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Wang C, Zhang Q, Yu L, Chen L, Chen J. Abrocitinib for prurigo nodularis: Clinical efficacy and safety profile. J Eur Acad Dermatol Venereol 2024. [PMID: 39264711 DOI: 10.1111/jdv.20322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024]
Affiliation(s)
- Changchun Wang
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quanhong Zhang
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lang Yu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Jianghan University School of Medicine, Wuhan, China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
| | - Jinbo Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
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2
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Liang J, Li W, Liu W, Yu Y, Ye H, Zhang X. Abrocitinib Monotherapy for Refractory Prurigo Nodularis: Report of Two Successful Cases. Clin Cosmet Investig Dermatol 2024; 17:1793-1797. [PMID: 39132031 PMCID: PMC11316487 DOI: 10.2147/ccid.s470641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024]
Abstract
Prurigo nodularis (PN) is a debilitating chronic neuroimmunologic skin condition due to the intense pruritus and difficult to treat. The pruritogenic cytokines, particularly IL-4, IL-13, IL-22, IL-31, and oncostatin M (OSM), play a crucial role in the pathogenesis of PN, potentially involving the JAK1-STAT pathway. An oral JAK1 inhibitor, abrocitinib, is presently undergoing Phase 2 trials for the treatment of PN. We evaluated the efficacy of abrocitinib at a daily dosage of 100 mg in treating two patients with PN affecting both lower limbs: a 50-year-old male with a 16-year disease history and a 38-year-old female with over three years of disease history, both of whom had failed to respond to multiple conventional treatments. Both patients responded rapidly after one week of treatment and exhibited a marked improvement. Following eight weeks of therapy, near-complete resolution of both pruritus and lesions was achieved, and no adverse effects were reported. Additionally, there were no reported side effects during the initial four months of continued treatment. Abrocitinib is an effective targeted therapy for PN, offering a promising new option for refractory patients.
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Affiliation(s)
- Jingyao Liang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, 510095, People’s Republic of China
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, Guangdong, 510095, People’s Republic of China
| | - Wei Li
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, 510095, People’s Republic of China
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, Guangdong, 510095, People’s Republic of China
| | - Wenyan Liu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, 510095, People’s Republic of China
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, Guangdong, 510095, People’s Republic of China
| | - Yihui Yu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, 510095, People’s Republic of China
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, Guangdong, 510095, People’s Republic of China
| | - Hui Ye
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, 510095, People’s Republic of China
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, Guangdong, 510095, People’s Republic of China
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, Guangdong, 510095, People’s Republic of China
- Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, Guangdong, 510095, People’s Republic of China
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3
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Yook HJ, Lee JH. Prurigo Nodularis: Pathogenesis and the Horizon of Potential Therapeutics. Int J Mol Sci 2024; 25:5164. [PMID: 38791201 PMCID: PMC11121340 DOI: 10.3390/ijms25105164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic pruritus that lasts for over 6 weeks can present in various forms, like papules, nodules, and plaque types, with prurigo nodularis (PN) being the most prevalent. The pathogenesis of PN involves the dysregulation of immune cell-neural circuits and is associated with peripheral neuropathies, possibly due to chronic scratching. PN is a persistent and challenging condition, involving complex interactions among the skin, immune system, and nervous system. Lesional skin in PN exhibits the infiltration of diverse immune cells like T cells, eosinophils, macrophages, and mast cells, leading to the release of inflammatory cytokines and itch-inducing substances. Activated sensory nerve fibers aggravate pruritus by releasing neurotransmitters, perpetuating a vicious cycle of itching and scratching. Traditional treatments often fail, but recent advancements in understanding the inflammatory and itch transmission mechanisms of PN have paved the way for innovative therapeutic approaches, which are explored in this review.
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Affiliation(s)
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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4
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Chia-Jen L, Yun-Chang L, Hui-Chin C, Yu-Ping H. Dupilumab for a 5-year-old child with prurigo nodularis. J Dtsch Dermatol Ges 2023; 21:1563-1565. [PMID: 37875782 DOI: 10.1111/ddg.15243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/06/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Lin Chia-Jen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Li Yun-Chang
- Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chang Hui-Chin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung, Taiwan
- Evidence-based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsiao Yu-Ping
- Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
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5
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Lin CJ, Li YC, Chang HC, Hsiao YP. Dupilumab bei einem 5-jährigen Kind mit Prurigo nodularis. J Dtsch Dermatol Ges 2023; 21:1563-1566. [PMID: 38082525 DOI: 10.1111/ddg.15243_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/06/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Chia-Jen Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yun-Chang Li
- Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hui-Chin Chang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung, Taiwan
- Evidence-based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Ping Hsiao
- Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
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Shao Y, Wang D, Zhu Y, Xiao Z, Jin T, Peng L, Shen Y, Tang H. Molecular mechanisms of pruritus in prurigo nodularis. Front Immunol 2023; 14:1301817. [PMID: 38077377 PMCID: PMC10701428 DOI: 10.3389/fimmu.2023.1301817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Pruritus is the most common symptom of dermatological disorders, and prurigo nodularis (PN) is notorious for intractable and severe itching. Conventional treatments often yield disappointing outcomes, significantly affecting patients' quality of life and psychological well-being. The pathogenesis of PN is associated with a self-sustained "itch-scratch" vicious cycle. Recent investigations of PN-related itch have partially revealed the intricate interactions within the cutaneous neuroimmune network; however, the underlying mechanism remains undetermined. Itch mediators play a key role in pruritus amplification in PN and understanding their action mechanism will undoubtedly lead to the development of novel targeted antipruritic agents. In this review, we describe a series of pruritogens and receptors involved in mediating itching in PN, including cytokines, neuropeptides, extracellular matrix proteins, vasculogenic substances, ion channels, and intracellular signaling pathways. Moreover, we provide a prospective outlook on potential therapies based on existing findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Hui Tang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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Woodbury MJ, Smith JS, Merola JF. Dupilumab-Associated Arthritis: A Dermatology-Rheumatology Perspective. Am J Clin Dermatol 2023; 24:859-864. [PMID: 37349633 DOI: 10.1007/s40257-023-00804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
Dupilumab is an interleukin (IL)-4/13 inhibitor approved by the US FDA for multiple atopic indications. It is well-known to have favorable efficacy and safety profiles; however, emerging reports of dupilumab-associated arthritis suggest an underrecognized potential adverse effect. In this article, we summarize the literature to date to better characterize this clinical phenomenon. Arthritic symptoms were most commonly peripheral, generalized, and symmetric. Onset was generally within 4 months following initiation of dupilumab, and most patients resolved fully after a matter of weeks following discontinuation. Mechanistic insights suggest that suppression of IL-4 may lead to increased activity of IL-17, a prominent cytokine in inflammatory arthritis. We propose a treatment algorithm that stratifies patients by severity, recommending that patients with more mild disease continue dupilumab and treat through symptoms, while patients with more severe disease discontinue dupilumab and consider switching to another class (e.g., Janus kinase inhibitors). Lastly, we discuss important ongoing questions that should be addressed in future studies.
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Affiliation(s)
- Michael J Woodbury
- Department of Dermatology, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, 319, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey S Smith
- Department of Dermatology, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, 319, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, 319, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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Muddebihal A, Khurana A, Sardana K. JAK inhibitors in dermatology: the road travelled and path ahead, a narrative review. Expert Rev Clin Pharmacol 2023; 16:279-295. [PMID: 36946306 DOI: 10.1080/17512433.2023.2193682] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Numerous cutaneous dermatoses mediated by cytokines depend on the JAK STAT pathway for intracellular signaling. JAK inhibitors form a useful therapeutic approach in treating these conditions. The literature on effectiveness of JAK inhibitors in treatment of alopecia areata, vitiligo, atopic dermatitis, psoriasis and several other inflammatory and autoimmune diseases is growing, although very few conditions have sufficiently well performed studies to their credit and barring a few indications, their use in rest remains empirical as yet. AREAS COVERED A search of the PubMed database was made using the keywords Janus kinase inhibitors OR JAK inhibitors AND dermatology with the time duration limited to the last 5 years. Here, we review the JAK STAT pathway and the various conditions in which JAK inhibitors are currently used in dermatology and other conditions their use is being explored in. EXPERT OPINION The pathology of a large number of dermatological disorders is mediated via inflammatory cytokines which signal via the JAK STAT pathway. JAKinibs have shown great promise in treating cutaneous disorders refractory to conventional therapy. Their current clinical use in dermatology is based on robust evidence (for some), and anecdotal evidence for most other dermatoses.
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Affiliation(s)
- Aishwarya Muddebihal
- Department of Dermatology, Venereology and Leprosy, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, Malka Ganj, Delhi, 110007, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
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Han Y, Woo YR, Cho SH, Lee JD, Kim HS. Itch and Janus Kinase Inhibitors. Acta Derm Venereol 2023; 103:adv00869. [PMID: 36789757 PMCID: PMC9944301 DOI: 10.2340/actadv.v103.5346] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
Itch is a common skin symptom, with complex aetiology and pathogenesis. It is mediated by 2 pathways, the histaminergic and non-histaminergic pathways. Chronic itch is understood to be processed by the latter and is difficult to treat with traditional pruritus therapies. The Janus kinase and signal transducer and activator of transcription pathway is a signalling mechanism that regulates gene expression through various cytokines. Janus kinase inhibitors, which have been tested and used for several autoimmune diseases, have also been shown to be effective for itch through clinical trials and case reports. Janus kinase inhibitors could be a good choice for pruritus in atopic dermatitis, psoriasis, and other diseases, such as prurigo nodularis and lichen planus, with rapid itch relief compared with conventional treatments. The most common adverse effects reported include nasopharyngitis, acne, and elevated blood creatine phosphokinase levels. Janus kinase inhibitors are currently prescribed with warnings about a potential increase in malignancies and cardiovascular diseases and usage in people of older ages. This review aims to provide knowledge about itch and the Janus kinase and signal transducer and activator of transcription pathway and to analyse the current evidence for itch relief by Janus kinase inhibitors.
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Affiliation(s)
- Yujin Han
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Ri Woo
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Hyun Cho
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Deuk Lee
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Liu T, Chu Y, Wang Y, Zhong X, Yang C, Bai J, Fang H, Qiao J. Successful treatment of prurigo nodularis with tofacitinib: The experience from a single center. Int J Dermatol 2022; 62:e293-e295. [PMID: 36573437 DOI: 10.1111/ijd.16568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/30/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Taoming Liu
- Department of Dermatology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Yuqi Chu
- Department of Dermatology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Yuqian Wang
- Department of Dermatology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Xinyue Zhong
- Department of Dermatology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Changyi Yang
- Department of Dermatology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Juan Bai
- Department of Dermatology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Hong Fang
- Department of Dermatology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Jianjun Qiao
- Department of Dermatology The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
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Wong LS, Yen YT. Chronic Nodular Prurigo: An Update on the Pathogenesis and Treatment. Int J Mol Sci 2022; 23:ijms232012390. [PMID: 36293248 PMCID: PMC9604302 DOI: 10.3390/ijms232012390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Chronic nodular prurigo (CNPG) is a recalcitrant chronic itchy disorder that affects the quality of life. It can be triggered by multiple etiologies, such as atopic dermatitis, diabetes, and chronic renal diseases. The mechanisms of CNPG are complicated and involved the interaction of the cutaneous, immune, and nervous systems. Diverse immune cells, including eosinophils, neutrophils, T cells, macrophages, and mast cells infiltrated the lesional skin of CNPG, which initiated the inflammatory cytokines and pruritogens release. In addition, the interaction between the immune cells and activated peripheral sensory nerve fibers by neurotransmitters caused neuroinflammation in the skin and intractable itch. This itch-scratch vicious cycle of CNPG results in disease exacerbation. CNPG is difficult to treat with traditional therapies. Recently, great advances have been made in the pathophysiology of both inflammation and pruritus transmission in CNPG. In this review, we summarize the updated mechanisms and novel therapies for CNPG.
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Affiliation(s)
- Lai-San Wong
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Ta Yen
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Dermatology, Fooyin University Hospital, Pingtung 928, Taiwan
- Correspondence: ; Tel.: +886-8-832-3146
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12
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Luo N, Wang Q, Lei M, Li T, Hao P. Dupilumab for Chronic Prurigo in Different Backgrounds: A Case Series. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1863-1867. [PMID: 36117770 PMCID: PMC9480179 DOI: 10.2147/ccid.s379231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/05/2022] [Indexed: 12/03/2022]
Abstract
Chronic prurigo (CPG) is a chronic inflammatory disease characterized by intense pruritus, and therapy is often challenging due to its unclear pathogenesis. Here, we report four patients with refractory CPG from different backgrounds who experienced failure of conventional therapy and were controlled with dupilumab, accompanied by a significant decrease in pruritus numerical rating scale, dermatology life quality index, and investigator global assessment, without adverse effects. Furthermore, dupilumab improved the condition of asthma in CPG patients along with an increase in asthma control test scores.
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Affiliation(s)
- Nana Luo
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China.,School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Qiuyue Wang
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Min Lei
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Tianhao Li
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Pingsheng Hao
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
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