A 56 year-old man presented with 2 year-old, itchy, erythematous to brownish papules with silver scales on both legs. He had hypertension and diabetes mellitus. The clinical diagnosis was prurigo nodularis and punch biopsy was done. Microscopic examination showed a pronounced granular layer and numerous lymphocytic infiltrations of the papillary dermis with mild spongiosis (c). The final diagnosis was Kyrle’s disease with prurigo nodularis. He was treated with cyclosporin (100 mg/day) and narrowband ultraviolet-B(NB-UVB) twice/week for 12 weeks. However, there was no improvement of symptoms. Therefore, oral alitretinoin (30 mg/day) was started. After 16 weeks of treatment, skin lesions and pruritus were improved. His score on the visual analog scale for pruritus improved (from 6 to 3). His treatment with oral alitretinoin continued for 19 months and he successfully achieved complete remission without recurrence.
A 42 year-old man presented with multiple scaly erythematous itchy papules on the whole body that were 12 months old. He had hypertension and diabetes mellitus. The clinical diagnosis was prurigo nodularis and treatment was started. Despite taking oral antihistamine and cyclosporine (200 mg/day) for 4 weeks, the patient’s symptoms were not improved. Medication was changed to oral alitretinoin in a dose of 30 mg/day. Within 5 weeks of treatment, symptoms had improved. The treatment of oral alitretinoin was continued for 12 weeks until complete remission and was stopped afterward without recurrence.