Patient presents with complaints of severe itching (pruritus) consistent with Prurigo Nodularis (PN).  Examination reveals multiple, symmetrically distributed, firm, hyperkeratotic nodules, primarily located on the extensor surfaces of the extremities.  The patient reports intense, paroxysmal itch, leading to significant excoriations, lichenification, and secondary infections around the nodules.  The onset of pruritus and nodule development was gradual, with a chronic and relapsing course.  Differential diagnoses considered include atopic dermatitis, psoriasis, and insect bite reactions.  However, the characteristic morphology and distribution of the lesions, along with the patient's history, support the diagnosis of Prurigo Nodularis.  Assessment includes evaluation for underlying systemic conditions such as chronic kidney disease, HIV infection, and hepatitis C.  Treatment plan includes topical corticosteroids (high potency), topical calcineurin inhibitors, and consideration for systemic therapies such as phototherapy (narrowband UVB), oral antihistamines, and immunomodulators if topical treatments are insufficient.  Patient education provided on skin care, trigger avoidance, and itch management techniques.  Follow-up scheduled to monitor treatment response and adjust therapy as needed.  ICD-10 code L28.0 assigned.