Chronic nodular prurigo is a very difficult problem to treat. It is characterized by severely itchy papules and nodules scattered over the extremities and buttocks. It is a multi-factorial skin disease that is often refractory to treatment. Treatments include topical steroids, topical calcineurin inhibitors, phototherapy, antidepressants, and other medications.
A recent article in the Journal of the American Academy of Dermatology described a cohort of patients who were placed on dupilumab ( a monoclonal antibody that inhibits IL-4 and IL-13 and otherwise known as Dupixent) who responded extremely well after 16 weeks of therapy. IL-4 and IL-13 may help stimulate the itch-sensory neuronal pathways; consequently, inhibiting this pathway would be theoretically helpful. Further studies are required to substantiate this finding but this gives patients with this condition some hope that there is an effective treatment.
Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigo. Chiricozzi A, Maurelli M, Gori N, Argenziano G, De Simone C, Calabrese G, Girolomoni G, Peris K. J Am Acad Dermatol. 2020 Jul;83(1):39-45.