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

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.