Pregabalin as a Potential Adjunct in the Management of Pruritus in Prurigo Nodularis: A Case Report

Prurigo nodularis (PN) is a chronic inflammatory skin disorder characterized by intense pruritus and hyperkeratotic nodules. Pregabalin, a γ-aminobutyric acid (GABA) analogue commonly used for neuropathic pain, has shown promise in alleviating chronic pruritus, including PN. Although not currently approved for the treatment of PN or chronic pruritus, pregabalin is considered a promising off-label therapeutic option. We report the case of a 69-year-old woman with PN who achieved complete resolution of skin lesions and marked improvement in pruritus following treatment with nemolizumab. However, after discontinuation of pregabalin, which had been prescribed for coexisting sciatic pain, the patient experienced a recurrence of pruritus over the course of two months, despite the continued absence of visible skin lesions. Reintroduction of low-dose pregabalin led to symptom stabilization within two months, suggesting that pregabalin may have contributed to the control of pruritus. Pregabalin may exert antipruritic effects by inhibiting the α2δ subunit of voltage-gated calcium channels and suppressing the release of excitatory neurotransmitters such as substance P and calcitonin gene-related peptide. This case highlights the potential utility of pregabalin in managing PN-associated pruritus, particularly in cases with a suspected neuropathic itch component. Further clinical studies are warranted to clarify the efficacy of pregabalin and better define its role as an adjunctive treatment for chronic pruritus in PN.