Prurigo Nodularis Mechanisms and Current Management Options

Abstract

Prurigo nodularis (PN) manifests with highly pruritic lesions that negatively impact patient quality of life. Due to the variability in manifestation, hypertrophic lichen planus, pemphigoid nodularis, and neurotic excoriations tend to mimic PN. The pathophysiology of PN is believed to be due to interactions in the neural and immune pathways causing the release of proinflammatory and pruritogenic cytokines. Dermatologic and systemic conditions, including atopic dermatitis and chronic kidney disease, accompany PN diagnoses. Patients with moderate to severe or recalcitrant PN may benefit from dupilumab, the first medication approved by the US Food and Drug Administration (FDA) to treat PN. Here, we provide an updated review of PN with a focus on its pathophysiology, histologic findings, and current treatment options.