Potentially inappropriate medication use among older adults with prurigo nodularis

Background: Prurigo nodularis (PN) is an extremely pruritic, chronic inflammatory skin disease that is often recalcitrant to treatment. PN is more frequently observed in older adults and guideline recommendations often involve the use of sedating medications featured on the Beers criteria as potentially inappropriate medications (PIMs). We sought to characterize the use of PIMs among older adults with PN. We performed a retrospective chart review of patients treated at a single-center institution in the US between 2013-2019. We limited our sample to PN patients for whom at least one medication was prescribed at 2:65 years of age. PIM use was defined based on Beers criteria, including first-generation antihistamines, antidepressants, and gabapentinoids. We estimated overall and class- specific proportions of PIM use. We also performed multivariable regression to determine factors associated with PIM utilization. We identified 226 older adults with PN. The majority were female (52.7%) and white (45.1%), with a mean age of 68.9 years. The overall proportion of PIM use among older adults with PN was 43.8% (95% CI: 37.4-50.4). Proportions of first-generation antihistamine, antidepressant, and gabapentinoid use were 31.0%, 12.4%, and 16.4%, respectively. Female patients were more likely than males to utilize PIMs (adjusted odds ratio: 2.39 [95% CI 1.33-4.27]. We demonstrated high proportions of PIM use among older adults with PN in comparison to the general population, highlighting the need for effective and safe therapies in this population. While prescribing of PIMs may be warranted in some cases, dermatologists should use caution prescribing such medications to older adults.