New insights from Vietnam on the effectiveness of methotrexate in treating prurigo nodularis: An interventional study with a control group
The effectiveness of methotrexate in treating prurigo nodularis
DOI:
https://doi.org/10.66344/jpad.v34i4.2876Keywords:
Desloratadine, methotrexate, prurigo nodularis, Pruritus Numeric Rating ScaleAbstract
Background Prurigo nodularis is a chronic inflammatory skin condition marked by firm nodules and severe itching, significantly impairing quality of life. Methotrexate (MTX) has demonstrated efficacy in alleviating itching and reducing skin lesions in difficult and recurrent cases, with sustained benefits and good tolerability.
Objective To evaluate the efficacy of MTX in treating prurigo nodularis in Vietnam.
Methods This interventional study included 33 patients in the MTX group, receiving weekly methotrexate (10 mg), daily desloratadine (5 mg), topical corticosteroids, and moisturizers. A control group received the same treatment, excluding MTX. Outcomes were assessed at 4, 8, and 12 weeks.
Results Before treatment, the MTX group's mean scores for pruritus severity (Pruritus Numeric Rating Scale - PNRS), number of nodules/lesions, and active lesion count were 3.61±0.79, 58.27±34.38, and 33.0±25.69, respectively. After 12 weeks, these scores significantly decreased to 1.52±1.03, 22.45±14.49, and 11.32±10.74 (P<0.001). The MTX group showed greater itch reduction than the control group at week 4 (P=0.006). The reduction in the number of active lesions and nodules/lesions in the MTX group was statistically significant compared to the control group at all follow-up points (P<0.05). Adverse effects included gastrointestinal symptoms (6.1%) and one infection (3.0%).
Conclusion MTX is effective and well-tolerated for treating prurigo nodularis, emphasizing its potential in clinical management.
References
1. Williams KA, Roh YS, Brown I, Sutaria N, Bakhshi P, Choi J, et al. Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis. Expert Rev Clin Pharmacol. 2021;14(1):67-77.
doi:10.1080/17512433.2021.1852080
2. Tsianakas A, Zeidler C, Ständer S. Prurigo Nodularis Management. Curr Probl Dermatol. 2016;50:94-101.
doi:10.1159/000446049
3. Satoh T, Yokozeki H, Murota H, Tokura Y, Kabashima K, Takamori K, et al. 2020 guidelines for the diagnosis and treatment of prurigo. J Dermatol. 2021;48(9):e414-e431.
doi:10.1111/1346-8138.16067
4. Müller S, Zeidler C, Ständer S. Chronic Prurigo Including Prurigo Nodularis: New Insights and Treatments. Am J Clin Dermatol. 2024;25(1):15-33.
doi:10.1007/s40257-023-00818-z
5. Kwatra SG. Prurigo Nodularis. JAMA Dermatol. 2022;158(3):336.
doi:10.1001/jamadermatol.2021.5307
6. Williams KA, Huang AH, Belzberg M, Kwatra SG. Prurigo nodularis: Pathogenesis and management. J Am Acad Dermatol. 2020;83(6):1567-75.
7. Almustafa ZZ, Weller K, Autenrieth J, Maurer M, Metz M. Dupilumab in treatment of chronic prurigo: A case series and literature review. Acta Derm Venereol. 2019;99(10):905-6.
doi:10.2340/00015555-3243
8. Bergqvist C, Fiani C, Simantov A, et al. Combined Methotrexate and Alitretinoin for the treatment of difficult-to-treat generalized prurigo nodularis: a case series. J Eur Acad Dermatol Venereol. 2021;35(8):e516-e519. doi:10.1111/jdv.17262
9. Spring P, Gschwind I, Gilliet M. Prurigo nodularis: Retrospective study of 13 cases managed with methotrexate. Clin Exp Dermatol. 2014;39(4):468-73.
doi:10.1111/ced.12365
10. Saraceno R, Chiricozzi A, Nisticò SP, Tiberti S, Chimenti S. An occlusive dressing containing betamethasone valerate 0.1% for the treatment of prurigo nodularis. J Dermatol Treat. 2010;21(6):363-6.
doi:10.3109/09546630903386606
11. Labib A, Ju T, Vander Does A, Yosipovitch G. Immunotargets and Therapy for Prurigo Nodularis. ImmunoTargets Ther. 2022;11:11-21.
doi:10.2147/ITT.S316602
12. Zeidler C, Yosipovitch G, Ständer S. Prurigo nodularis and its management. Dermatol Clin. 2018;36(3):189-97.
doi:10.1016/j.det.2018.02.003
13. Yosipovitch G, Mollanazar N, Ständer S, et al. Dupilumab in patients with prurigo nodularis: two randomized, double-blind, placebo-controlled phase 3 trials. Nat Med. 2023;29:1-11.
doi:10.1038/s41591-023-02320-9
14. Klejtman T, Beylot-Barry M, Joly P, Richard MA, Debarbieux S, Misery L, et al. Treatment of prurigo with methotrexate: A multicentre retrospective study of 39 cases. J Eur Acad Dermatol Venereol. 2018;32(3):437-440. doi:10.1111/jdv.14646
15. Ständer S, Pereira MP, Berger T; Zeidler C; Augustin M, Bobko S, et al. IFSI-guideline on chronic prurigo including prurigo nodularis. Itch. 2020;5:e42.
doi:10.1097/itx.0000000000000042
16. Pereira MP, Steinke S, Zeidler C, Forner C, Riepe C, Augustin M, et al. EADV Task Force Pruritus group members. European Academy of Dermatology And Venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo. J Eur Acad Dermatol Venereol. 2018;32(7):1059-65. doi:10.1111/jdv.14570
17. Zeidler C, Pereira MP, Augustin M, Spellman M, Ständer S. Investigator’s Global Assessment of Chronic Prurigo: A New Instrument for Use in Clinical Trials. Acta Derm Venereol. 2021; 101(2):adv00401.
doi:10.2340/00015555-3701
18. Gründel S, Pereira MP, Storck M, Osada N, Schneider G, Ständer S, et al. Analysis of 325 patients with chronic nodular prurigo: Clinics, burden of disease and course of treatment. Acta Derm Venereol. 2020;100(16):adv00269. doi:10.2340/00015555-3571
19. Spring P, Gschwind I, Gilliet M. Prurigo nodularis: retrospective study of 13 cases managed with methotrexate. Clin Exp Dermatol. 2014;39(4):468-473.
doi:10.1111/ced.12365
20. Wong LS, Yen YT. Chronic Nodular Prurigo: An Update on the Pathogenesis and Treatment. Int J Mol Sci. 2022;23(20):12390. doi:10.3390/ijms232012390
21. Pereira MP, Zeidler C, Nau T, Bobko S, Evers AWM, Garcovich S, et al. Position Statement: Linear prurigo is a subtype of chronic prurigo. J Eur Acad Dermatol Venereol. 2019;33(2):263-6.
doi:10.1111/jdv.15275
22. Yun DK, Yeom K, Shon U, Park BC, Choi MS, Kim MH. Successful treatment of refractory prurigo nodularis with alitretinoin and methotrexate combination therapy. Ann Dermatol. 2023;35(Suppl 2):S388-S389.
doi:10.5021/ad.21.109
23. McCampbell LE, Zaino ML, Ranpariya M, Patel T, Feldman SR. Systemic medication for the treatment of prurigo nodularis-A systematic review. J Cutan Med Surg. 2023;27(6):641-645. doi:10.1177/12034754231211797.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Huyen Tran Thi, Vinh Nguyen Thi Ha , Trang Tran Le Linh , Phuong Pham Thi Minh , Doanh Le Huu

This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.






