A Visual Guide to Diagnosing Prurigo Nodularis in Skin of Color, With Mona Shahriari, MD

At the 2025 Fall Clinical Dermatology Conference in Las Vegas, Nevada, the HCPLive team sat down with Mona Shahriari, MD, regarding her conference talk titled ‘ Seeing Clearly: A Visual Guide to Diagnosing Prurigo Nodularis in Skin of Color.’1

Shahriari, known for her work as associate clinical professor of dermatology at Yale University and the host of The Medical Sisterhood podcast, was asked about the major takeaways from her session on prurigo nodularis. Shahriari touched on several clinical pearls and recent data on inflammatory skin disease, a condition characterized by intensely pruritic nodules.2

“A couple of pearls that people can hopefully take away from our talk is that the itch of [prurigo nodularis] tends to be much more deep and intense in our patients of all skin types, but more so in our patients with skin of color,” Shahriari explained. “[This is] because pruritus is a bigger factor in those individuals, transdermal water loss, lower amounts of ceramides in the stratum corneum, as well as large mast cells in the skin of our skin of color patients just makes them more susceptible to pruritus.”

Shahriari highlighted prurigo nodularis’s characteristic unrelenting itch and the inflammation felt especially by patients with skin of color.

“The other thing we talked about was the post-inflammatory pigmentary changes that come with PN in patients from a variety of skin tones, and why it's so important for us to intervene early, because prevention is always easier than going back and playing catch-up and trying to treat,” Shahriari said. “Lastly, we emphasized the importance of considering PN as not just a skin disease, but a systemic condition, because there's new data actually coming out that the inflammation of PN can actually cause kidney issues.”

Shahriari noted, historically, clinicians viewed kidney disease as a comorbidity and believed having it might set off prurigo nodularis. Now, however, the inflammation related to prurigo nodularis is believed to actually cause issues in the body.

“We also went through the therapeutic landscape, dupilumab and nemolizumab, both FDA-approved for the treatment of PN across skin types,” Shahriari said. “Both studies actually enrolled a fair number of skin of color patients, which is really reminiscent of what is going on in the space with respect to the overall prevalence of the disease in a variety of skin tones; it is three to four times more common in skin of color. So it's really nice that they were able to capture that in the clinical trial studies. Both drugs work exceptionally well for this disease.”

For more information on this session, view the interview posted above.

Shahriari has previously reported personal fees from AbbVie, Apogee, Arcutis, Bristol Myers Squibb, Dermavant, Galderma, Incyte, Johnson & Johnson, LEO, Lilly USA, Novartis, Ortho Dermatologics, Regeneron, Sanofi-Genzyme, Takeda, and UCB and has served as a speaker for AbbVie, Arcutis, Bristol Myers Squibb, Dermavant, Johnson & Johnson, Lilly USA, Pfizer, Regeneron, Sanofi-Genzyme, and UCB. She has also served as an investigator for AbbVie, Cara, CorEvitas Atopic Dermatitis Registry, CorEvitas Psoriasis Registry, Dermavant, Dermira, Lilly USA, Mindera, Novartis, and Unio.

References

1. Shahriari M, Kwatra S, et al. Seeing Clearly: A Visual Guide to Diagnosing Prurigo Nodularis in Skin of Color. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

2. Liao V, Cornman HL, Ma E, Kwatra SG. Prurigo nodularis: new insights into pathogenesis and novel therapeutics. Br J Dermatol. 2024 May 17;190(6):798-810. doi: 10.1093/bjd/ljae052. PMID: 38345154; PMCID: PMC11099982.