Successful Resolution of Prurigo Nodularis with Tailored TCM: A 15-Month Case Study 采用个性化中医治疗成功改善结节性痒疹：一项为期15个月的病例研究
Case Report
A 30-year-old male presented with papular and nodular lesions accompanied by excoriations over both elbows. The patient recalled that intensely itchy nodules developed a few weeks after receiving a SARS-CoV-2 vaccination, though he was uncertain whether there was a direct correlation between the vaccination and the skin condition. His medical history was negative for atopic dermatitis or other chronic pruritic skin disorders. Despite attempting various over-the-counter moisturizing creams and antihistamines to relieve his symptoms, there was no significant improvement. The persistent and severe itching disrupted his sleep, necessitating the use of antidepressants for symptom management. Additionally, he underwent intralesional steroid injections and UVB therapy, yet these interventions proved ineffective.
Frustrated by the lack of improvement, the patient turned to our Traditional Chinese Medicine (TCM) clinic for alternative treatment. A customized herbal regimen was prescribed, leading to gradual yet significant progress over the course of 15 months. The photographic timeline illustrates the step-by-step recovery from Prurigo Nodularis (PN) with TCM therapy.
At the initial assessment, the nodules were firm, hyperkeratotic, and inflamed, with clear signs of excoriation due to persistent scratching. By the end of the first month, there was a slight reduction in inflammation, though the nodules remained raised and firm. Between months 3 and 5, a noticeable decrease in lesion size and hardness was observed, although some residual thickening persisted. By months 7 to 9, the nodules continued to flatten, hyperpigmentation faded, and the skin’s texture showed improvement, accompanied by a decline in itch intensity. By months 11 through 15, the affected areas demonstrated significant resolution, leaving only faint traces of previous lesions.
The progressive softening of the nodules, reduction in lesion size, and alleviation of pruritus indicate that TCM herbal treatment effectively disrupted the chronic itch–scratch cycle, promoting sustained skin recovery and restoring skin integrity. However, after this period, the patient was lost to follow-up.
Discussion
PN is characterized by clusters of intensely itchy, thickened nodules, which often appear on the arms, legs, trunk, and buttocks. The nodules are hyperkeratotic and prone to excoriation due to continuous scratching. Interestingly, some areas—such as the central back—are often spared, a phenomenon known as the butterfly sign [1], as this region is difficult to reach.
Patients frequently endure PN for years before obtaining a definitive diagnosis, with an average diagnostic delay of approximately 6.5 years [2]. Identifying the exact cause can be challenging, as patients often struggle to recall whether another dermatological condition preceded the PN or if external triggers, such as allergens or irritants, played a role [3]. The etiology remains complex, though research suggests that nearly half of PN patients have a history of atopy, such as eczema or asthma [2]. However, the precise mechanisms linking PN to other systemic conditions remain unclear.
Beyond its physical symptoms, PN has profound effects on daily life. The relentless itch interferes with sleep, concentration, and overall well-being. The visibility of the nodules often leads to self-consciousness, social withdrawal, and psychological distress, including anxiety and depression. In severe cases, the condition can contribute to suicidal ideation, underscoring the need for comprehensive management that addresses both physical and emotional health [4,5].
Moving Forward
Living with PN presents a significant challenge, but early diagnosis and effective treatment can improve outcomes. A multidisciplinary approach—including medical interventions, lifestyle modifications, and psychological support—is crucial for managing symptoms and enhancing quality of life. Patients are encouraged to seek specialized care, explore alternative treatment options, and adopt strategies to cope with the condition’s emotional burden. The case presented here highlights the potential of TCM as an effective therapy for PN, demonstrating substantial and sustained improvement over time.
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Reference
- , . The ‘butterfly’ sign in patients with atopic dermatitis: evidence for the role of scratching in the development of skin manifestations . J Am Acad Dermatol 1989 ;21 : 579 – 80 .
- , , et al . Prurigo as a symptom of atopic and non-atopic diseases: aetiological survey in a consecutive cohort of 108 patients . J Eur Acad Dermatol Venereol 2013 ; 27 : 550 – 7 .
- , , . Prurigo nodularis: epidemiology and clinical features . J Am Acad Dermatol 2020 ; 83 : 1559 –65
- , , , , . The impact of prurigo nodularis on quality of life: a systematic review and meta-analysis . Arch Dermatol Res 2021 ;313 : 669 – 77 .
- , , , , . Anxiety, depression and suicide in patients with prurigo nodularis . J Eur Acad Dermatol Venereol 2017 ; 31 : e106 – 7 .
Privacy
In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.
