Bridging the Gap in Chronic Prurigo Care: Evidence-Based Diagnostic and Therapeutic Recommendations from a Delphi Consensus Panel

OBJECTIVE: Chronic prurigo (CPG) is a chronic neuroinflammatory skin disease characterized by persistent itch, repeated scratching, and the presence of multiple skin lesions. CPG is a highly burdensome disease that significantly impairs patients' quality of life. The objective of these consensus recommendations is to summarize available evidence and provide standardized guidance for the diagnosis and management of patients with CPG. METHODS: These recommendations were developed using a Delphi methodology, conducted over two rounds of online voting by the participation of 23 Portuguese dermatologists. The strength of consensus was defined as strong consensus (≥ 95% agreement), consensus (≥ 75%), and majority agreement (≥ 50%). RESULTS: The diagnosis of CPG requires the concomitant presence of a ≥ 6-week history of pruritus; a history of repeated excoriation; and multiple skin lesions (including nodules, papules, umbilicated lesions, and linear lesions, among others). Diagnosis should be based on patient history and physical examination, and complemented by laboratory tests and additional investigations if needed. Treatment should follow a personalized protocol, according to disease severity and guided by both clinician- and patient-reported outcomes. Systemic therapeutic options for eligible patients include CPG-approved biological agents (dupilumab and nemolizumab), gabapentinoids, and antidepressants. Additional treatment options may be considered, including interleukin (IL)-13 inhibitors, Janus kinases (JAK) inhibitors, opioid receptor modulators, methotrexate, and cyclosporine. Treatment efficacy should be regularly assessed to ensure clinical improvement and patient adherence. CONCLUSION: This study provides guidance on the diagnosis and treatment of CPG supporting diagnosis and treatment decision-making.