I have had painful acne-like nodules all over my chest, trunk, shoulder, back, right thigh, and pubic area since December of 2011. The pain is excruciating and has prevented me from sleeping, however the painkillers that have been prescribed aggravate my insomnia. My sleeping log for the month of June averaged only 3.3 hours of sleep per night. For the past week I have been getting rest (5hr avg) using Ambien and topical lidocaine 2% viscous solution and not taking traMADol or Hydrocodone . I have noticed some improvement in the ulcerated lesions, but this is affecting all aspects of my life (can't focus, constant fatigue, no confidence, pain, achy body, paler than usual skin). I have been seen by 4x doctors, 3x nurses, 1x dermatologist - each have given me a different diagnosis - none listen to my actual symptoms. I believe the original diagnosis of folliculitis was correct; in high school my physician in TX diagnosed me with cystic acne and I had awful skin allergies and sensitive skin. I have been prescribed Doxycyclene (30days), Erythmyocin topical solution, Bactroban, cephalexin (30days). I do smoke (started smoking menthol in November 2011) about 3/4 - 1 pack per day - variable usage for 9 of the last 14 years. I am 30 in 3 days, white, male, 6'2" 178lbs - increasingly sedentary since December. Have severe anxiety, history of depression, bi-polar II disorder. I have my lab results from the blood work performed 10 days ago - well within normal range on everything. The dermatologist diagnosed me with Prurigo Nodularis, I have had no itching symptoms though he only examined me for 3 minutes (at the time I had 26 lesions) the follow up visit he saw me for only 5 minutes and did not examine the lesions, though he said there was a 3-5% chance that I have skin cancer and asked me if I wanted a biopsy. I don't want a doctor to follow my treatment plan. I have been tested for HIV 6x in the past year, MRSA 3x in the past six months. The lesions are generally 1-10mm the largest have been up to 15mm. Before ulcerating the lesions swell out up to 9mm, some have generated heat, one has exhibited red spider like lines leading away on two sides (right thigh) of the lesion, but with antibiotic ointment they go away. When the lesions rupture they ooze various substances usually white, yellowish, or clear liquid - sometimes hard white material, or long staph like material (up to 17mm in length), two have exhibited foul odor akin to rotting meat one of which looked dark brown/black. Both of these have started to heal and the odor is gone. Some of the lesions are ulcerated to what I am guessing is fascia (was pre-med over a decade ago) I know that they are beyond the dermis and epidermis. The lesion on the center of my abdomen (approx 4cm above my navel) is now only 8mm in diameter down from 15mm in diameter is very hard (feels like something solid is inside, but I'm guessing it's just the keratin build up) however I can feel the muscle beneath the lesion and it feels as though a section of the muscle is now gone. I am concerned and my doctors (4 different clinics/hospitals) don't seem to have any answers. My physician in Houston was a hematologist, specialized in dermatology, respiratory medicine, allergies, and pathology (even worked with CDC) he was very well educated (ULondon, Yale, and a few other med schools in Nor., Ger., and I believe Switzerland as well). I am intelligent and appreciate honest answers that are not overly simplified. I just want to feel well enough to exercise again and get back to normal - 7 1/2 months of pain is too long and the scarring that I know I will have is a serious concern (former model so an inordinate amount of value and my self-esteem is based on my appearances). Anyone that has experience with similar cases or has any insight would be very much appreciated! Cheers!