The SWITCH algorithm: An expert consensus on treat-to-target criteria for chronic prurigo

Area of Science:

• Dermatology
• Clinical Research
• Evidence-Based Medicine

Background:

• Chronic prurigo (CPG), also known as prurigo nodularis, lacks detailed long-term treatment guidelines.
• Current management relies on expert consensus without specific recommendations for sustained therapy.

Purpose of the Study:

• To define and validate treat-to-target (T2T) criteria for CPG.
• To develop a consensus-based treatment algorithm to support clinical decision-making in CPG management.

Main Methods:

• A prospective, non-interventional study involving adult CPG patients with moderate-to-severe itch (NRS ≥7) and successfully treated patients.
• Expert committee evaluation of patient-reported symptoms and therapy goals, identification of outcome tools, and iterative consensus-building for T2T criteria and algorithm development.

Main Results:

• Itch, scratching, and skin lesions were the primary severe symptoms reported by 171 patients.
• Key therapeutic goals included pruritus relief and lesion healing.
• Experts defined T2T criteria for itch control (NRS ≤3) and lesion healing (IGA-S 0/1), forming the basis of the treatment algorithm.

Conclusions:

• The developed T2T criteria and SWITCH treatment algorithm provide a systematic approach to CPG management.
• This framework utilizes patient-reported and expert-validated data to refine treatment strategies.
• Implementation of these tools is expected to improve the long-term treatment outcomes for patients with CPG.