Swiss Practice Recommendations for Chronic Prurigo Including Prurigo Nodularis

Area of Science:

• Dermatology
• Clinical Practice Guidelines
• Therapeutics

Background:

• Chronic prurigo (CPG), including prurigo nodularis (PN), presents significant management challenges due to its persistent nature and complex treatment landscape.
• Existing international guidelines for CPG management may be outdated and lack consideration for country-specific nuances.

Purpose of the Study:

• To develop updated, practical practice recommendations for the diagnosis and treatment of chronic prurigo (CPG).
• To provide clinicians with comprehensive, evidence-based guidance for managing CPG and PN.

Main Methods:

• A structured expert consensus process involving twelve specialists.
• Recommendations were formulated following a standardized literature review and voted upon until at least 75% agreement was reached.
• GRADE methodology was adapted to include a "Can be considered" category for practical, differentiated guidance.

Main Results:

• Recommendations cover history taking, diagnostics (laboratory tests, biopsy), questionnaires, general measures, and various therapeutic options.
• "We recommend" treatments include topical corticosteroids, NB-UVB, dupilumab, and nemolizumab.
• "We suggest" or "Can be considered" for numerous other therapies like topical calcineurin inhibitors, gabapentinoids, JAK inhibitors, and CBT, while some agents received no recommendation.

Conclusions:

• These practice recommendations offer comprehensive, up-to-date guidance for the diagnosis and management of CPG and PN.
• The guidelines aim to support clinicians in Switzerland and internationally in optimizing patient care for chronic prurigo.
• The consensus process ensured practical, differentiated advice, enhancing clinical decision-making for this challenging condition.