From the Guidelines
Prurigo and atopic dermatitis are distinct skin conditions with different pathophysiologies and treatment approaches, and the most recent guidelines prioritize a personalized treatment plan based on disease severity, quality of life, and patient preferences 1.
Key Differences
- Atopic dermatitis is a chronic inflammatory skin condition characterized by intense itching, redness, and eczematous lesions, often beginning in childhood and associated with other atopic conditions like asthma and allergic rhinitis.
- Prurigo, particularly prurigo nodularis, presents as firm, intensely itchy nodules typically on the extensor surfaces of limbs, resulting from chronic scratching and can occur at any age.
Treatment Approaches
- Atopic dermatitis treatment includes moisturizers, topical corticosteroids, calcineurin inhibitors, and in severe cases, systemic therapies like dupilumab, with a focus on shared decision-making between patients and clinicians 1.
- Prurigo treatment focuses on breaking the itch-scratch cycle with potent topical steroids, intralesional steroid injections, antihistamines, and sometimes gabapentinoids or phototherapy.
Recent Guidelines
- The most recent guidelines from the American Academy of Dermatology (2024) provide evidence-based recommendations for the management of atopic dermatitis in adults with phototherapy and systemic therapies, highlighting the importance of personalized treatment plans and shared decision-making 1.
- These guidelines support strong recommendations for the use of biologics and Janus kinase inhibitors, such as dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, in the treatment of atopic dermatitis.
From the Research
Comparison of Prurigo and Atopic Dermatitis
- Prurigo is a reactive, hyperplastic skin condition characterized by pruritic papules, plaques, and/or nodules, whereas atopic dermatitis is a chronic relapsing and remitting inflammatory skin disease affecting one in 10 people in their lifetime 2, 3.
- Both conditions involve intense pruritus, with atopic dermatitis caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors, and prurigo showing similarities with atopic dermatitis due to the involvement of IL-4 and IL-13, IL-22, and IL-31 3, 2.
Treatment Options
- Treatment for atopic dermatitis includes liberal use of emollients, daily bathing with soap-free cleansers, and use of topical corticosteroids as first-line treatment, while prurigo treatment includes antihistamines, topical steroids, dupilumab, and JAK inhibitors 3, 2.
- Antihistamines are not recommended for atopic dermatitis, except for short-term sedating antihistamine use for insomnia secondary to itch, while they may have a synergistic effect when combined with topical steroids for pruritus in atopic dermatitis 4, 5.
- Newer medications such as crisaborole and dupilumab are effective in treating atopic dermatitis, but are currently cost-prohibitive for most patients, and may be considered for patients with moderate-to-severe atopic dermatitis or prurigo 3, 6.
Diagnosis and Quality of Life
- The American Academy of Dermatology has created simple diagnostic criteria for atopic dermatitis based on symptoms and physical examination findings, while prurigo diagnosis must precede correct treatment, with several conditions manifesting clinically as prurigo-like lesions 3, 2.
- Both conditions can significantly impact the patient's quality of life, with atopic dermatitis causing a self-perpetuating itch-scratch cycle, and prurigo representing a recalcitrant and distressing dermatosis, especially in the elderly 3, 2.