Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus

Sarina Elmariah, Brian Kim, Timothy Berger, Sarah Chisolm, Shawn G. Kwatra, Nicholas Mollanazar, Gil Yosipovitch

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Background: Prurigo nodularis (PN) is a chronic disease characterized by intensely pruritic, raised, nodular lesions. Because there are currently no United States Food and Drug Administration-approved therapies specifically for PN, management is highly variable, and no consensus exists on treatment regimens. Objective: To provide practical guidance to help United States dermatologists diagnose and effectively treat patients with PN. Methods: We participated in a roundtable discussion to develop consensus recommendations on diagnosis and treatment of PN from a United States perspective. Results: The core findings in PN are the presence of firm, nodular lesions; pruritus lasting at least 6 weeks; and a history or signs, or both, of repeated scratching, picking, or rubbing. The diagnostic workup involves a complete review of systems, considering potential systemic diseases, and assessment of disease severity, including disease burden and pruritus intensity. Treatment should be selected based on a patient's clinical presentation, comorbidities, and response to prior treatments and should address both neural and immunologic components of pruritus. Limitations: Data on PN are from anecdotal or small clinical trials, and all treatments are currently used off-label. Conclusion: An effective treatment approach for patients with PN should be based on clinical judgment and tailored to the individual needs of the patient.

Original languageEnglish (US)
Pages (from-to)747-760
Number of pages14
JournalJournal of the American Academy of Dermatology
Issue number3
StatePublished - Mar 2021


  • chronic nodular prurigo
  • diagnosis
  • prurigo nodularis
  • pruritus
  • treatment

ASJC Scopus subject areas

  • Dermatology


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