5 developments in the treatment of prurgio nodularis in 2025

Prurigo nodularis (PN) is a chronic skin condition that causes hard raised bumps that are intensely itchy and sometimes painful. The bumps are usually dry or crusted and tend to itch more at night, which can interrupt sleep and everyday activities. PN can appear on many areas of the body, including the arms, legs, abdomen, scalp, shoulders and upper back. Repeated scratching can cause bleeding, scarring and long-term damage to the skin.

PN can affect anyone, but it is more common in adults ages 40 to 69 years, women and African Americans, according to the Cleveland Clinic. It can occur alongside other skin conditions such as eczema or psoriasis and may also be linked to certain underlying health conditions. In the U.S., PN affects about 72 out of every 100,000 people, though experts believe it may be underdiagnosed or mistaken for other skin diseases.

In 2025, progress in PN research shifted beyond managing symptoms toward treatments that target the immune pathways driving itch and inflammation. Studies highlighted therapies aimed at IL-31 and JAK and TYK2 signaling, offering new ways to address the root causes of the disease. From late-stage phase 3 data for nemolizumab to emerging oral and topical options such as soficitinib, ruxolitinib cream and tofacitinib, the treatment pipeline continued to grow, giving hope for a more hopeful and tailored future for patients living with PN.

Below are 5 developments in the PN space in 2025:

• Vixarelimab shows instant itch relief in PN

Data published in JAMA Dermatology in December showed that vixarelimab, an investigational monoclonal antibody, improved PN symptoms. The study found that patients treated with vixarelimab had faster and greater reductions in itch and skin lesions compared with placebo, with improvements beginning as early as week 2 and lasting through week 16 and beyond. Higher doses worked more quickly, though differences between the two highest doses were small by the end of the study.

Many patients achieved clear or almost clear skin and had large drops in itch scores, showing strong relief from symptoms. Side effects were mostly mild, and no serious treatment-related safety issues were reported.
Researchers also noted that the study included a diverse group of patients, making the findings more relevant to real-world populations. Researchers of the study suggest that blocking the IL-31 pathway with vixarelimab may offer an effective and well-tolerated new treatment option for people living with PN.

• Oral tyk2 inhibitor entered global phase 2 testing

In November 2025, InnoCare Pharma announced that the first patient had been dosed in a global phase 2 clinical trial of soficitinib, an oral TYK2 inhibitor, for PN treatment. Soficitinib is designed to block key immune signaling pathways involved in itch and inflammation, including IL-4, IL-13, and IL-31, which are known drivers of PN symptoms. By targeting TYK2, a key part of the JAK-STAT pathway, the drug aims to reduce severe itching and skin inflammation that disrupt daily life for patients.
The trial utilizes results seen with soficitinib in atopic dermatitis and reflects growing interest in oral targeted therapies for PN.

• Topical Opzelura (ruxolitinib) shows rapid itch relief in phase 3 trials

In September 2025, data presented at the European Academy of Dermatology and Venereology Congress revealed the potential of topical ruxolitinib 1.5% cream for adults with moderate to severe PN. Results from the phase 3 TRuE-PN1 trial were reported by sister brand, Dermatology Times, and showed that nearly 45% of patients using ruxolitinib achieved meaningful itch reduction at 12 weeks, compared with about 21% using vehicle, with some patients reporting improvement as early as day 3.
Although the companion TRuE-PN2 study didn’t meet its primary endpoint due to a high vehicle response, multiple secondary measures still favored ruxolitinib, and benefits were sustained through longer-term follow-up.

• Oral Xeljanz (tofacitinib) shows promise in managing PN

A March 2025 study published in Dermatologic Therapy reported positive results for tofacitinib, an oral JAK inhibitor, in adults with moderate to severe PN that had not responded to standard treatments. Over 16 weeks, most patients experienced improvements in severe itching and skin lesions, leading to better quality of life. Benefits were seen as early as four weeks, although some patients showed a slight decline in response after 12 weeks.
The treatment was generally well tolerated, with no serious adverse events reported. While these findings suggest that tofacitinib may be a promising option for refractory PN, researchers noted that larger, longer-term, placebo-controlled studies are needed to confirm its safety and lasting effectiveness.

• Nemluvio (emolizumab) improves itch and lesions in adults

A study published in JAMA Dermatology in November reported that nemolizumab, a monoclonal antibody targeting IL-31, led to rapid and sustained improvements in adults with moderate to severe PN. In the OLYMPIA 1 trial, patients experienced a significant reduction in itch, skin lesions and sleep disturbance as early as week 4, with benefits continuing through week 24.

The results were consistent with the earlier OLYMPIA 2 study. Nemolizumab was generally well tolerated, though some patients reported mild to moderate side effects such as eczema or headaches.