Prurigo nodularis is an intensely pruritic
dermatosis characterized by lichenified and excoriated papules and nodules. The course of
prurigo nodularis is often chronic, and some patients respond very poorly to the standard therapeutic modalities. Because the pathogenesis of this disease remains obscure, the treatment of
prurigo nodularis can be disappointing and frustrating for both the patients and physicians.
Thalidomide, a
tumor necrosis factor-alpha antagonist, has been suggested as an alternative treatment option for recalcitrant
prurigo nodularis. In the past, the regimen for treatment of
prurigo nodularis often required
thalidomide at 200 mg/day. We recruited patients with intractable
prurigo nodularis and treated them with low-dose
thalidomide. Six patients with idiopathic
prurigo nodularis were successfully treated with low-dose
thalidomide (50-100 mg/day) without clinical development of
peripheral neuropathy. In summary, our preliminary results suggest that low-dose
thalidomide may be a safe and effective treatment option for patients with recalcitrant idiopathic
prurigo nodularis.