Practical approaches for diagnosis and management of prurigo nodularis: US expert panel consensus.

ABSTRACT Background Prurigo nodularis (PN) is a chronic disease characterized by intensely pruritic, raised, nodular lesions. As there are currently no US 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 US dermatologists diagnose and effectively treat patients with PN. Methods The authors participated in a roundtable discussion to develop consensus recommendations on diagnosis and treatment of PN from a US perspective. Results The core findings in PN are the presence of firm, nodular lesions; pruritus lasting at least 6 weeks; and history and/or signs 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.