A systematic review of evidence-based treatments for prurigo nodularis

Qureshi, Anas Sarwar; Abate, Laura; Yosipovitch, Gil; Friedman, Adam

doi:10.1016/j.jaad.2018.09.020

Cited by 63 publications

(48 citation statements)

References 61 publications

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“…No licensed drugs are currently available for the treatment of CPR, and despite an intense effort to develop new therapeutic modalities, the first licensed drugs will not be available for several years. The various forms of phototherapy, including BB‐ and NB‐UVB, UVA‐1, and PUVA, as well as targeted treatments with an excimer laser, have all demonstrated significant improvements of pruritus and the pruriginous skin lesions in this debilitating disease . In patients with prurigo nodularis, bath PUVA was compared with bath PUVA combined with excimer laser therapy for 2 months.…”

Section: Uv Therapy In Chronic Prurigomentioning

confidence: 99%

Is there still a role for UV therapy in itch treatment?

Legat

2019

Experimental Dermatology

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Itching is a frequent and greatly distressing symptom related to many skin and systemic diseases. New insights into the pathophysiology of itchy skin and potentially involved mediators have increased the interest in and development of new treatments that specifically act on targets involved in the transmission and perception of itching. Phototherapy has long been known and used as an effective treatment for various kinds of chronic itching. However, despite its well‐known beneficial effects, the mechanisms behind the antipruritic effect of phototherapy are less well‐known. In addition, phototherapy requires the use of expensive equipment in dermatology offices, patients must undergo repeated treatments and no large, randomized, controlled trials have yet supported the antipruritic effect of UV. Therefore, phototherapy is rarely recommended as a treatment method for chronic pruritic diseases or only used as a last recourse. However, the wide range of pruritic conditions that can be successfully treated with phototherapy, together with its low acute side effects, extremely low frequency of interactions with other medications, possibilities to combine phototherapy with other treatment modalities and the fact that patients of almost all ages—from childhood to old age, including women during pregnancy or lactation—can be treated make UV therapy advantageous over other treatments of chronic pruritus. Thus, despite the development of new targeted therapies against pruritus, UV therapy is neither outdated nor the ‘last recourse’, but should be considered early on in the treatment of chronic pruritus.

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Section: Uv Therapy In Chronic Prurigomentioning

confidence: 99%

Is there still a role for UV therapy in itch treatment?

Legat

2019

Experimental Dermatology

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“…Chronic itch can have a significant impact on a patient’s quality of life, and strongly correlates with measures of anxiety and depression in patients with PN [ 5 , 6 ]. Effective therapeutic options are limited, and long-term treatment with off-label systemic medications, such as cyclosporine, methotrexate, or thalidomide, can result in significant side effects [ 1 ]. Dupilumab, which inhibits signaling of IL-4 and IL-13, has demonstrated efficacy and safety in a retrospective review of 90 AD patients with the generalized PN phenotype [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Topical and intralesional steroids are often trialed with varying success. Several systemic medications have been studied, such as thalidomide or methotrexate, but these can be associated with significant side effects [ 1 ]. Dupilumab, a fully humanized IL-4Rα antibody, has a favorable safety profile and is FDA-approved for the treatment of atopic dermatitis (AD), asthma, and chronic rhinosinusitis with nasal polyposis [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Resolution of Treatment-Refractory Prurigo Nodularis With Dupilumab: A Case Series

Wieser

Mercurio

Somers

2020

Cureus

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Prurigo nodularis is a pruritic skin condition that can present therapeutic challenges. We present a series of three patients diagnosed with prurigo nodularis who had failed several commonly trialed therapies, but experienced relief from symptoms and improvement in skin lesions following initiation of dupilumab therapy. All patients in this series lacked a diagnosis of atopic dermatitis and had lesions on the lower extremities, although other locations such as the trunk were also involved. Continued study of dupilumab in patients with prurigo nodularis is advocated.

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“…There is still minute evidence concerning the efficacy of the various topical and systemic therapies used in the treatment of chronic prurigo. High‐powered randomized clinical trials targeting this patient population are needed . Also, psychotherapeutic approaches such as behavioural therapeutic modalities aiming at reducing the degree of scratching and stress‐induced pruritus should be investigated for chronic prurigo, since they have shown promising results in patients with other pruritic conditions .…”

Section: Unmet Needs and Future Perspectivesmentioning

confidence: 99%

How to define chronic prurigo?

Pereira

Ständer

2019

Experimental Dermatology

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Chronic prurigo impairs quality of life and is immensely challenging to treat. Until recently, no clear definition or classification system was available for this disease. A European task force specialized in pruritus defined chronic prurigo as a distinct disease characterized by chronic pruritus, a lengthy scratching behaviour and the presence of pruriginous lesions. Papular, nodular, plaque, umbilicated and linear prurigo were identified as clinical subtypes according to the most prominent lesion type observed in the physical examination. Various clinical and pathophysiological aspects, which are common across the range of clinical manifestations of chronic prurigo, argue for chronic prurigo as a disease in its own right. Chronic prurigo should be clearly demarcated from other conditions such as so‐called acute or subacute prurigo forms as well as from psychogenic self‐inflicted skin lesions, since different diagnostic criteria apply for these diseases. This viewpoint essay provides a detailed definition and classification of chronic prurigo including its obligatory and associated diagnostic criteria and discusses chronic prurigo as a distinct disease as well as the demarcation to other relevant conditions.

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A systematic review of evidence-based treatments for prurigo nodularis

Cited by 63 publications

References 61 publications

Is there still a role for UV therapy in itch treatment?

Is there still a role for UV therapy in itch treatment?

Resolution of Treatment-Refractory Prurigo Nodularis With Dupilumab: A Case Series

How to define chronic prurigo?

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