Prurigo pigmentosa is a rare skin disease characterized by pruritic papules and reticular pigmentation. An article in the New England Journal of Medicine (Volume 394, Number 4, January 22, 2026) describes the clinical picture, diagnosis and treatment. It typically affects young women of Asian descent, with lesions on the neck, chest and back. The cause is unknown, often associated with a ketogenic diet or weight loss. Histologically, it manifests as spongy dermatitis with keratinocyte necrosis. The treatment of first choice is minocycline or doxycycline at a dose of 100 mg daily for 4–8 weeks. After treatment, the lesions resolve and the pigmentation fades. The diagnosis is established clinically and histologically, with differential diagnosis against lichen planus pilaris.