Beyond the Endpoints: Discussing Meaningful Response in PN

In prurigo nodularis, the first signs of improvement may come long before the skin looks substantially different. But what happens when a patient is clearly better yet still wants more? James Q. Del Rosso, DO, and Diego Ruiz Dasilva, MD, discuss PN as a systemic disease and how biologic treatment has changed its management, including the often uneven progression of itch relief, nodule flattening, and resolution of discoloration. Drawing on their clinical experience with dupilumab, they explore how to set expectations, recognize when treatment is making a meaningful difference, and navigate the decision to continue, add therapy, or change course. They also consider how reliance on trial enrollment criteria, particularly lesion counts, may lead clinicians to underestimate disease burden in patients who could benefit from treatment.