Janus Kinase Inhibitors for the Treatment of Prurigo Nodularis: A Systematic Review of 211 Patients

Prurigo nodularis (PN) is a chronic, intensely pruritic dermatosis driven by neuroimmune dysregulation for which targeted therapies are emerging. The objective of our study is to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-Is) for the treatment of PN. We conducted a systematic search in sources including PubMed/Medline, Scopus, Web of Science, and Embase; the search was completed on September 9, 2025. Inclusion criteria were the use of any JAK-I in a patient with confirmed PN, and exclusion criteria were reviews, duplicate reports, and studies with incomplete outcome data. Risk of bias was assessed using the NHLBI quality assessment tools for observational studies and the Murad et al. checklist for case reports and case series. Ten clinical studies (n = 180 patients) and 21 case reports/series (n = 31 patients) were included (total n = 211). Agents evaluated included upadacitinib, tofacitinib, abrocitinib, and baricitinib. Applying standardized response criteria, 139/180 patients (77.2%) in clinical studies achieved meaningful clinical improvement. Rapid itch relief was frequently observed (days to weeks). Quality of life improved substantially (mean reduction from 20.4 to 3.9). Reported adverse events were generally mild (infections, laboratory abnormalities, dyslipidemia, acneiform eruption); serious events were rare. Limitations include small sample sizes, predominance of uncontrolled and observational designs, heterogeneity of outcomes, and limited long-term safety data. Current evidence suggests JAK-Is are highly effective and generally well tolerated for PN, warranting larger randomized controlled trials with extended follow-up.