Prurigo nodularis of Hyde treated with low-dose thalidomide

Prurigo nodularis of Hyde is a skin disorder characterized by pruritic excoriated nodules. Improvement in pruritus and decrease in nodules was demonstrated in patients treated with oral thalidomide 200-400 mg daily. We report a case of a 52 year old woman with a history of widespread, persistent, and intensely pruritic lesions on all extremities and a histological diagnosis of "prurigo nodularis". The patient was treated with topical agents without significant improvement. Cyclosporine was administered with partial improvement but it had to be discontinued because of side effects. Treatment with corticosteroids and antibiotics resulted in significant improvement, but at reduction of steroid dosage the skin lesions reappeared. Thalidomide was started at a dose of 100 mg once a day and after one month it was reduced to 50 mg and 100 mg orally on alternate days. Six months after starting thalidomide treatment the patient was in remission with a few residual scars and sporadic asymptomatic lesions. No significant side effects occurred. In this clinical case, a woman with prurigo nodularis was successfully treated with low-dose of thalidomide. We consider that in the treatment of prurigo nodularis is better to test a low dose of thalidomide before starting higher dosages because low dose of this drug can be efficacy without clinical development of side effects.