Chronic nodular prurigo (CNPG), also known as prurigo nodularis, is an inflammatory neuroimmune skin disorder characterized by intense pruritus and nodular lesions resulting from scratching. CNPG affects patients’ health-related quality of life (HRQoL); however, the magnitude of burden and clinical implications remain underrecognized in dermatologic practice. This systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches of PubMed and the Cochrane Library (April 2025) identified observational studies reporting HRQoL, symptom burden, or unmet needs in adults with CNPG. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the STROBE checklist. Of 464 records identified, 23 studies met the inclusion criteria. CNPG was consistently associated with substantial impairment in HRQoL, primarily driven by uncontrolled pruritus. Mean Dermatology Life Quality Index scores ranged from 7 to 22, EQ-5D scores from 57.4 to 65.3, and Health Utilities Index Mark III scores were approximately 0.52, significantly lower than in control population (p < 0.001). Pruritus emerged as the dominant symptom and central determinant of HRQoL impairment, reflected by elevated Itchy Quality of Life, 5-D Itch, and 5-D Pruritus Life Quality scores. Sleep disturbances were reported by up to 100% of patients, while anxiety and depressive symptoms affected 26–46% and 16–57% of patients, respectively. CNPG was associated with impairment in daily activities (up to 100%), occupational functioning (up to 83%), and social or sexual relationships (27–95%). Treatment satisfaction was low (mean 57.4%), and higher pruritus intensity was associated with worse HRQoL and lower satisfaction. However, no mediation analyses were performed, and causal relationships between pruritus severity and HRQoL impairment cannot be established. CNPG is associated with a substantial and multidimensional disease burden extending beyond cutaneous manifestations. Pruritus may emerge as the central driver of this burden, underscoring the importance of systematic assessment of HRQoL and itch severity. Chronic nodular prurigo, also known as prurigo nodularis, is a long-lasting skin condition that causes severe and persistent itching and the development of hard, itchy skin nodules due to repeated scratching. This condition can strongly affect daily life, but its full impact on patients’ quality of life is often underestimated in routine clinical care. In this study, the authors reviewed published observational research to better understand how chronic nodular prurigo affects patients’ physical, emotional, and social well-being. The review showed that people living with this condition experience a marked reduction in quality of life, mainly driven by the intensity of itching. Many patients reported sleep problems, emotional distress such as anxiety or depression, and difficulties carrying out everyday activities, working, and maintaining social or intimate relationships. Overall satisfaction with available treatments was low, particularly among patients with more severe itching. These findings suggest that managing chronic nodular prurigo requires more than treating skin symptoms alone. Better patient-centered care approaches are needed, with a strong focus on effective itch control and attention to the emotional and social challenges faced by patients, in order to meaningfully improve their quality of life.
Pinto et al. (Tue,) studied this question.