Itchy Skin with Hard Nodules Diagnosed as Nodular Prurigo; Biological Treatment Shows Promise

A 35-year-old woman experienced persistent and severe itching on her limbs, leading to repeated scratching and the subsequent development of multiple dark brown, intensely itchy nodules. These lesions not only affected her appearance but also severely disrupted her daily life and sleep quality.

Seeking medical help at Tainan Municipal An-Nan Hospital's dermatology department, she was diagnosed with nodular prurigo. After undergoing treatment with biological agents for four months, her skin lesions have visibly receded, and the itching symptoms have considerably improved. This treatment is currently self-funded.

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Nodular prurigo is a chronic skin disease marked by unbearable itching. Patients often scratch compulsively, forming hard, raised, reddish-brown nodules.

Dr. Luo Tzu-kun, head of dermatology at An-Nan Hospital, explained that nodular prurigo is a chronic skin disease marked by unbearable itching. Patients often scratch compulsively, forming hard, raised, reddish-brown nodules. The persistent and recurring nature of these lesions frequently leads to sleep disturbances, emotional distress, and social anxiety.

Luo elaborated that nodular prurigo is not merely a superficial skin inflammation but is linked to immune system abnormalities, nerve fiber proliferation, and neuro-immune interactions. Continuous inflammatory responses stimulate nerve endings, causing intense itching. Repeated scratching damages the skin barrier, leading to keratinization and localized inflammation, creating a vicious cycle of 'itch-scratch-itch' that exacerbates the condition. While past treatments included steroid creams, injections, phototherapy, and oral immunosuppressants, their efficacy was limited for some, and long-term use carried side effects. Newer treatments, such as targeted biological agents and small molecule drugs, offer new hope by addressing specific inflammatory pathways and itch signals at their source.

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Continuous inflammatory responses stimulate nerve endings, causing intense itching. Repeated scratching damages the skin barrier, leading to keratinization and localized inflammation, creating a vicious cycle of 'itch-scratch-itch' that exacerbates the condition.