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Opinion

Video

Prioritizing Rapid Itch Relief in a 58-Year-Old Patient With Severe Prurigo Nodularis

An expert discusses how to approach a 58-year-old African American woman with severe prurigo nodularis experiencing extreme itch (9/10 rating) and extensive lesions, emphasizing the need for rapid systemic intervention with nemolizumab due to its faster onset of itch relief compared with other biologics.

Video content above is prompted by the following:

Case 1 presents a 58-year-old African American woman, a restaurant manager with severe prurigo nodularis diagnosed 18 months prior. She reports extreme itch rated 9 of 10 on a numerical rating scale, with over 50 excoriated hyperkeratotic nodules on her arms, shoulders, and legs. Her medical history includes hypertension, hyperthyroidism, and anxiety, with previous treatments including topical hydrocortisone, amitriptyline, and clobetasol providing minimal relief.

The patient's presentation demonstrates high disease burden with unrelenting itch causing sleep disruption to only a few hours nightly and work absenteeism. African American patients show higher susceptibility to prurigo nodularis compared with Caucasian patients, and this patient exhibits common comorbidities including hypertension and anxiety. The extensive disease with more than 20 lesions and severe itch rating clearly indicates need for systemic intervention rather than topical treatments.

For rapid itch relief, nemolizumab represents the optimal first-line choice due to its ability to achieve significant improvement after just 1 injection. Unlike dupilumab, which requires longer time to effect, nemolizumab administered every 4 weeks provides the fastest antipruritic effect. The psychological impact of prurigo nodularis, previously misunderstood as a cause rather than consequence of the disease, requires addressing through effective itch control. Modern targeted biologics not only improve physical symptoms but also secondary comorbidities like depression and anxiety, offering comprehensive patient care through shared decision-making approaches.

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