Clin Cosmet Investig Dermatol. 2026 Nov 9;19:651906. doi: 10.2147/CCID.S651906. eCollection 2026.

ABSTRACT

BACKGROUND: Prurigo nodularis (PN) is a chronic, intensely pruritic inflammatory skin disorder with limited efficacy of traditional therapies. Upadacitinib represents a novel therapeutic approach.

PURPOSE: This study aimed to describe the clinical response and observed safety outcomes of upadacitinib for refractory PN.

PATIENTS AND METHODS: We report four patients with refractory PN receiving upadacitinib for 3-6 months and present a narrative literature review of published studies.

RESULTS: In our four cases, the Peak Pruritus Numerical Rating Scale (PP‑NRS) scores decreased from 8-10 at baseline to 0-2 after treatment, with all achieving a ≥6‑point reduction. Investigator's Global Assessment (IGA) score improved from 3-4 to 0-1, and Dermatology Life Quality Index (DLQI) from 22-26 to 0-2. The literature review identified three cohort studies and five case reports. The proportions of patients achieving a ≥4-point reduction in pruritus scores were 94% at week 16, 100% at week 24, and 100% at month 6 in the three cohort studies, respectively. Among five published cases, post-treatment pruritus scores ranged from 0 to 2, with reductions of 7-9 points in four cases with paired data. No adverse events were documented in our four patients during follow-up, although adverse events were reported in published studies.

CONCLUSION: Our findings provide additional real-world evidence supporting the potential role of upadacitinib in refractory PN.

PMID:43032682 | PMC:PMC13761334 | DOI:10.2147/CCID.S651906