The State of the Art in Chronic Prurigo Nodularis.

Chronic prurigo nodularis (CPN) is a highly burdensome chronic inflammatory dermatosis characterized by intensely pruritic papulonodular lesions that may persist for years. Its pathophysiology reflects a neuro-immune-fibrotic axis in which type-2 cytokines (IL-4/IL-13/IL-31), neuropeptides, and profibrotic signaling interact to sustain the itch-scratch cycle and dermal fibrosis. CPN predominantly affects older adult women and is frequently associated with dermatologic, neuropsychiatric, and cardiometabolic comorbidities. Definition, nomenclature, and management remain areas of debate, with relevant differences between European and US consensus documents. The therapeutic landscape has expanded with dupilumab and nemolizumab, the only agents currently supported by phase III evidence, whereas JAK inhibitors remain promising but investigational options that require careful safety contextualization. This narrative review synthesizes current knowledge on CPN, from definition and epidemiology to etiopathogenesis and evolving therapy, while highlighting persistent unmet needs in diagnosis and management.