Unfortunately there is no one treatment for this condition and any of the approaches listed below may have varying success with individual patients.
All treatments work toward breaking the itch-scratch cycle and are broken into the following headings (click on links):
Emollients (eg. E45, Doublebase, aqueous cream) - these are usually in cream or ointment form and should be applied liberally to the affected areas on a regular basis. They soothe and cool the skin. Most ranges include types that can be added to bath water or used as a facial/hand wash.
Potent topical corticosteroids (eg. Dermovate) - applied sparingly to the lesions these have mixed results and cannot be used on a continuing basis. Healing of lesions may occur and itching is generally reduced.
Antibiotic creams (eg. Fucidin cream) - These are used if there is secondary infections of the lesions.
Coal tar products - this can be used as an alternative to corticosteriod creams.
Capsaicin cream - the purified alkaloid from chilli peppers induces burning and itching until the itching stops completely. This should not be used on broken skin.
Bandaging - various impregnated bandages are used. The aim is to restrict scratching and allow the lesions to heal. A topical corticosteroid is often used in combination with them. Some patients find that itching increases to the point where they can no longer tolerate the bandages. If large areas of the body are affected, especially the limbs, bandaging can cause complications for bathing. Wearing cotton gloves at night can also help to restrict scratching.
Cryotherapy - freezing of individual lesions using liquid nitrogen. This will result in some scarring and cannot be used for more than a few lesions.
Pulsed dye laser - This may go some way to reduce the blood vessels associated with the lesions. Like cryotherapy it is only appropriate where the number of lesions is small.
Antihistamines (eg. Atarax , Cetirizine)- these help to reduce the itchiness of lesions. Sleep is often disturbed by nodular pruritis and antihistamines may help to improve this. Patients often find that itchiness increases at night with feelings of heat on the body surface. It is recommended that bed-clothing should be as light as possible depending on the season.
Antidepressants - the psychological toll of NP can lead to depression and a loss of a positive self-regard. Antidepressants play an important part in the psychological support of patients with long-standing NP.
Oral steroids (eg. Prednisolone) - oral steroids can give almost instant relief from the irritation, but due to the serious side effects they are not normally prescribed long-term. After a short course the itchiness will return after a week or so.
Ultraviolet phototherapy (Image - Phototherapy cabinet) - the use of ultraviolet light has long been used for the treatment of other skin conditions. With NP this is usually PUVA treatment - long wave ultraviolet radiation (UVA) combined with Psoralens (P), plant extracts that make the skin more sensitive to ultraviolet light. Psoralens can either be taken in tablet form one hour before treatment, or the patient can be immersed in a bath containing psoralens immediately before treatment. A course of treatment is limited to a maximum exposure 2-3 times a week over a 12 week period depending on skin type.
Ciclosporin - a potent immunosuppressant this is reserved for more serious cases where other treatments have failed. Its effects include dampening down the inflammation of the skin. Ciclosporin may need to be taken over a long period to be effective. It has a number of significant side-effects and patients will need to have regular blood tests whilst under treatment.
Azathioprine - another potent immuno-suppressant which is again reserved for more serious cases where other treatments have failed.
Thalidomide - first introduced in the 1950's to control nausea in pregnant women, it became notorious as a result of the severe birth defects associated with its use. In the UK there are restrictions on the use of this drug and permission has to be sought by the treating physician to use it. Thalidomide may cause peripheral nerve damage and Nerve Conduction Studies prior to and during treatment with the drug would be helpful in monitoring any resulting nerve toxicity.
Low Dose Naltraxone -There are numerous claims on the Internet (website - Low Dose Naltraxone) that this drug is a "wonder cure" for a wide spectrum of conditions and diseases. Nodular Prurigo International does not support these claims or its use in the treatment of NP. Firstly these claims are only supported by anecdotal evidence and personal stories and there are no peer reviewed clinical trials to backup its use in any condition other than its original use, as a treatment for drug and alcohol misuse. It is also given credence by the statement that it is approved by the Federal Drug Administration and other national drug licensing bodies. In fact in these instances it is being used "off label", i.e. used to treat conditions for which the drug has not been approved and licensed. We would advise anyone thinking of taking this drug to treat their NP, to carefully consider the side-effects before commencing treatment.
Hypnotherapy - this has been found helpful to some patients to find alternative strategies for dealing with the itchiness.
Counselling - with the progression of this condition many patients suffer from a loss of positive self-regard. They become negative about their bodies and become limited to the type of clothing that they can wear; not wishing to expose parts of their bodies that are covered with lesions. They find that they are no longer able to participate in some types of sport eg. swimming and can feel excluded. Counselling may help in relieving some of these stresses and help to find alternative coping strategies.
We would welcome any anecdotal evidence or research papers for the use of alternative therapies in NP eg. homoeopathy, Chinese medicine, acupuncture, herbalism etc. Please use our contact form to tell us. Latest additions can be seen here.
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