Review on Updated Management of Prurigo Nodularis (PN)

Background: Prurigo Nodularis (PN) presents as a challenging chronic dermatological condition characterized by intensely pruritic nodules on the skin, leading to significant morbidity. Despite its prevalence and impact on patients' quality of life, treatment options remain limited, necessitating evidence-based approaches to address this complex condition effectively. Objective: This study aims to provide an updated overview of evidence-based management strategies for PN, highlighting recent advancements in treatment modalities. Method: A systematic review of clinical studies on PN treatment was conducted by searching the PubMed and Scopus databases from January 1, 2001, to December 1, 2023. A total of 706 unique studies published in English were identified and screened for inclusion criteria. Only primary clinical studies investigating treatment strategies in PN patients were included, while case reports and series with fewer than five patients were excluded. Relevant publications were further supplemented by searching bibliographies for additional studies meeting the inclusion criteria. Results: The review identified significant advancements in evidence-based management strategies for PN, driven by a growing body of clinical research and therapeutic innovation. Pharmacological interventions targeting pruritus, inflammation, and lesion resolution have shown efficacy, including topical agents such as corticosteroids, emollients, Vitamin D3 analogues, tacrolimus creams, and systemic therapies like antihistamines, gabapentinoids, immunosuppressant and anti-inflammatory agents, JAK inhibitors, retinoids, and sometimes selective serotonin reuptake inhibitors (SSRIs). Additionally, emerging biological agents and non-pharmacological approaches, such as multidisciplinary interventions, have demonstrated promise in improving patient outcomes. Conclusion: Evidence-based management of PN represents a dynamic field with evolving treatment modalities. While challenges persist, including limited efficacy and safety concerns of certain treatments, recent developments in targeted therapies, systemic immunomodulators, and novel pharmacological approaches offer hope for improved patient care. Further research into genetic underpinnings and personalized therapies is warranted to address the heterogeneous nature of PN and enhance treatment efficacy and safety.