evolve slowly. Treatment is to break the itch/scratch cycle.

Patient Education:
To comply with the prescribed treatments and to be aware that scratching the lesions will worsen the condition.

Nursing Measures:
To review patient education goals, access compliance and to monitor side effects and effectiveness of the treatment plan. Monitor and maintain patient comfort.