Prurigo nodularis is a chronic dermatologic condition involving the development of multiple cutaneous nodules in the setting of intractable pruritus. Given emerging treatment options for this difficult-to-treat condition, a current review of therapeutics is needed. A systematic review was performed for clinical studies investigating prurigo nodularis treatment published from 1990 to present including ≥5 subjects. A total of 35 articles were assigned a level of evidence according to the Oxford Center for Evidence-based Medicine. All 5 studies investigating topical agents, including corticosteroids, calcineurin inhibitors, calcipotriol, and capsaicin, conveyed some beneficial effect with level of evidence 2b or higher. Six of 8 reports investigating photo- and photochemotherapy achieved levels of evidence 2b or greater and showed good partial response rates. Thalidomide was studied by 6 reports providing evidence of good symptom response, only 2 of which were rated level 2b or greater. Cyclosporine and methotrexate have demonstrated benefit in 4 combined studies, albeit with level 4 evidence. Pregabalin, amitriptyline, paroxetine, fluvoxamine, and neurokinin-1 receptor antagonists have demonstrated promising evidence in 5 level 2b studies. Higher-powered studies and additional randomized controlled trials are needed for the evaluation of safe and efficacious systemic treatment options for prurigo nodularis.Le texte complet de cet article est disponible en PDF.
Key words : chronic pruritus, nodular prurigo, prurigo nodularis
Abbreviations used : CGRP, IL, LOE, MC, MTX, NRS, PN, PUVA, RCT, VAS
| Funding sources: None.
| Dr Friedman has received honoraria for participation in advisory boards for Menlo Therapeutics, Inc, and serves as an investigator for Kiniksa Pharmaceuticals. Dr Yosipovitch has received honoraria for participation in advisory boards for Menlo Therapeutics, Inc, Trevi, Sienna, Galderma, Novartis, OPKO Health, Inc, Pfizer, Sanofi, and UCB. He has received grant/research support for his role as an investigator from Menlo Therapeutics, Inc, Galderma, Vanda Pharmaceuticals, Kiniksa Pharmaceuticals, Sun Pharma, and Pfizer.