Swiss Practice Recommendations for Chronic Prurigo Including Prurigo Nodularis

Management of chronic prurigo (CPG), including prurigo nodularis (PN), is challenging due to its chronic, often treatment-refractory course, high disease burden, and increasing complexity of therapies. International guidelines are partly outdated and may not fully reflect country-specific considerations. Our aim was to develop practice recommendations for the diagnosis and treatment of CPG. Twelve hospital- and practice-based experts formulated recommendations following a standardized literature review and structured expert consensus process, with recommendations voted on until ≥ 75% agreement was reached. Recommendation levels were guided by the GRADE methodology but adapted to allow practical, differentiated guidance, including the additional "Can be considered" category. Recommendations address history taking, laboratory testing, biopsy, questionnaires, general measures, pharmacological and non-pharmacological therapies. "We recommend" applies to topical corticosteroids, narrow-band ultraviolet B (NB-UVB), dupilumab, and nemolizumab; "We suggest" to topical calcineurin inhibitors, zinc oxide dressings, cryotherapy, intralesional corticosteroids, gabapentinoids, antidepressants, methotrexate, ciclosporin, μ-opioid receptor antagonists, Janus kinase inhibitors, and cognitive behavioral techniques; and "Can be considered" to capsaicin, ultraviolet A1 (UVA1), psoralen plus ultraviolet A (PUVA), and sedating antihistamines for sleep. No recommendation could be made for azathioprine, non-sedating antihistamines, κ-opioid receptor agonists, retinoids, neurokinin-1 receptor antagonists, thalidomide, or lenalidomide. These recommendations provide comprehensive, up-to-date guidance for CPG, supporting clinicians in Switzerland and internationally.