Skin condition has few treatment options

September 24th, 2010

DEAR DR. GOTT: I have been plagued for years by an incurable skin condition I am told is called prurigo nodularis. Nothing has helped in clearing it up, and it has been active for more than two years. I have tried a sunlight box and a tanning bed, as well as cortisone injections, medical cortisone tape and creams — both over-the-counter and prescription. All seem to help only a little.

Do you have any idea as to how I can get rid of this or at least keep it under control? I eat healthy and take vitamins.

I am 22 years past breast cancer diagnosed at the age of 32. I had nine rounds of chemotherapy and took tamoxifen for 10 years. I was divorced in 2006 after a lengthy marriage of much discord. I’m now stressed, as I was a homemaker and never worked. I face a mortgage and a pile of bills and am trying to find a job. I haven’t worked in two years, my unemployment ran out several months ago, and I have a pile of bills and no health insurance. It’s difficult to maintain my sanity under all the stress.

DEAR READER: Prurigo nodularis resembles multiple soybean-sized nodules on the skin, particularly the legs and thighs of women. While the urge to scratch is overwhelming, repetitive touching results in plaque buildup and hyperkeratosis (thickening of the skin). Therefore, covering, wrapping or avoiding touching the nodules is extremely important. Anxiety exacerbates the symptoms.

Current available treatments only provide mild to moderate improvement of the condition. Capasicin cream applied four to six times a day, vitamin D3, antihistamines, dapsone, gabapentin, cryotherapy and topical anesthetics might be options. Thalidomide appears the drug of choice at this stage, but it was a horror drug in the 1960s that can cause peripheral neuropathy, and I can’t endorse it without further research. Chinese herbs have been reported to help, but I am unfamiliar with the remedies recommended and, again, cannot endorse these, either. Share my suggestions with your physician for his or her consideration.