A patient's itch from prurigo nodularis returned after stopping pregabalin and resolved again when it was restarted, suggesting the drug may work by suppressing neuropeptide release including substance P and CGRP.
Itch recurred within 2 monthsPruritus returned after pregabalin was stopped and resolved again within 2 months of restarting, despite no visible skin lesions
What the researchers found
A 69-year-old woman with prurigo nodularis achieved complete skin lesion resolution with nemolizumab. Discontinuation of pregabalin (prescribed for coexisting sciatic pain) led to pruritus recurrence within 2 months despite continued absence of visible lesions. Reintroduction of low-dose pregabalin stabilized symptoms within 2 months. The proposed mechanism is pregabalin's inhibition of α2δ voltage-gated calcium channel subunits, suppressing release of excitatory neuropeptides including substance P and CGRP.
Why it matters
Prurigo nodularis causes debilitating itch that severely impacts quality of life. While new biologics like nemolizumab clear skin lesions, some patients continue to experience neuropathic itch. Understanding that pregabalin may address this residual itch through neuropeptide suppression could provide an affordable adjunctive treatment, especially since pregabalin is already widely available and inexpensive as a generic.
How the study worked
Single-patient case report documenting the temporal relationship between pregabalin use/discontinuation/reintroduction and pruritus control in a patient with prurigo nodularis concurrently treated with nemolizumab.
What this study cannot tell us
This is a single case report, the lowest level of clinical evidence. The temporal association between pregabalin and itch control is suggestive but cannot prove causation. The patient was concurrently on nemolizumab, making it difficult to fully attribute effects to pregabalin. Placebo effects cannot be excluded. No itch severity scoring was reported.
How to read the evidence
This is a single case report providing anecdotal evidence for pregabalin's antipruritic effect. While the on-off-on pattern is suggestive, it cannot establish causation or generalizability without controlled studies.
When this study was published
Published in 2025, this case report reflects current interest in addressing the neuropathic component of chronic itch conditions using existing medications.
The bigger picture
The recognition that chronic itch can have a neuropathic component — driven by aberrant neuropeptide signaling (substance P, CGRP) — is changing how dermatologists approach treatment. Pregabalin, already used for neuropathic pain, may bridge the gap between dermatological and neurological approaches to itch, particularly for patients who don't fully respond to skin-targeted therapies alone.
Questions still open
- Would a controlled trial of pregabalin as adjunct therapy for prurigo nodularis confirm this observation?
- Is the neuropathic itch component (driven by substance P and CGRP) a distinct phenotype within prurigo nodularis that predicts response to pregabalin?
- Could combining pregabalin with CGRP-blocking antibodies provide synergistic anti-itch effects?
Common questions
How might pregabalin reduce itch if it's a pain medication?
What is prurigo nodularis and why is it so hard to treat?
Read the original research
Pregabalin as a Potential Adjunct in the Management of Pruritus in Prurigo Nodularis: A Case Report.
Cureus, 17(7), e88297
Citation
Mima, Yoshihito; Yamamoto, Masako; Iozumi, Ken. (2025). Pregabalin as a Potential Adjunct in the Management of Pruritus in Prurigo Nodularis: A Case Report.. Cureus, 17(7), e88297. https://doi.org/10.7759/cureus.88297