Prurigo nodularis is a chronic, relapsing neurodermatitis that is often 
resistant to standard therapies with topical corticosteroids and oral 
antihistamines. Thalidomide, while efficacious in treating recalcitrant cases of 
prurigo nodularis, causes significant toxicity. Thalidomide-induced peripheral 
neuropathy frequently results in drug discontinuation. Lenalidomide (Revlimid; 
Celgene Corporation, Summit, NJ) is a derivative of thalidomide with less 
neurotoxicity approved for the treatment of multiple myeloma and myelodysplastic 
syndromes that has not been widely studied in dermatologic disorders. Here, we 
report a case of refractory prurigo nodularis effectively treated with 
lenalidomide. Given its favorable side-effect profile, lenalidomide may offer a 
superior alternative to thalidomide in the treatment of this condition.