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.
To provide practical guidance to help United States dermatologists diagnose and effectively treat patients with PN.
We participated in a roundtable discussion to develop consensus recommendations on diagnosis and treatment of PN from a United States perspective.
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.
Data on PN are from anecdotal or small clinical trials, and all treatments are currently used off-label.
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
| 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.