Peripheral neuropathy associated with nodular prurigo

Nodular prurigo is characterized by nodules and papules that are intensely pruritic. Thalidomide is used to treat patients with recalcitrant disease. Because thalidomide may cause peripheral neuropathy, it is current practice to perform nerve conduction studies to exclude subclinical neuropathy before treatment. The clinical record of eight patients with nodular prurigo, in whom thalidomide treatment was proposed, were looked at. Five of them showed evidence of subclinical neuropathy, thereby contraindicating the use of thalidomide. None of the patients had any symptoms of a peripheral neuropathy and none was taking any medications with a recognized potential to cause peripheral neuropathy. We propose that nodular prurigo may be associated with an underlying peripheral neuropathy in a subset of patients. In patients with nodular prurigo and demonstrable peripheral neuropathy, there may be a role for treatment with agents such as amitryptiline and gabapentin, which are normally used for neuropathic pain.