Targeting Prurigo Nodularis From the Inside Out

Targeting Prurigo Nodularis From the Inside Out

Online Course | Specialties: Dermatology
Released: 12/20/2021
Expires: 12/19/2022
Max Credits: 1.0

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Brian Kim, MD, MTR
Sol and Clara Kest Professor of Dermatology
Vice Chair of Research
Site Chair Mount Sinai West and Morningside
Director of the Mark Lebwohl Center for Neuroinflammation and Sensation
Director of the Clinical Center for Itch
New York, NY

Shawn Kwatra, MD, FAAD
Associate Professor of Dermatology and Oncology
Director, Johns Hopkins Itch Center
Johns Hopkins University School of Medicine
Baltimore, MD

Activity Planners
Genevieve Olucha, PhD
Clinical Content Manager
Baltimore, MD

Rebecca L. Julian, MS, ELS
Senior Manager, Editorial
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Kathryn Schaefer, MSN, RN, CPHRM, CHCP
Associate Director, Education Quality and Compliance
East Lansing, MI

Stephanie Wenick, MPhil
Wenick Communications, LLC
Chevy Chase, MD

Learning Objectives
Upon completion, participants should be able to:

  • Describe the underlying pathophysiology and characteristic features of PN and the effects of chronic itch on patients’ quality of life
  • Review recent scientific findings and clinical trial data supporting the use of current and emerging therapies for PN
  • Design a comprehensive, personalized management strategy for PN that incorporates topical and systemic agents to reduce symptoms and improve outcomes

Target Audience
This activity is intended for dermatology clinicians, including physicians, nurses, nurse practitioners, and physician assistants.

Statement of Need
Prurigo nodularis (PN) is a chronic skin condition characterized by hyperkeratotic nodules, severe itch, a substantial clinical and healthcare burden, and a profound effect on patients’ quality of life. Current therapeutic options are limited; however, advances in understanding the pathogenesis of PN are revealing therapeutic targets that are informing the clinical development of new and emerging treatments, which may have practice-changing implications. Clinicians would benefit from a better understanding of the mechanisms of PN, potential pathway targets for therapy, the mechanisms of action of current and emerging therapies, and the role of targeted therapies within the treatment paradigm.

Providership Statement
Provided by Med-IQ.

Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Med-IQ designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME MOCSuccessful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

CLAIMING MOC POINTS: If you intend to claim MOC points for your participation, you will need to provide your unique, six-digit ABIM ID Number. Please note, your name, ABIM ID number, birthdate and completion status will be shared with ABIM through the ACCME PARS system. Your points will be automatically submitted to the ABIM on your behalf; please allow 4 weeks for your points to display on the ABIM website.

Med-IQ is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This nursing activity has been approved for up to 1.0 contact hour.

Physician assistants and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available.

Instructions to Receive Credit
This is a 1.0-credit CE activity. To receive credit, read the introductory CE material, complete all of the modules, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.

Initial Release Date: December 20, 2021
Expiration Date: December 19, 2022
Estimated Time to Complete This Activity: 1 hour

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 24 months that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Drug/Product Usage by Faculty
Off-label/unapproved drug uses or products are mentioned within this activity.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Brian Kim, MD
Consulting fees/advisory boards: AbbVie Inc., Almirall, AstraZeneca, Bristol-Myers Squibb, Cara Therapeutics, Galderma Laboratories, L.P., Granular Therapeutics, LEO Pharma, Inc., Lilly, Pfizer, Inc., RecensMedical, Inc., Regeneron Pharmaceuticals, Inc., Sanofi-aventis U.S. Inc., Trevi Therapeutics 
Contracted research: Cara Therapeutics, LEO Pharma, Inc.
Ownership interest (stocks/stock options – excluding mutual funds): Locus Biosciences, RecensMedical, Inc.

Shawn Kwatra, MD, FAAD 
Consulting fees/advisory boards: AbbVie Inc., Celldex Therapeutics, Galderma Laboratories, L.P., Incyte Corporation, Kiniksa Pharmaceuticals, Novartis Pharmaceuticals Corporation, Pfizer, Inc., Regeneron Pharmaceuticals, Inc., Sanofi-aventis U.S. Inc. 
Contracted research: Galderma Laboratories, Kiniksa Pharmaceuticals, Pfizer, Inc., Sanofi-aventis U.S. Inc.

The peer reviewers and activity planners have no financial relationships to disclose.

Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, Med-IQ has a policy to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.

Contact Information
For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email

System Requirements



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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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Complimentary CE
This activity is available free of charge to participants.

Acknowledgment of Commercial Support
This activity is supported by educational grant Sanofi Genzyme and Regeneron Pharmaceuticals.



Epidemiology and the Effects of PN

PN is a chronic, inflammatory, dermatologic condition characterized by intense itching and hyperkeratotic nodules.1,2 Patients with PN experience the hallmark symptom of an unrelenting itch-scratch cycle that is more intense and frequent than other chronic itch-associated pruritic skin diseases. In fact, PN-associated itch is so intense that bleeding frequently occurs from scratching.1-3 It profoundly affects patients’ quality of life by impairing sleep, work productivity, and social participation. In addition, patients with PN frequently experience psychosocial disturbances, such as anxiety and depression.1,3-5

Patient Demographics
Compared with other inflammatory skin diseases like atopic dermatitis (AD) and psoriasis, PN is relatively rare. In the United States, the overall prevalence of PN is 58 per 100,000, whereas the overall prevalence of AD and psoriasis is 432 and 366 per 100,000, respectively.6 The average age of patients with PN is between 50 and 60 years, and adults are more likely to be affected than children.2,6 Indeed, the prevalence of PN in adults is 70 per 100,000 compared with 7 per 100,000 in children.2,6

In addition, PN tends to affect women slightly more than men. A recent claims data analysis showed that 53.5% of patients with PN were women.6 However, differences in gender distribution of PN may vary by race. In a single-center study of 909 patients with PN, 54.6% of African American patients were female compared with 50.5% of White patients and 41.9% of Asian patients.7

PN also occurs more frequently in patients with skin of color than in White patients. Data from the previously mentioned single-center study showed that African American patients were 3.4 times more likely to have PN than White patients.7 Similarly, an analysis of 2016 National Inpatient Sample hospital data found that patients hospitalized with PN were more likely to be Black (odds ratio [OR], 4.43; P < .001), Asian (OR, 3.44; P = .003), or Hispanic (OR, 1.77; P = .02) than White.8 In general, a high prevalence of pruritus among Black patients combined with barriers to healthcare access likely contribute to the disproportionate burden of PN in this population.9 In addition, Black skin exhibits several unique properties related to the pathogenesis of pruritus, including increased transepidermal water loss, decreased ceramide levels, lower pH in stratum corneum, and increased mast cell size, which can lead to deeper-seated nodules than those seen in White patients.1,10 More research is needed to better characterize these differences and their implications on the mechanisms of chronic pruritus in those with skin of color.1,10

Quality-of-Life Effects
As previously mentioned, the effects of PN on quality of life are significant. A majority of patients experience pain, burning, stinging, and prickling sensations in addition to itching.4 Symptoms of pruritus occur throughout the day, with the most intense symptoms occurring in the evening and night.5 Therefore, sleep quality is frequently poor.4,5 Indeed, a survey of 52 patients with PN found that nearly 20% used sleep medication at least once a month.5

Nearly one-half of patients with PN report diagnoses of anxiety or depression.4 In addition, approximately 27% of patients refrain from participating in social activities, are frequently absent from work, or have retired from work because of PN.5 Taken together, the economic impact of PN is significant.11 On average, 6.5 lifetime quality-adjusted life years are lost per patient, with an individual lifetime economic burden of $323,292 and a societal burden of $38.8 billion.11

Currently, no therapies are approved for use in PN, which creates treatment challenges.1 Because of these challenges, frequent provider visits are common.4 Specifically, patients visit their providers an average of 6 times per year, with more than one-third visiting their providers 10 times or more per year.4

View reference list.

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