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Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus - 15/02/21

Doi : 10.1016/j.jaad.2020.07.025 
Sarina Elmariah, MD, PhD a, Brian Kim, MD b, Timothy Berger, MD c, Sarah Chisolm, MD d, e, Shawn G. Kwatra, MD f, Nicholas Mollanazar, MD, MBA g, Gil Yosipovitch, MD h,
a Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 
b Center for the Study of Itch and Sensory Disorders, the Division of Dermatology, Department of Medicine, the Department of Anesthesiology, and the Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St Louis, Missouri 
c Department of Dermatology, University of California, San Francisco, California 
d Department of Dermatology, Emory University, Grady Memorial Hospital, Atlanta, Georgia 
e Regional Telehealth Service, Veterans Affairs Veterans Integrated Service Network 7 Southeast Network, Duluth, Georgia 
f Department of Dermatology, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 
g Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 
h Miami Itch Center, Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida 

Correspondence and reprint requests to: Gil Yosipovitch, MD, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave, RMSB 2067B, Miami, FL 33136.Dr. Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of Medicine1600 NW 10th Ave, RMSB 2067BMiamiFL33136

Abstract

Background

Prurigo nodularis (PN) is a chronic disease characterized by intensely pruritic, raised, nodular lesions. Because there are currently no United States Food and Drug Administration-approved therapies specifically for PN, management is highly variable, and no consensus exists on treatment regimens.

Objective

To provide practical guidance to help United States dermatologists diagnose and effectively treat patients with PN.

Methods

We participated in a roundtable discussion to develop consensus recommendations on diagnosis and treatment of PN from a United States perspective.

Results

The core findings in PN are the presence of firm, nodular lesions; pruritus lasting at least 6 weeks; and a history or signs, or both, of repeated scratching, picking, or rubbing. The diagnostic workup involves a complete review of systems, considering potential systemic diseases, and assessment of disease severity, including disease burden and pruritus intensity. Treatment should be selected based on a patient's clinical presentation, comorbidities, and response to prior treatments and should address both neural and immunologic components of pruritus.

Limitations

Data on PN are from anecdotal or small clinical trials, and all treatments are currently used off-label.

Conclusion

An effective treatment approach for patients with PN should be based on clinical judgment and tailored to the individual needs of the patient.

Le texte complet de cet article est disponible en PDF.

Key words : chronic nodular prurigo, diagnosis, prurigo nodularis, pruritus, treatment

Abbreviations used : AE, ICD-10, IL, mAb, NK1, PN, PUVA, RCT, US


Plan


 Drs Elmariah and Kim contributed equally to the work.
 Funding sources: Supported by Menlo Therapeutics Inc.
 Conflicts of interest: Dr Elmariah has served as a scientific advisor or advisory board member to Menlo Therapeutics, New Frontier Bio, Resolute Bio, and Sanofi, as a consultant for RAPT Therapeutics, as a speaker for Pfizer, and as an investigator in trials sponsored by Trevi Therapeutics. Dr Kim has served as a consultant for AbbVie, Concert Pharmaceuticals, Incyte Corporation, Menlo Therapeutics, and Pfizer, is a stockholder, founder, and chief scientific officer of Nuogen Pharma, and has served as an advisory board member for Boehringer Ingelheim, Cara Therapeutics, Celgene Corporation, Kiniksa Pharmaceuticals, Menlo Therapeutics, Regeneron Pharmaceuticals, Sanofi Genzyme, and Theravance Biopharma. Dr Berger has served as an advisory board member for Menlo Therapeutics, Pfizer, and Sanofi. Dr Chisolm is an investigator for Incyte and has received research support from Pfizer, has served as a scientific advisor or advisory board member for companies including Menlo Therapeutics, AbbVie, Janssen Pharmaceutical, Kiniksa Pharmaceuticals, and Pfizer, and serves as a consultant for Kimberly-Clark. ITCH-E, the itch center at Emory, for which Dr Chisolm serves at the managing director, has received support from Sanofi Pharmaceuticals, Pfizer, and Genentech. Dr Kwatra has served as an advisory board member for Menlo Therapeutics, Pfizer, Regeneron Pharmaceuticals, and Trevi Therapeutics, and received grant funding from Kiniksa Pharmaceuticals. Dr Mollanazar has served as an investigator in trials sponsored by Regeneron Pharmaceuticals and Sanofi and as an advisory board member for Menlo Therapeutics. Dr Yosipovitch has participated on advisory boards for BELLUS Health, Eli Lilly, Galderma, Kiniksa Pharmaceuticals, LEO Pharma, Menlo Therapeutics, Novartis, Pfizer, Sanofi Regeneron, Sienna Biopharmaceuticals, and Trevi Therapeutics, and is a principal investigator on grants from Galderma, Kiniksa Pharmaceuticals, LEO Pharma, Menlo Therapeutics, Novartis, Sanofi, Sun Pharma, and Vanda Pharmaceuticals.
 IRB approval status: Not applicable.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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