Chronic prurigo is a disease characterized by the presence of chronic pruritus and singular or multiple usually hyperkeratotic symmetrically distributed itchy papules, nodules, and/or plaques. This condition is difficult to treat and leads to a substantial impairment of the quality of life. It may originate from dermatological, systemic, neurological, psychiatric/psychosomatic, multifactorial or unknown conditions causing itch, which lead to prolonged scratching behavior and sensitization mechanisms and ultimately to the development of pruriginous lesions. Thorough diagnostic efforts, including a detailed clinical history and physical examination, as well as targeted complementary examinations should be initiated as soon as possible. The German guideline recommends topical steroids and phototherapy as first-choice options. Pimecrolimus and capsaicin (topical), as well as antihistamines, anticonvulsants, and immunosuppressive drugs (systemic) should be considered as valid alternatives.