Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus

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.