A Systematic Review of Evidence-Based Treatments for Prurigo Nodularis

Publication date: Available online 25 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Azam A. Qureshi, Laura E. Abate, Gil Yosipovitch, Adam J. Friedman

Abstract

Prurigo nodularis is a chronic dermatologic condition involving the development of multiple cutaneous nodules in the setting of intractable pruritus. Given emerging treatment options for this difficult-to-treat condition, a current review of therapeutics is needed. A systematic review was performed for clinical studies investigating prurigo nodularis treatment published from 1990 to present including at least 5 subjects. A total of 35 articles were assigned a level of evidence according to the Oxford Center for Evidence-based Medicine. All five studies investigating topical agents, including corticosteroids, calcineurin inhibitors, calcipotriol, and capsaicin, conveyed some beneficial effect with level of evidence 2b or higher. Six of eight reports investigating photo- and photochemotherapy achieved levels of evidence 2b or greater and showed good partial response rates. Thalidomide was studied by six reports providing evidence of good symptom response, but only two of which were rated level 2b or greater. Cyclosporine and methotrexate have demonstrated benefit in four combined studies, albeit with level four evidence. Pregabalin, amitriptyline, paroxetine, fluvoxamine, and neurokinin-1 receptor antagonists have demonstrated promising evidence in five level 2b studies. Higher-powered studies and additional randomized controlled trials are needed for evaluation of safe and efficacious systemic treatment options for prurigo nodularis.