Nodular prurigo is a severely itching dermatosis of unknown aetiology. Potent topical corticosteroids may be beneficial and their efficacy may be enhanced in the extremities by occlusion bandages. Cryotherapy with liquid nitrogen may be a useful adjunct. In the most severe cases the itching may be controlled by oral thalidomide. Fortunately, often the (female) patients with this disease are no longer fertile; however, there exists a real risk for peripheral sensory neuropathies in thalidomide therapy.