Prurigo nodularis on the arms an African-American male patient with mixed connective tissue disease (MCTD). Prurigo nodularis is characterised by the appearance of very itchy, wart-like bumps, or nodules, on the skin. The bumps occur when the skin has been itched for a long time. Then, the formation of the nodules brings on more severe itching, triggering a cycle that can lead to skin damage (excoriated lesions). MCTD is a rare rheumatic autoimmune disease where the patient has Raynauds phenomenon, the discolouration of the fingers and toes caused by decreased blood supply, and at least two connective tissue diseases. The two diseases do not usually occur at the same time, but over a number of years. The cause of either disease is not known. Treatment for prurigo nodularis include steroid creams, antihistamines and phototherapy.