Controlling the Itch in Prurigo Nodularis

Raja Sivamani:

I am Raja Sivamani. I'm a board-certified dermatologist. I'm actually an integrative dermatologist because I have training in Ayurvedic medicine as well. And I practice in Sacramento, California. We have a private practice there. We see a lot of Medi-Cal patients as well, so I really am interested in treating the underserved. And as such, I also do a lot of clinical research, so I get to play in both worlds of clinical care and clinical research.

There are some really big unmet needs with PN. We're getting better and better when we think of prurigo nodularis. We're thinking of what are the ways that we can keep pushing the boundaries of our knowledge and pushing the boundaries of our care. Let me start with care. We have to really get this itch under control. And it's really important that we don't just look at the itch singularly. We have a holistic person, so you really have to look at their entire medical history, their history with maybe new medications and other sort of past medical history, like, "Do they have a history of cancers?" Do you have to think about is something coming back or is something new there? And then just treating the itch.

The real big thing with itch is that it used to be thought that it was just neural, but now we know it's neuroimmune. You have immune system that's involved along with the nerves, so you have to treat both. You have to address inflammation. You can't just treat the itch in an isolated fashion. And so I think we've entered this new paradigm where this neuroimmune control where we're looking at these inflammatory signals and cytokines is going to be central to how we treat it.