Main Article Content
prurigo nodularis, dupilumab, atopic dermatitis
Objectives: Prurigo nodularis (PN) is a disease of aberrant and recalcitrant itching which is difficult to effectively manage. There are no current FDA-approved therapies for PN. The current topical and systemic medications used for this condition provide less than optimal efficacy for the majority of patients with this condition and often have unacceptable side effects. We report 4 patients who were effectively treated with dupilumab (Dupixent) for the treatment of recalcitrant PN.
Methods: Four patients were treated successfully with dupilumab, a systemic biologic agent that is not immunosuppressive (Dupixent; Sanofi-Regeneron). Patients were treated with dupilumab monotherapy, without the use of other systemic immunosuppressing agents. The peak pruritus numerical rating scale (NRSi) was used to evaluate patients at weeks 0 and 4.
Results: Dupilumab therapy results in a dramatic reduction in NRSi scores by week 4 and that result continues throughout the duration of therapy. This reduction in itch is seen with continuous therapy.
Conclusion: Dupilumab therapy appears effective in reducing the overall itch severity in patients with PN. The usage of dupilumab as a monotherapy shows promise in the treatment of PN. The therapeutic response to dupilumab seen in PN suggests that the pathogenesis of PN may overlap with that of atopic dermatitis.
1. Stander S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol. 2013;168:1273-1280.
2. Winhoven SM, Gawkrodger DJ. Nodular prurigo: metabolic diseases are a common association. Clin Exp Dermatol. 2007; 32:224-225.
3. Sonkoly E, Muller A, Lauerma AI, et al. IL-31: a new link between T cells and pruritus in atopic skin inflammation. J Allergy Clin Immunol. 2006;117:411-417.
4. Park K, Mori T, Nakamura M, Tokura Y. Increased expression of mRNAs for IL-4, IL-17, IL-22 and IL-31 in skin lesions of subacute and chronic forms of prurigo. Eur J Dermatol. 2011; 21:135-136.
5. Nakashima C, Otsuka A, Kabashima K. Interleukin-31 and interleukin-31 receptor: New therapeutic targets for atopic dermatitis. Exp Dermatol. 2018 Apr;27(4):327-331.
6. Bruni E, Caccialanza M, Piccinno R. Phototherapy of generalized prurigo nodularis. Clin Exp Dermatol. 2009;35:549-550.
7. Gencoglan G, Inanir I, Gunduz K. Therapeutic hotline: treatment of prurigo nodularis and lichen simplex chronicus with gabapentin. Dermatol Ther. 2010;23:194-198.
8. Beck, K., Yang, E., Sekhon, S., Bhutani, T., Liao, W. Dupilumab treatment for generalized prurigo nodularis. JAMA Dermatology. 2019; 155:118-120.
9. Mollanazar, N., Elgash, M., Weaver, L., Valdes-Rodriquez, R., Hsu, S. Reduced itch associated with dupilumab treatment in 4 patients with Prurigo Nodularis. JAMA Dermatology. 2019; 155:121-122.
10. Beck, LA., et.al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med. 2014; 37(2):130-139.
11. Boonstra M, Rustemeyer T, Middelkamp-Hup MA. Both children and adult patients with difficult-to-treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized. J Eur Acad Dermatol Venereol. 2018 Sep;32(9):1554-1561.