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

J Am Acad Dermatol. 2021 Mar;84(3):747-760. doi: 10.1016/j.jaad.2020.07.025. Epub 2020 Jul 15.


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.

Keywords: chronic nodular prurigo; diagnosis; prurigo nodularis; pruritus; treatment.

Publication types

  • Review

MeSH terms

  • Chronic Disease / drug therapy
  • Consensus*
  • Dermatologic Agents / therapeutic use*
  • Dermatology / standards
  • Diagnosis, Differential
  • Drug Therapy, Combination / methods
  • Drug Therapy, Combination / standards
  • Humans
  • Off-Label Use
  • Practice Guidelines as Topic*
  • Prurigo / diagnosis*
  • Prurigo / drug therapy
  • Prurigo / etiology
  • Treatment Outcome
  • United States


  • Dermatologic Agents