Treating Prurigo Nodularis: Medications and Home Remedies

The primary therapy decisions for prurigo nodularis are:

• Topical corticosteroids
• Nonsteroidal topical drugs
• Antihistamines
• Steroid injections
• Phototherapy
• Systemic therapies corresponding to injectable biologics
• Cryosurgery (procedures utilizing excessive chilly to destroy undesirable tissue)
• Antidepressants

Topical Corticosteroids A mainstay of prurigo nodularis therapy. “These could be very efficient at decreasing itch and may even truly assist take away a number of the nodules themselves,” Cohen says.

Medical tape coated with a corticosteroid can relieve itch, function a protecting barrier to forestall scratching, and assist flatten bumps, per the AAD.

However topical steroids aren’t a long-term therapy: They’ll solely be used for about two weeks or so at a time as a result of they’ll skinny or discolor pores and skin, says Cohen.

Nonsteroidal Topical Drugs Topical calcineurin inhibitors (TCIs) can assist with signs of prurigo nodularis, says Cohen. Different drugs on this group embody pimecrolimus (Elidel) and tacrolimus (Protopic). Dermatologists may prescribe a vitamin D by-product, calciprotriene (Dovonex).

Antihistamines Nonsedating antihistamines for daytime and sedating antihistamines at bedtime could calm prurigo nodularis itchiness, per StatPearls.

Steroid Injections “Individuals who have just a few very bothersome spots that don’t reply properly to topical remedy generally do reply to steroid injection proper into the lesion,” says Cohen. “This may be completed a number of occasions, usually as soon as a month, and that may actually assist.”

Phototherapy Publicity to ultraviolet (UV) gentle could be a subsequent step for individuals with prurigo nodularis when topical therapies aren’t doing sufficient to handle irritation and itching.

“Folks with prurigo nodularis who do phototherapy get uncovered to UV gentle in a really managed setting within the workplace; it’s not like going to a tanning mattress,” says Cohen. “It’s a medical grade UV gentle that could be very particular, efficient, and properly tolerated.”

One problem with phototherapy is that it requires repeat visits. Sufferers often obtain it two to 3 occasions per week for a number of weeks, in line with the AAD.

Systemic Therapies If phototherapy and topicals aren’t doing an enough job of relieving signs, medical doctors could flip to systemic therapies, per the AAD. Among the many decisions:

• Dupilumab Dupilumab (Dupixent) injection is the primary and solely prurigo nodularis therapy permitted U.S. Food and Drug Administration (FDA). It’s a biologic remedy administered by way of subcutaneous (under the pores and skin) injection: usually, a 300 milligram dose administered by way of pre-filled syringe or prefilled pen each two weeks after an preliminary “loading” dose. In scientific trials, corresponding to one reported in the journal NatureMedicine, the drug resulted in important enhancements in itch and in decreasing or clearing nodules. Cohen calls the remedy “new and extremely efficient.”
• Nemolizumab Though the FDA has not but permitted this monoclonal antibody for prurigo nodularis, research published in the The New England Journal of Medicine has proven that the remedy is efficient however is related to gastrointestinal unwanted side effects.
• Immunosuppressants Drugs corresponding to methotrexate or cyclosporine can blunt the immune system with the intention to cut back irritation and assist with itch, however additionally they could trigger critical unwanted side effects.

Thalidomide and lenalidomide are immunomodulators (drugs that have an effect on the immune system) which might be generally used to handle prurigo nodularis, per StatPearls.

Cryosurgery This therapy can be utilized if others don’t assist with the itch and ache of prurigo nodularis, says the AAD. Nevertheless it’s usually not a primary or second choice in individuals with darker pores and skin as a result of it could trigger noticeable gentle spots, scarring, or each.

Antidepressants Antidepressants could assist relieve itch, in line with the AAD.

As for pure or complementary therapies for prurigo nodularis, none have been confirmed to assist, says Cohen. “Some individuals have tried treatments corresponding to apple cider vinegar, however that’s not likely one thing that’s been properly researched,” he says.