From the Guidelines
Prurigo, a chronic skin condition characterized by intensely itchy, firm nodules or papules, requires a comprehensive treatment approach to break the itch-scratch cycle and improve quality of life. The treatment of prurigo typically involves a combination of therapies, including high-potency topical corticosteroids, antihistamines, and oral medications.
- High-potency topical corticosteroids like clobetasol 0.05% applied twice daily for 2-4 weeks can help reduce inflammation and itching, followed by maintenance therapy 1.
- Antihistamines such as hydroxyzine (25-50mg at bedtime) or cetirizine (10mg daily) can help control itching, although sedative antihistamines may predispose to dementia and should be avoided, except in palliative care 1.
- Oral medications like gabapentin (starting at 300mg daily, gradually increasing) or pregabalin (75mg twice daily) may be prescribed for severe cases, although gabapentin should not be used in hepatic pruritus 1.
- Newer treatments include dupilumab injections (300mg every two weeks) for refractory cases.
- Patients should avoid scratching, keep nails short, use gentle fragrance-free soaps, apply moisturizers regularly, and wear loose cotton clothing.
- Underlying conditions such as iron deficiency, lymphoma, polycythaemia vera, solid cancers, uraemia, liver disease, neuropathy, and psychological and emotional factors should be addressed and treated accordingly, as they can contribute to the development and persistence of prurigo 1. The most effective treatment approach for prurigo involves a combination of therapies tailored to the individual's symptoms and response, with a focus on breaking the itch-scratch cycle and improving quality of life.
From the FDA Drug Label
Triamcinolone acetonide cream, 0.1% is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. Triamcinolone cream is indicated for the relief of pruritic manifestations of corticosteroid-responsive dermatoses, which includes prurigo.
- The drug is used to relieve inflammatory and pruritic symptoms.
- Prurigo is a condition characterized by intense pruritus (itching), which may be relieved by triamcinolone cream 2.
From the Research
Definition and Characteristics of Prurigo
- Prurigo is a condition characterized by nodular cutaneous lesions that itch intensely 3
- It can be caused by various factors, including insect stings, toxic agents, parasites, bacteria, or topically or orally administered drugs 3
- Prurigo is sometimes associated with atopy, pregnancy, internal diseases, malabsorption, or malignancy 3
- Emotional factors can also influence the perception of itch and induce prurigo by provoking scratching 3
Classification and Types of Prurigo
- Prurigo can be classified into different types, including prurigo nodularis, prurigo chronica multiformis, and prurigo (not otherwise specified) 4
- The temporal classification includes acute/subacute and chronic disease (≥ 6 weeks), with different clinical variants, synonymies, and underlying etiological factors 5
- Prurigo pigmentosa is a specialized form of prurigo that has some ethnic preference 3
Treatment Options for Prurigo
- Topical treatments, such as corticosteroids, coal tar, bath photochemotherapy, UVB, cryotherapy, or capsaicin, can be used to treat prurigo 3
- Systemic regimens, involving use of psoralen + UVA (PUVA), erythromycin, arotinoid acid, cyclosporine, chloroquine, dapsone, minocycline, naltrexone, azathioprine, or thalidomide, can also be used 3
- Non-systemic forms of treatment, including topical corticosteroids, topical steroid-sparing agents, and phototherapy, can be effective for prurigo nodularis 6
- Duloxetine hydrochloride, a serotonin-norepinephrine reuptake inhibitor, has been shown to be useful for treating prurigo via modulating itch signals and immune responses 7