Chronic prurigo: current insights and future directions

Chronic prurigo (CPG), particularly prurigo nodularis, is a highly burdensome skin disease that is characterized by the presence of chronic pruritus and hyperkeratotic, pruriginous papules and nodules. CPG demands accurate diagnostic and individualized therapeutic strategies. Clinically, CPG is primarily diagnosed through physical examination, assessing the quantity and severity by using validated tools like the Prurigo Activity and Severity score and the Investigator’s Global Assessment. Further diagnosis includes an assessment of the lesion type, underlying causes, comorbidities, and potential systemic issues through additional radiological diagnostics. Therapeutically, CPG requires a multimodal strategy that is tailored to patient-specific, individual factors. Besides therapy, options like topical treatments and phototherapy and systemic therapies like small molecules and biologics offer significant clinical improvements. Currently, dupilumab is the only Food and Drug Administration and europäische arzneimittelagentur-approved systemic treatment for adult chronic nodular prurigo patients. Emerging therapies include monoclonal antibodies like nemolizumab and vixarelimab and Janus Kinase inhibitors like ruxolitinib and tofacitinib, showing promising results in clinical trials enhancing the quality of life for affected patients. This review aims to highlight that ongoing research is focused on expanding the range of validated diagnostic tools and the spectrum of approved therapy options and discuss historical and modern research trends.