Can treatment for prurigo nodularis reverse the condition?

Question

Hello doctor,

My younger brother is 29 and was diagnosed with prurigo nodularis about eight months ago. He started a new medication around three weeks ago. It is possibly Nemolizumab or something similar.

However, his itching is still very intense; in some areas, the nodules seem to be increasing rather than improving. We were told this treatment would work quickly, but now we are unsure if it is helping.

Could his body not respond due to some underlying issue? He is feeling quite distressed, and we were not sure whether to give it more time or consider a different treatment.
What would you recommend as the next step?
Also, is this condition fully reversible?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Prurigo nodularis or PN (a chronic skin condition characterized by intensely itchy, firm nodules that often appear on the arms, legs, and torso) is a challenging condition, and treatment can vary based on the individual’s response and severity of symptoms. There are several options available, both approved and off-label.

Currently, two FDA (Food and Drug Administration)-approved medications for PN are Dupixent (Dupilumab) and Nemolizumab (marketed as Nemluvio). Nemolizumab is a newer medication targeting the IL-31 receptor, which is involved in the itch-scratch cycle seen in PN. While it can provide relief, it may take several weeks to show significant improvement. In some cases, symptoms may temporarily worsen before improving, but a doctor should review any increase in severity.

Off-label treatments can also be beneficial. These include topical corticosteroids, vitamin D analogs, gabapentinoids, and certain antidepressants, especially for managing chronic itch and sleep disruption.

In addition, over-the-counter options like calamine lotion, cooling creams, and antihistamines may offer temporary relief. Non-pharmacologic treatments such as phototherapy or cryosurgery might be considered in resistant cases. Working closely with a dermatologist to adjust treatment based on how the condition evolves is important.

I hope this helps.

Please revert in case of further queries.

Thank you.