Experts in dermatology discuss treatment goals for PN and how they can differ based on severity of itching and nodules.
Raj Chovatiya, MD, PhD: That really leads into the next theme that I think is worth us exploring a bit. What really are our goals of treatment when it comes to prurigo nodularis [PN]? What are we looking to do? Maybe Dr Sarina B. Elmariah, you can take us through what you’re thinking about when that patient comes in with a variety of severities in terms of prurigo nodularis? You’re thinking about itch. You’re thinking about that itch-scratch cycle, and you’re thinking about sleep and pain. How do you balance all this together? What do you break down for them?
Sarina B. Elmariah, MD, PhD: That’s a great question. It’s something I think we all have to really focus on. The idea when you’re treating a patient with PN, first and foremost, is that you want to relieve their itch. It’s usually their greatest complaint. It’s also what’s keeping them up at night. It’s the crux of this disorder. A very closely tied goal is also to heal the nodular lesions. Allow them to heal. Whether that be improving ulcerations, improving the nodules, even helping along the line with the later, more chronic phases of hyperpigmentation. The idea would be relieve the itch, heal the nodules.
Then the underlying, but most important aspect, of this is we’re trying to give people their lives back. To improve their quality of life. Whether that be also and simultaneously addressing the associated, or frequently associated, anxiety, depression, and the sleep loss. One thing that I just want to emphasize is you really do need to have a multidisciplinary team and have a very good relationship with the patient’s primary care doctor. Dr Shawn Kwatra even said, sometimes we’re getting these patients’ primary care doctors. Now, certainly, we can’t be the ones to make all these phone calls and do everything all the time. If there is a clear lack of support structure both clinical, like medical help, as well as even just social support for these patients, to some extent, we’re doing them a disservice by not helping them realize that and establishing that necessary framework. It is a disorder that has such a broad impact on a patient’s quality of life overall. That is something that I spend the time doing. When they’re sleeping better and they’re taking care of their diabetes or making sure that they’re seeing their nephrologist more often, they tend to, I think, embrace an improvement in all aspects of their life, in addition to the PN.
Transcript edited for clarity