Living With Prurigo Nodularis
Diagnosing PN
You may experience some or all of the following symptoms of prurigo nodularis (PN) including:
- Extremely itchy skin otherwise known as pruritis (in fact, among the common causes of chronic itching, PN has the highest itch intensity)1,2
- Burning and stinging skin3
- Itchy bumps or nodules due to repeated scratching/picking that can vary in size, color, and number3
- Bleeding and painful skin as scratches break open, resulting in dark spots and pebbly/hard skin4
- Scarring as the bumps clear4
The itching associated with PN is typically severe and episodic but it can be chronic and last longer than 6 weeks. Sweating, heat, clothing, and stress can aggravate the itching.3
Your doctor will arrive at a diagnosis based on your clinical symptoms and responsiveness to treatment. Other investigations may include a skin biopsy to confirm the diagnosis, patch testing to identify the presence of allergen triggers, and blood tests such as a full blood count, liver/kidney/thyroid function tests, and HIV testing to eliminate or identify the presence of other systemic diseases.5,6
Current and Emerging Treatments for PN
Standard therapies for PN include behavioral and pharmacologic therapies. Behavioral treatments include ways to prevent itching, including trimming fingernails, wearing long-sleeved clothes and gloves, appropriately bandaging lesions, adequately cleansing and moisturizing the skin, and using anti-itch lotions such as calamine, menthol, and camphor lotions. Pharmacologically, topical corticosteroids are the first type of treatment, followed by antihistamines. Additional therapies can include phototherapy and immunosuppressants, as well as antidepressants/anticonvulsants, which also can be used with psychotherapy and relaxation techniques to address the psychological effects of PN.3
Dupilumab and nemolizumab are the only FDA-approved drugs for the treatment of PN.7 However, your physician is likely to prescribe treatments used for other skin disorders, ranging from topical creams that can be applied to the itchy site to oral medications that alter your body’s immune response, as previously described.3 These alternate therapies are likely to have limited efficacy and safety, making treatment of PN extremely challenging.8
| Current Treatments for PN9,* | Treatments in the Pipeline for PN10,* |
|---|---|
| Antidepressants (eg, SNRIs, SSRIs) | Barzolvolimab |
| Azathioprine | Povorcitinib |
| Calcineurin inhibitors | Abrocitnib |
| Corticosteroids | Vixarelimab |
| Cyclosporine | |
| Dupilumab† | |
| Nemolizumab† | |
| Gabapentinoids | |
| Methotrexate | |
| Opioid receptor antagonists | |
| Phototherapy | |
| Thalidomide | |
| Topical amitriptyline/ketamine/lidocaine | |
| Topical capsaicin | |
|
*All treatments are listed in alphabetical order. †Only FDA-approved treatment for PN. |
|
FDA = US Food and Drug Administration; PN = prurigo nodularis; SNRI = serotonin and norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.
References
- Ludmann P. Prurigo nodularis. American Academy of Dermatology Association. Updated 9/14/21 (https://www.aad.org/public/diseases/a-z/prurigo-nodularis-overview). Accessed 6/13/23.
- Leis M, et al. Prurigo nodularis: review and emerging treatments. Skin Therapy Lett. 2021;26:5-8.
- National Organization for Rare Disorders (NORD). Prurigo nodularis. 2021. Updated 2/13/23 (https://rarediseases.org/rare-diseases/prurigo-nodularis/). Accessed 6/13/23.
- Gonçalves RB. Nodular prurigo. DermNet. Updated 7/22 (https://dermnetnz.org/topics/nodular-prurigo). Accessed 6/10/23.
- Huang AH, et al. Prurigo nodularis: epidemiology and clinical features. J Am Acad Dermatol. 2020;83:1559-1565.
- Mullins TB, et al. Prurigo nodularis. StatPearls. Updated 9/12/22 (https://www.ncbi.nlm.nih.gov/books/NBK459204/). Accessed 6/13/23.
- Regeneron Pharmaceuticals. Dupixent® (dupilumab) approved by FDA as the first and only treatment indicated for prurigo nodularis. 9/28/22 (https://investor.regeneron.com/news-releases/news-release-details/dupixentr-dupilumab-approved-fda-first-and-only-treatment). Accessed 6/13/23.
- Williams KA, et al. Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis. Expert Rev Clin Pharmacol. 2021;14:67-77.
- Elmariah S, et al. Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus. J Am Acad Dermatol. 2021;84:747-760.
- US National Library of Medicine. ClinicalTrials.gov (https://beta.clinicaltrials.gov/). Accessed 9/11/23.
