A 54 year-old man had developed several scattered, itchy, excoriated erythematous papules on both the arms and back (5 years previously). He had no underlying disease. The clinical diagnosis was prurigo nodularis and treatment was started. Oral cyclosporine (200 mg/day) was taken for 1 year, but his symptoms waxed and waned. Treatment was changed to oral alitretinoin (30 mg/day). Within 16 weeks of treatment, the symptoms and skin lesions had improved more than with previous treatment. His treatment with oral alitretinoin continued for 3 years without progression or any side effects.
A 41 year-old woman presented with localized brownish papules and patches with crust and a scaly skin lesion. She had chronic kidney disease. Her skin lesion was diagnosed as prurigo nodularis. Because of her impaired kidney function, medication that might impair renal function was limited. Treatment with oral alitretinoin was selected in a dose of 30 mg/day. Within 4 weeks of treatment, the symptoms had improved compared to conventional treatment. She continued treatment with oral alitretinoin during which the symptoms waxed and waned.