Twenty-two patients suffering from prurigo nodularis were treated with thalidomide 50-300 mg daily for an average of 12 months (two weeks to five years), following a special arrangement between the Danish Government and the producer Grünenthal GMBH, by which the Government took full economical responsibility for any claims related to the treatment. All patients received prior to treatment a detailed written information about all potential side-effects from the treatment, and had by their signature acknowledged, that they wished to be treated. All but two of the patients had an immediate pronounced effect on their main symptom, the tormenting itching. The same patients had a significant decrease in size and numbers of skin lesions after one to two months of treatment. However, the therapy had to be discontinued in thirteen patients (59%) due to side-effects. The most important side-effect, neuropathy, was the reason for discontinuation of thalidomide in five patients (22%). In spite of the high frequency of side-effects, we consider that this treatment modality should still be offered to the patients with the most severe symptoms due to the pronounced effect on this otherwise therapy resistant disease.