Chronic nodular prurigo (syn.: prurigo nodularis) is a highly pruritic condition often refractory to treatment. We performed a multicenter prospective study in Europe to understand patients’ needs and satisfaction with therapy. Improvement of itch is the most important therapy goal for patients. Although most patients had a moderate/severe disease, only a minority were treated with potent medications such as systemic immunosuppressants, gabapentinoids or novel biologic drugs, which likely contributes to high levels of dissatisfaction with therapy. Our findings highlight the suboptimal management of patients with this burdensome condition. Implementation of the new guideline for chronic prurigo is essential to improve care.