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Prurigo nodularis is an extremely pruritic skin condition as a result of chronic and vicious cycle of itching and scratching. It is rare in children. We report a case of a 4-year-old child with a background of poorly controlled atopic dermatitis with early-onset, severe prurigo nodularis, who was treated successfully with off-label use of dupilumab injection. There was a significant reduction in itchiness by week 2 of treatment, and achieved 80% reduction in Eczema Area and Severity Index with almost complete resolution of prurigo nodules by week 8. Dupilumab can be considered a treatment option for young pediatric patients with early-onset prurigo nodularis.