ReviewDiagnostic and treatment algorithm for chronic nodular prurigo
Section snippets
Diagnosis and treatment of chronic nodular prurigo
The initial assessment of a patient who presents with possible CNPG should include a medical history and cutaneous examination to determine if the core symptoms are present. These include the presence of pruritus for at least 6 weeks preceding the occurrence of multiple pruriginous lesions and history and/or signs of repeated scratching (eg, excoriations and scars).1 CNPG initially manifests with 1 or several grouped lesions and can progress to be generalized with numerous (up to hundreds) of
Treatment
Management of CNPG is challenging. Data from randomized controlled trials are limited, and there are currently no approved therapies specifically for CNPG.3 CNPG is usually treated with topical antipruritic therapies, such as emollients, corticosteroids, anesthetic agents, and calcineurin inhibitors; intralesional corticosteroids; or systemic antipruritic therapies, such as ultraviolet phototherapy (ultraviolet A/B), gabapentinoids, antidepressants, opioid antagonists, and immunosuppressants.3,
Future directions
Response to available therapies is often inadequate or associated with unpleasant adverse effects. Investigational therapies are currently being evaluated for the treatment of pruritus associated with CNPG and other underlying dermatologic conditions. Recent studies have shown the potential of neurokinin 1 receptor (NK1R) antagonists, μ-opioid receptor antagonists, interleukin (IL) 31 receptor antagonists, and IL-4 receptor antagonists to treat patients with CNPG. Initial evidence for the
Summary
CNPG is an intensely pruritic disease that is associated with impaired quality of life and adverse effects on sleep, social settings, relationships, work, and the patient's emotional well-being. Accurate and early diagnosis is important for optimal management of the disease and to potentially prevent scarring. Long-term management is important, because it can take months to years to achieve the ultimate goal of treatment, healing of pruriginous lesions. Interdisciplinary cooperation is
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2022, Actas Dermo-SifiliograficasA systematic review of interleukin-31 inhibitors in the treatment of prurigo nodularis
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2024, Expert Review of Clinical Immunology
Funding sources: Supported by Menlo Therapeutics Inc.
Disclosure: Dr HF Ständer is a member of scientific advisory boards and is a consultant for Menlo Therapeutics, Leo, Novartis, and Sanofi-Aventis. Dr Elmariah serves as a scientific advisor to Menlo Therapeutics, AOBiome, and Trevi Therapeutics. Dr Spellman was employed by Menlo Therapeutics Inc. Dr. S Ständer is a principal investigator for Dermasence, Galderma, Kiniksa, Menlo Therapeutics, Trevi Therapeutics, Novartis, and Vanda and is a member of scientific advisory boards and a consultant for Almirall, Astellas, Beiersdorf, Celgene, Galderma, Kiniksa, Kneipp, Maruho, Menlo Therapeutics, NeRRe Therapeutics, Novartis, Sanofi, Sienna, and Trevi Therapeutics. Dr Zeidler has no conflict of interest to declare.