Prurigo nodularis: a physician survey to evaluate current perceptions of its classification, clinical experience and unmet need

Pereira, Manuel P.; Basta, Sameh A; Moore, Jolene; Ständer, Sonja

doi:10.1111/jdv.15107

Cited by 39 publications

(38 citation statements)

References 27 publications

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“…Despite PN’s fairly frequent occurrence in the clinical setting, studies on the prevalence and incidence of PN have to date consisted of small case studies and case reports. To ascertain the incidence of PN, Pereira et al performed a survey study across 14 countries and demonstrated that 60% of respondents, on average, saw fewer than five PN patients per month presenting to clinic 16. Overall, epidemiological studies are lacking.…”

Section: Epidemiologymentioning

confidence: 99%

<p>Treatment-resistant prurigo nodularis: challenges and solutions</p>

Kowalski¹,

Kneiber²,

Valdebran³

et al. 2019

CCID

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Prurigo nodualris (PN) is a chronic condition with highly pruritic, hyperkeratotic papules or nodules arising in the setting of chronic pruritus. While PN may serve as a phenotypic presentation of several underlying conditions such as atopic dermatitis, chronic kidney disease-related pruritus, and neurological diseases, it represents a distinct clinical entity that may persist despite the removal of the underlying cause, if one is identified. Neuronal proliferation, eosinophils, mast cells, and small-fiber neuropathy play a role in the production of pruritus in PN, although the exact mechanism has not yet been established. Identifying an underlying cause, if present, is essential to prevent recurrence of PN. Due to often present comorbidities, treatment is typically multimodal with utilization of topical and systemic therapies. We performed a PubMed/MEDLINE search for PN and present a review of recent developments in the treatment of PN. Treatment typically relies on the use of topical or intralesional steroids, though more severe or recalcitrant cases often necessitate the use of phototherapy or systemic immunosuppressives. Thalidomide and lenalidomide can both be used in severe cases; however, their toxicity profile makes them less favorable. Opioid receptor antagonists and neurokinin-1 receptor antagonists represent two novel families of therapeutic agents which may effectively treat PN with a lower toxicity profile than thalidomide or lenalidomide.

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Section: Epidemiologymentioning

confidence: 99%

<p>Treatment-resistant prurigo nodularis: challenges and solutions</p>

Kowalski¹,

Kneiber²,

Valdebran³

et al. 2019

CCID

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“…Although occurring for a prolonged period of time owing to the long‐lasting itch, scratching behaviour is usually not compulsive or obsessive. These compulsive or obsessive behaviours may, however, develop in the course of the chronic prurigo condition, even occurring when no itch is perceived . Patients presenting with SISL do not report itch, and thus, the skin lesions result from pathological manipulation due to psychological aetiology rather than as an alleviating response to intense itch .…”

Section: Delimitation To Self‐inflicted Skin Lesionsmentioning

confidence: 99%

“…Establishing a clear definition and classification of chronic prurigo was an important first step to ultimately achieve a better care. Recently, specialists in the field of chronic pruritus identified unmet needs, namely a more comprehensive understanding of the pathophysiology underlying chronic prurigo and novel more effective therapies …”

Section: Unmet Needs and Future Perspectivesmentioning

confidence: 99%

“…Regarding the therapeutic management of chronic prurigo, several systemic therapies including antihistamines, antidepressants, gabapentinoids, immunosuppressive agents, opioid receptor modulators and neurokinin‐1 receptor antagonists have been employed, however, with low efficacy rates, according to specialists . As for supportive therapies, emollients seem to be valuable agents for the treatment of chronic prurigo, while phototherapy, sedatives in case of sleep disturbance, anxiolytic drugs and relaxation techniques are less effective . There is still minute evidence concerning the efficacy of the various topical and systemic therapies used in the treatment of chronic prurigo.…”

Section: Unmet Needs and Future Perspectivesmentioning

confidence: 99%

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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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“…However, we report more frequent topical therapy and less frequent systemic therapy prescriptions. 5 As PN continues to be studied, more evidence-based treatment options will emerge to provide additional guidance for healthcare providers. Since multiple healthcare providers manage PN, it is important to consolidate treatment recommendations to prevent mismanagement.…”

mentioning

confidence: 99%