Advances in the Management of Prurigo Nodularis - Episode 6

Physician Guidelines for PN

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Raj Chovatiya, MD, PhD; Shawn Kwatra, MD; and Sarina B. Elmariah, MD, PhD; share guideline resources that physicians turn to when treating PN.

Raj Chovatiya, MD, PhD: In some ways, it’s not that surprising oftentimes that our patients with the most severe PN [prurigo nodularis] have so many issues that leave them so disconnected from the health system. They’ve gone years without appropriate treatment. It’s been years, potentially, since someone’s even really given a second thought to what might be going on. That’s really the tough part of the disease, when you get those patients coming into the office. Oftentimes, there’s a lot of work that you have to do as the quarterback of that team. I really love how you put it, that at the end of the day that almost might be the most important thing you can do to get them over the hump and really get them to buy into the treatment plan you’re trying to set up when it comes to managing the disease appropriately. I might follow up on your statement, since you’re definitely the right person to ask about this. Are there any particular guidelines that folks turn to for disease management? What exactly has been put out there in terms of recommendations about how you go about therapy?

Sarina B. Elmariah, MD, PhD: Yes. Thanks for asking that. A group of physicians who are interested in PN and see a lot of PN patients — Dr Shawn Kwatra is 1 of my esteemed colleagues, and a series of others — we got together to offer some guidance on this topic of how to evaluate and to consider treatment for patients with PN that was published in the Journal of Affective Disorders over a year ago. I think that was the first of many steps that we’re taking as a community of itch dermatologists, or individuals interested in this neuroimmune dysregulation, towards making those suggestions. Again, that’s already, to some extent, outdated because of the landscape, there’s much interest in this disorder. We’re building awareness of the disorder and an understanding of the pathophysiology. The treatment landscape is already changing dramatically.

I do want to make 1 more point. I do want to emphasize to anybody watching this that the majority of patients whom you may see with PN are not necessarily going to have renal disease. They’re not going to have associated diabetes. While there are increased odds of that, of having PN if you have those disorders, these patients do not always have it. I don’t want to give the impression that every patient walking in the door is going to have some other completely uncontrolled disease. It is important to ask. It’s important to be aware of their overall health. That will play into even just our understanding of this disease and how to then treat it. Which is the topic we’ll probably get to soon.

Raj Chovatiya, MD, PhD: That’s a very nice way to encapsulate the fact that it’s really a disservice to patients to pigeonhole them into categories based on what you might think or be expecting or what little you know. This is also in regard to the point both of you very nicely made, which is that for everyone thinking that this is some psychological thing first that manifests, that is not the hole you want to put your patients in.

Transcript edited for clarity