Prurigo Nodularis Pictures: What Does It Look Like?

Medically Reviewed By Joan Paul, MD, MPH, DTMH
Was this helpful?
3

Prurigo nodularis is a disease that results in a rash that may be the same color of your skin, or pink, brown, or black. It can vary in size and cause hardened skin and scars. Prurigo nodularis causes intense itchiness and the development of skin bumps or plaques. Symptoms can range in color, size, and form.

This article features pictures of prurigo nodularis, discusses symptoms, when to contact a doctor, and diagnosis.

Learn more about prurigo nodularis, including its causes, treatment, and outlook.

Prurigo nodularis pictures 

A person feels the skin on the upper back with both hands.
Sergey Narevskih/Stocksy United

According to the American Academy of Dermatology (AAD), prurigo nodularis may start with severely itchy skin, followed by visible changes.

Symptoms can look like multiple discolored bumps, areas of hardened skin, or both.

Clinicians may refer to the hardened skin as “plaques” and the bumps as “papules” or “nodules,” depending on their size. A papule is a lesion smaller than 1 centimeter (cm) in diameter. Nodules are lesions that are more than 1 cm in diameter. Nodules also tend to extend into the deeper layers of the skin.

Papules and nodules from prurigo nodularis may be firm and look round or dome-shaped. They can appear symmetrically on the body.

Prurigo nodularis bumps and plaques can also:

  • be different colors, including the same color as your surrounding skin, or pink, brown, or black
  • be felt; for example, they may feel firm
  • vary in size from a few millimeters to a few centimeters 
  • be elevated, depressed, or level with the skin
  • cause lichenification of affected areas of skin, particularly after scratching, meaning the skin darkens, thickens, or both
  • cause scars on the skin
  • cause the skin to crust, break open or form lesions, and bleed, especially after scratching
  • cause other skin changes, such as:
    • bumpy texture
    • scaling skin
    • prominent skin lines

Below are pictures of prurigo nodularis.

Medical image of prurigo nodularis.

Prurigo nodularis may cause multiple round, discolored papules to form on the skin. The nodules may appear scaly and can be raised or indented.

Getty Images

Medical image of prurigo nodularis.

Prurigo nodularis can cause larger dome-shaped nodules.

Masryyy, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

lichenification-1.jpg

Lichenified skin may also give the skin a rough, scaly, or cracking texture.

Photo: DermNet New Zealand

Medical image of prurigo nodularis

Prurigo nodularis may lead to infection, causing further symptoms such as tenderness, swelling, and pus.

Michael Katotomichelakis, Dimitrios G Balatsouras, Konstantinos Bassioukas, Nikolaos Kontogiannis, Konstantinos Simopoulos, Vassilios Danielides., CC BY 2.0, via Wikimedia Commons

Prurigo nodularis bumps can appear anywhere on the skin, but they commonly form on the:

  • legs
  • arms
  • scalp
  • upper back
  • abdomen

Additional symptoms 

Prurigo nodularis can trigger an itch-scratch cycle. The itchiness can become more intense after scratching, causing you to continue feeling itchy and wanting to scratch more. 

Itchiness may also flare up in response to:

  • heat or sweat
  • stress
  • friction
  • clothing or other sources of irritation to the surface of the skin

Some people may experience short, intense bursts of itchiness. Others may have long lasting or chronic itchiness. Many people scratch until the skin ulcerates or becomes sore. This can increase the risk of infection. 

Also, prurigo nodularis often develops alongside other skin conditions that cause itchiness, such as eczema. As a result, you may notice further symptoms in addition to prurigo nodularis.

Additional symptoms can include:

  • burning and stinging skin
  • skin soreness or tenderness
  • dry skin
  • sleep problems 
  • psychological problems, such as depression
  • impairment to daily life, such as a withdrawal from social activities 

Untreated symptoms may also lead to

  • chronicity, or hard-to-treat, recurrent symptoms
  • automatic scratching behavior, which is when a person scratches even when there is no itch
  • infection

Skin infections

Sometimes areas of skin affected by prurigo nodularis can develop an infection. This is particularly likely if the skin is broken due to scratching.

Symptoms of skin infection include:

  • flushed or discolored skin
  • swelling or blistering of the skin
  • painful skin
  • skin that feels warm to the touch
  • pus
  • fever or chills
  • headache

Contact a doctor if you notice any possible symptoms of infection.

Read more about skin infections, including their symptoms and treatment.

When to see a doctor

Contact your doctor for any symptoms of prurigo nodularis or severe itching. Also, seek advice if you notice possible symptoms of skin infection.

Prurigo nodularis can develop with other long-term conditions, such as:

These conditions may produce additional symptoms. Contact for these a doctor if you experience the following:

  • You have new symptoms affecting the skin or other bodily areas.
  • Your symptoms do not improve with your prescribed treatment.
  • Your symptoms worsen or improve and then come back.
  • Your skin becomes broken and does not heal quickly.
  • Your symptoms impact your quality of life or feel severe.

Diagnosis 

Your doctor will ask about your symptoms and medical history, which helps rule out other conditions. They may also want to know whether you use drugs that produce chronic itch, such as:

  • opioids
  • antimalarials
  • targeted cancer treatments

During a physical exam, your doctor will check the characteristics of the papules, nodules, and plaques, such as:

  • color
  • shape
  • size
  • distribution 
  • texture 
  • location 

Your doctor may also recommend tests to help diagnose the condition, such as:

  • a skin biopsy or scrapings to examine skin samples
  • a dermoscopy, a noninvasive method to examine the skin’s surface
  • blood tests
  • urine and stool analysis
  • skin patch testing to rule out allergies

After diagnosis, your doctor will prescribe treatment. According to a 2022 overview, prurigo nodularis can have a positive outlook. However, without treatment, symptoms may continue. Follow your prescribed treatment plan for the best outcome.

Summary

Prurigo nodularis is a skin condition that can cause extreme itching and the development of bumps and plaques of hard skin. Symptoms can vary slightly in appearance. Prurigo nodularis pictures show how bumps and plaques may differ in color, size, and form.

Doctors can diagnose prurigo nodularis using a physical exam or diagnostic tests such as a skin biopsy.

Contact your doctor if you notice any symptoms of prurigo nodularis, persistent itching, or infection.

Was this helpful?
3
Medical Reviewer: Joan Paul, MD, MPH, DTMH
Last Review Date: 2022 Nov 30
View All Skin, Hair and Nails Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Benedetti, J. (2022). Description of skin lesions. https://www.msdmanuals.com/en-gb/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/description-of-skin-lesions
  2. Gonçalves, R. B., et al. (2022). Nodular prurigo. https://dermnetnz.org/topics/nodular-prurigo
  3. Ludman, P. (2021). Prurigo nodularis. https://www.aad.org/public/diseases/a-z/prurigo-nodularis-overview
  4. Mullins, T. B., et al. (2022). Prurigo nodularis. https://www.ncbi.nlm.nih.gov/books/NBK459204/
  5. Oakley, A. (2016). Dermatological investigations and tests. https://dermnetnz.org/topics/dermatological-investigations-and-tests
  6. Prurigo nodularis. (2021). https://rarediseases.org/rare-diseases/prurigo-nodularis/
  7. Satoh, T., et al. (2021). 2020 guidelines for the diagnosis and treatment of prurigo. https://onlinelibrary.wiley.com/doi/full/10.1111/1346-8138.16067