A 65 year-old man had developed multiple, scattered, itchy excoriated erythematous papules on both arms starting 2 years prior. He had no underlying disease. The biopsied skin lesion showed hyperkeratotic epidermis with acanthosis. Elongated and irregular rete ridges were observed. The final diagnosis was prurigo. He was treated with oral cyclosporine (25 mg/day) and naltrexone (50 mg/day), and there was no improvement in the symptoms within 2 years. Therefore, the oral alitretinoin treatment (30 mg/day) was started. After 3 weeks of alitretinoin treatment, the patient achieved partial remission. The skin lesions and itching sensation were improved and the patient stopped medical treatment.
A 54 year-old man presented with multiple, 1 month-old, itchy erythematous maculopapular patches on both legs, both arms, and back, which were diagnosed as prurigo nodularis. He had no underlying disease. Treatment with oral cyclosporine (50 mg/day) was started. However, his blood pressure exceeded the hypertension borderline after 8 weeks of treatment even though he had no underlying hypertension. Therefore, the treatment was changed to oral alitretinoin (30 mg/day) for 2 weeks. His itching sensation was reduced after the treatment without recurrence.