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and joined the MJH Life Sciences team in February 2023. She attended Kent State University and earned a Bachelor of Science degree in journalism with minors in public relations and creative writing. She enjoys making and listening to music, reading, and spending time with her cats, Astrid and Marceline.

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In case you missed it, this week we had news about a significant dual treatment approach for AD, organic filter-based sunscreens for sensitive skin, what we’re most looking forward to in 2025, and more.

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As 2024 comes to a close, Dermatology Times is taking a look back at the studies, therapies, and advances in prurigo nodularis this year.

Dermatology Times 2024 In Review: Prurigo Nodularis

Increased awareness for prurigo nodularis may help to usher in a new era of timelier and more targeted treatment.

The Burden of Prurigo Nodularis

Data from Galderma's OLYMPIA 1 trial was recently published in JAMA Dermatology.

Nemolizumab Shows Significant Efficacy in Treating Signs, Symptoms of Prurigo Nodularis in OLYMPIA 1 Trial

Patients treated with dupilumab saw substantial healing, with over 70% achieving >50% lesion improvement in 24 weeks.

Dupilumab Reduces Lesion Burden in Patients with PN

A study showed NB-UVB phototherapy effectively reduced prurigo nodularis symptoms, with 80% of patients achieving full response.

NB-UVB Phototherapy Demonstrates Efficacy, Leads to Complete Response in Prurigo Nodularis

Managing Moderate Prurigo Nodularis in a 52-Year-Old Female With Atopic Dermatitis

Please share your impressions of the case. As prurigo nodularis is often a clinical diagnosis, what would you do to distinguish it from other pruritic skin conditions in this case?

What are the potential long-term impacts of untreated prurigo nodularis on this patient’s quality of life?

Describe your approach to pharmacologic treatment for this patient. Does her history of atopic dermatitis impact your decision-making for treatment options?

Videos

A panelist discusses how diagnostic differentiation of prurigo nodularis requires careful examination of the characteristic firm, hyperkeratotic nodules and consideration of the patient's history of chronic pruritus and scratching behavior, while noting that comorbid atopic dermatitis may influence treatment selection toward dual-targeting therapies.

Video Series

Advances in Systemic Treatment Options for Prurigo Nodularis

Video content above is prompted by the following:

Priorto the FDA approval of 2 systemic treatment options for PN, what was your typical treatment approach for patients with PN? At what point would systemic therapy be considered for a patient?

How has this treatment approach changed in recent years after the FDA approval of biologic systemic treatments for PN? In your opinion, what is the role in therapy for these agents?

Briefly discuss the 2 agents that are currently FDA-approved for PN, including how they work to address itch and skin lesions, as well as efficacy and safety data.

Discuss other systemic therapies in the pipeline for the treatment of prurigo nodularis (eg, Janus kinase inhibitors).

A panelist discusses how the treatment landscape for prurigo nodularis (PN) has evolved from primarily using topical therapies and off-label systemic medications to incorporating FDA-approved targeted biologics such as dupilumab and nemolizumab, which have demonstrated significant efficacy in reducing both the itchiness and nodular lesions.

Understanding Patient Comorbidities and Burden of Disease in Prurigo Nodularis

Please comment on the prevalence of prurigo nodularis and the patient subtypes who are primarily impacted by this condition.

What are some of the comorbidities that are often associated with prurigo nodularis, and what are some of the challenges involved with the management of those comorbidities?

Based on your experience treating patients with this condition, what is the burden of disease for those with prurigo nodularis, particularly individuals with moderate-to-severe disease.

How does this condition affect patients both physically and mentally?

A panelist discusses how prurigo nodularis is a chronic inflammatory skin condition that disproportionately affects middle-aged adults and those with immune disorders, causing intensely pruritic nodules that significantly impact quality of life through both physical discomfort and psychological distress.

Considerations for Setting Treatment Goals in Prurigo Nodularis

When treating patients with prurigo nodularis, what are some of the factors to consider when setting treatment goals?

How might the treatment approach differ based on the severity of the disease and other comorbidities?

TJ Chao, MPAS, PA-C, discusses how treatment goals for prurigo nodularis should be based on disease severity and comorbidities, with adjustments to the treatment approach to optimize patient outcomes.

New Systemic Treatment Options for Prurigo Nodularis

There are two 2 systemic biologic treatments that have been recently approved for prurigo nodularis within the past few years. Can you describe these two 2 agents, including mechanisms of action, efficacy and safety, and what differentiates them from each other and from other PN treatment options?

A collection of clinical insights on prurigo nodularis, exploring awareness and educational efforts as well as trends in treatment.

Provider and Patient Considerations for Prurigo Nodularis Treatment

6. What  kind of clinical and practical considerations would you suggest when selecting a treatment for treating patients with prurigo nodularis? How might a treatment approach differ based on severity of disease?

7. How would you characterize patient awareness regarding these treatment options, and do you have any tips for talking to patients about the importance of systemic treatment?

Prurigo nodularis presents diagnostic challenges due to its overlapping symptoms with other pruritic conditions and the lack of specific diagnostic tests. Clinicians often rely on clinical evaluation and patient history to differentiate it from other conditions. Certain patient subtypes, such as those with atopic dermatitis, may exhibit increased prevalence. Distinguishing prurigo nodularis involves assessing the characteristic nodules, chronic itch, and potential underlying systemic conditions. A thorough examination and consideration of differential diagnoses are crucial for accurate identification and management of this condition.

Melodie Young, MSN, A/GNP-C, discusses how clinical and practical considerations, such as disease severity, patient preferences, and comorbidities, should guide the selection of treatment for prurigo nodularis, and emphasizes the importance of educating patients about the role of systemic therapies, addressing their concerns, and improving awareness of available treatment options.

New Systemic Treatments for Prurigo Nodularis

5. Two systemic treatments are now FDA-approved for prurigo nodularis: dupilumab and nevolizumabnemolizumab. Can you briefly discuss these two 2 agents, including similarities/differences as well as efficacy and safety?

Melodie Young, MSN, A/GNP-C, discusses how the FDA-approved systemic treatments for prurigo nodularis, dupilumab and nevolizumabnemolizumab, differ in their mechanisms of action—dupilumab targeting IL-4 and IL-13, and nevolizumabnemolizumab targeting IL-31—and highlights their similar efficacy in reducing pruritus and lesion size, while also considering differences in safety profiles and treatment considerations.

Talking to Patients About Itch Management

4. How do you talk to patients about itch, and do you have any tips to help patients manage it?

Melodie Young, MSN, A/GNP-C, discusses how to effectively communicate with patients about managing itch in prurigo nodularis, offering practical tips such as setting realistic expectations, emphasizing the importance of consistent skin care routines, and exploring both pharmacologic and non-pharmacologic strategies to alleviate discomfort.

Challenges in Diagnosing Prurigo Nodularis and Distinguishing From Other Pruritic Conditions

2. What are some of the challenges of diagnosing prurigo nodularis? Are there certain patient subtypes with increased prevalence?

3. How do you distinguish prurigo nodularis from other pruritic conditions?

Melodie Young, MSN, A/GNP-C, discusses how diagnosing prurigo nodularis can be challenging due to its similarity to other pruritic conditions, and highlights the importance of recognizing key features and patient subtypes with increased prevalence to accurately differentiate it from conditions like eczema and psoriasis.

Prurigo Nodularis Burden of Disease

How would you characterize the burden of disease, both physically and mentally, in patients with prurigo nodularis?

Prurigo nodularis imposes a significant burden on patients, both physically and mentally. The chronic, intense itching and skin lesions lead to substantial physical discomfort and can severely impact daily functioning. Patients often experience sleep disturbances and reduced quality of life due to persistent symptoms. Mentally, the condition can lead to psychological distress, including anxiety and depression, as patients struggle with the visible and often stigmatizing nature of the skin lesions. The chronic nature of the disease necessitates long-term management strategies, further contributing to the overall burden.

Melodie Young, MSN, A/GNP-C, discusses how prurigo nodularis imposes a significant physical and mental burden on patients, with chronic itching, skin lesions, and emotional distress leading to a reduced quality of life and increased anxiety and depression.

Prurigo Nodularis

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