Prurigo nodularis is a chronic skin disease that causes hard, itchy lumps or nodules to form on the  skin.

            And, the itching can be so intense that it causes people to scratch themselves to a point of bleeding or

pain and the scratching can cause more lesions to appear. And,these.skin nodules or lumps usually appear in

a symmetrical  pattern in easy to reach places  such as the arms,legs or upper back.

           Therefore, prurigo nodularis causes a scratch itch cycle since the more you itch,the more you scratch

and the more yopu scratch, the more you itch. Consequently,treatment includes  topical(applied on the skin),

oral and intralesional(ie,injected) corticosteroids in an allemp to alleviate the inflammation and the sense

of itching.

         In addition, antihistamines and anti-anxiety drugs  are also given orally as well as a drug notorious for

causing  birth defects called thalidomide-although this drug and its derivatives can only be given to women

of child bearing age if they are on strict birth control  measures.

         Also, there are small case studies showing the potential for  the use of methotrexate,a folic acid

antagonist widely used for autoimmune inflammatory disorders such as psoriasis.

        However,before treatment especially in recalcitrant cases,a thorough history and physical exam as well

as lab work should be done to rule out underlying medical conditions such as severe anemia or liver and

kidney disease or a type of malignancy called lymphoma as well as HIV(human immunodeficiency virus).

        In my practice,I have even done skin biopsies on various skin nodules to rule out a type of skin

cancer called squamous cell carcinoma which can eventuate from chronic itching and skin irritation.

      In conclusion,I would urge anyone with long  term itchy, crusty skin   lesions to contact their

healthcare provider  to ascertain that they are not coming from an internal disease.

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