IFSI-guideline on chronic prurigo including prurigo nodularis

Abstract

Chronic prurigo (CPG) is a highly burdensome pruritic disease characterized by chronic itch, a prolonged scratching behavior and the development of localized or generalized hyperkeratotic pruriginous lesions. Neuronal sensitization and the development of an itch-scratch cycle contribute to the augmentation of pruritus and the chronicity of the disease. We provide here the first international guideline for a rational diagnostic and therapeutic approach for CPG. Recommendations are based on available evidence and expert opinion. The diagnosis of CPG is made clinically. A detailed medical history together with laboratory and radiological examinations are advised in order to determine the severity of CPG, identify the underlying origin of the itch and assist in the elaboration of a treatment plan. Therapeutically, it is advised to adopt a multimodal approach, including general strategies to control itch, treatment of the underlying pruritic conditions, and of the pruriginous lesions. Topical (corticosteroids, calcineurin inhibitors, capsaicin) and systemic antipruritic agents (eg, gabapentinoids, immunosuppressants, and opioid modulators) as well

Combined Methotrexate and Alitretinoin for the treatment of difficult‐to‐treat generalized prurigo nodularis: a case series

“…IgE immunodetection was the sane methods as described previous before. 1 Western blot of the patient's serum detected 110, 95, 68, 52, 46, 33, 21, 15, 12 and 11 kDa antigens (Fig 1b). No antigens were detected in the sera of the healthy controls (Fig 1c).…”

“…C. Bergqvist, 1 C. Fiani, 1,2 A. Simantov, 1 C. Lebre, 1 C. Hua, 1 N. Ortonne, 2,3 P. Wolkenstein, 1,2 O. Chosidow 1,2,*…”

“…Combined Methotrexate and Alitretinoin for the treatment of difficult-to-treat generalized prurigo nodularis: a case series Dear Editor, Prurigo nodularis (PN) is a chronic disabling skin disease with an adverse impact on quality of life. 1 It is characterized by multiple intensely pruritic firm nodules, typically distributed symmetrically over the extensor surface of extremities. Treatment of PN is very challenging, involving treatments aimed at interrupting the itch-scratch cycle and flattening of the skin lesions.…”

“…Despite the scarcity of strong data, a recent guideline and reviews have provided a treatment algorithm and summaries of evidencebased treatments with level of evidence ratings for each supporting study. [1][2][3] Conventional therapy includes topical therapies such as corticosteroids, calcineurin inhibitors, anaesthetic agents, ultraviolet phototherapy and systemic antipruritic therapies, such as gabapentin, antidepressants, opioid antagonists and immunosuppressants. 2,4 However, these treatments often fail; and combination of several therapies may be required to control the disease.…”

Patients with nodular prurigo commonly have pre‐existing psychological disease that requires treatment concomitant with cutaneous therapies

“…The aims of this study were to assess the demographic profile and psychological comorbid status of patients with NP, to survey the range of treatments offered and to compare our treatment approach to the latest International Forum for the Study of Itch (IFSI) guidelines. 1 Psychological comorbidity was assessed by a consultant psychiatrist with validated tools and definitions from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The study was registered with our audit department and complied with local ethical standards.…”