Prurigo nodularis (also called picker's nodule) is another chronic variant of atopic dermatitis that is often seen in the same clinical context as lichen simplex chronicus (see above).

It is characterized by intensely pruritic nodules that are difficult to treat, occurring mainly on the extensor aspect of the lower extremities. It is more common in adults but may affect both children and adolescents.

Lesions are reddish, brown, or hyperpigmented dome-shaped firm, papules or nodules that typically resolve with prominent postinflammatory hyperpigmentation (Figs. 13.33 and 13.34).

Lesions are most commonly noted on the pretibial shafts and sometimes on the extensor areas of the arms as well as the upper and lower back and are often crusted or excoriated—pruritus may be intense.