Systemic Medication for the Treatment of Prurigo Nodularis-A Systematic Review

Diagnosis and management of prurigo nodularis in skin of color patients

Prurigo nodularis is a chronic, intensely pruritic eruption that results in excoriated papules, mostly on the extensor surfaces of the arms and legs. Previous studies have indicated that the condition disproportionally affects those of African descent. Although the etiology has not been fully elucidated, patients with prurigo nodularis have been found to have associated comorbidities such as hypertension, renal disease, and HIV infection. This review covers the principles of work-up and diagnosis of prurigo nodularis in skin of color patients as well as management considerations in this population.

Efficacy and Safety of Nemolizumab in Patients With Prurigo Nodularis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This meta-analysis evaluated the efficacy and safety of nemolizumab in treating prurigo nodularis through a systematic review of randomized controlled trials. A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science, identifying relevant studies until January 5th 2025. Four randomized controlled trials involving 859 participants were included in the final analysis. The primary outcomes assessed were itching response measured by the Worst Itch Numeric Rating Scale (WI-NRS) and Investigator's Global Assessment (IGA) success. Nemolizumab demonstrated significant improvement in itch response compared to control, with a risk ratio of 3.52 (95% CI: 2.48 to 5.02, p < 0.00001) and low heterogeneity (I² = 28%). Similarly, IGA success rates were notably higher in the nemolizumab group, with a risk ratio of 4.40 (95% CI: 2.86 to 6.75, p < 0.00001) and low heterogeneity (I² = 11%). While adverse events were slightly more frequent in the nemolizumab group, the difference was not statistically significant (RR: 1.11, 95% CI: 0.99 to 1.24). The analysis was limited by the small number of included trials, relatively short follow-up periods, and lack of subgroup analysis. Despite these limitations, the findings suggest that nemolizumab is an effective and well-tolerated treatment for prurigo nodularis. Further research with longer follow-up periods and larger, more diverse patient populations is recommended to establish the long-term efficacy and safety profile of nemolizumab in treating this condition.

Proposed therapeutic and care approach in a patient with chronic prurigo: Clinical case

We present the clinical case of an 87-year-old man who presents with chronic prurigo without skin treatment. The aim is to apply an individualized care plan that allows, based on the latest evidence, to achieve skin integrity, which is deteriorated, and improve its quality of life due to the current failure toad dress the pathology. Several NANDA International diagnostic labels were identified using the NNNConsult online tool and the expected outcomes were plan along with the planned nursing interventions. The care plan shows the intrinsic difficulty of a multifactorial pathology that is little known and rare but that entails a notable impact on the quality of life and skin integrity, especially when new treatment approaches are currently emerging that are un explored by patients and professionals. This situation makes it necessary to expose and train cases like the one presented, update treatment path ways, real involvement of professionals for adaptation, individualization and continuous search to meet the needs and problems suffered by the people we care for, as well as the need to know new skin approaches. This work outlines a line of skin care that respects skin integrity, following the latest evidence and points out the therapeutic medical approach without going into depth as it is not the aim of the work or nursing competence.

A systematic review of interleukin-31 inhibitors in the treatment of prurigo nodularis

BACKGROUND

Prurigo nodularis (PN) is a neuroimmunological skin disease. Severe itching is the most challenging symptom which affects patients' quality of life. T helper 2-derived cytokines, such as interleukin-31 and oncostatin M (OSM), play a crucial role in PN pathogenesis. Nemolizumab and vixarelimab are two biologics acting as IL-31 inhibitors. Vixarelimab also suppresses the OSM activity. This systematic review evaluates the efficacy and safety of nemolizumab and vixarelimab in PN management.

METHODS

A systematic search was conducted in PubMed/Medline, Ovid Embase, and Web of Science up to September 17th, 2023. Clinical trials and cohort studies published in English were included.

RESULTS

Among a total of 96 relevant records, five were included. The results of four studies with 452 patients using nemolizumab showed that a significantly higher percentage of patients treated with nemolizumab demonstrated a reduction in peak pruritus numerical rating scale (PP-NRS) and investigator's global assessment along with improved sleep disturbance (SD) and quality of life than the placebo group. Moreover, one study administered vixarelimab to 49 PN patients, and their finding illustrated a higher rate of subjects who received vixarelimab experienced ≥ 4-point diminution in worst itch NRS, visual analog scale, healing of representative lesions, and SD quality compared to the placebo group.

CONCLUSIONS

IL-31 inhibitors suggest distinct advantages in improving pruritus, sleep quality, and overall quality of life in subjects with moderate-to-severe PN. Further clinical studies are recommended to compare the effectiveness of these biologics to other therapeutic choices.