Prurigo nodularis: disease burden, clinical features and approach to management

Prurigo nodularis (PN) is a distinct, chronic inflammatory skin disease characterized by intensely pruritic, fibrotic nodular lesions. Despite continued progress in the field, the lack of clarity regarding the definition of PN as a disease, its clinical presentation, and therapeutic options results in delayed diagnosis and management. PN can arise following other diseases, but once established, it is considered an independent disease. Here, we summarize current knowledge of the epidemiology, clinical characteristics, disease burden and management approaches that may help healthcare providers recognize PN as a primary diagnosis, independent of triggers or associated comorbidities. PN is more common among patients aged 50-60 years, and some evidence suggests it is more frequent among Black populations than White and Asian populations. A subset of patients with PN have an atopic background and can present with comorbid atopic dermatitis; however, PN can also exist without atopic comorbidities. Other comorbidities typically include diabetes, obesity, thyroid disease, kidney disease, chronic liver disease, hypertension, HIV infection, skin infections, malignancies and mental health disorders. Multiple intensely pruritic lesions induce chronic scratching, which leads to inflammation, hyperkeratotic nodules and perpetuation of a vicious itch-scratch cycle. PN is associated with a high disease burden and negative effect on quality of life; patients often report intense and relentless itching, poor sleep, absence from work, anxiety and depression. Early diagnosis of PN and identification of comorbidities are important to facilitate better disease management. By increasing their awareness of PN epidemiology, disease burden, clinical presentation and management, physicians may begin to identify the disease as a distinct condition, independent of its triggers or associated comorbidities and provide patients with appropriate care earlier in their treatment journeys.