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Nilforoushzadeh MA, Heidari N, Ghane Y, Heidari A, Hajikarim-Hamedani A, Hosseini S, Jaffary F, Najar Nobari M, Tavakolzadeh P, Najar Nobari N. A systematic review of interleukin-31 inhibitors in the treatment of prurigo nodularis. Inflammopharmacology 2024; 32:991-1003. [PMID: 38332383 DOI: 10.1007/s10787-024-01436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Prurigo nodularis (PN) is a neuroimmunological skin disease. Severe itching is the most challenging symptom which affects patients' quality of life. T helper 2-derived cytokines, such as interleukin-31 and oncostatin M (OSM), play a crucial role in PN pathogenesis. Nemolizumab and vixarelimab are two biologics acting as IL-31 inhibitors. Vixarelimab also suppresses the OSM activity. This systematic review evaluates the efficacy and safety of nemolizumab and vixarelimab in PN management. METHODS A systematic search was conducted in PubMed/Medline, Ovid Embase, and Web of Science up to September 17th, 2023. Clinical trials and cohort studies published in English were included. RESULTS Among a total of 96 relevant records, five were included. The results of four studies with 452 patients using nemolizumab showed that a significantly higher percentage of patients treated with nemolizumab demonstrated a reduction in peak pruritus numerical rating scale (PP-NRS) and investigator's global assessment along with improved sleep disturbance (SD) and quality of life than the placebo group. Moreover, one study administered vixarelimab to 49 PN patients, and their finding illustrated a higher rate of subjects who received vixarelimab experienced ≥ 4-point diminution in worst itch NRS, visual analog scale, healing of representative lesions, and SD quality compared to the placebo group. CONCLUSIONS IL-31 inhibitors suggest distinct advantages in improving pruritus, sleep quality, and overall quality of life in subjects with moderate-to-severe PN. Further clinical studies are recommended to compare the effectiveness of these biologics to other therapeutic choices.
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Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yekta Ghane
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Arman Hajikarim-Hamedani
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - SeyedAyin Hosseini
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Jaffary
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Minou Najar Nobari
- Department of Orofacial Pain and Dysfunction, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Pegah Tavakolzadeh
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Najar Nobari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Costa Martins J, Magno M. Prurigo nodularis-A case report. Semergen 2024; 50:102129. [PMID: 37980783 DOI: 10.1016/j.semerg.2023.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 11/21/2023]
Affiliation(s)
- J Costa Martins
- Family Medicine Residents at ACES Vale Sousa Sul, Penafiel, Portugal.
| | - M Magno
- Family Medicine Residents at ACES Vale Sousa Sul, Penafiel, Portugal
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Biazus Soares G, Yosipovitch G. A critical review of dupilumab for adult patients with prurigo nodularis. Expert Rev Clin Immunol 2024; 20:249-254. [PMID: 37811660 DOI: 10.1080/1744666x.2023.2268291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Prurigo nodularis (PN) is a chronic inflammatory skin condition that presents with pruritus and hyperkeratotic nodules. These symptoms impact patients' quality of life and mental health. Treating prurigo nodularis is challenging, and many of the available topical and systemic therapies have limited efficacy and a myriad of adverse effects. AREAS COVERED In this article, we discuss the use of dupilumab for adult patients with prurigo nodularis. Dupilumab is a biologic that inhibits Th2-mediated inflammation and has been successfully used to treat a variety of dermatologic disorders. Dupilumab has revolutionized the management of PN, with recent clinical trials showing its efficacy in treating both pruritus and prurigo nodules, as well as improving quality of life. It has a favorable safety profile and is well tolerated. Other novel treatments are also currently under investigation for the treatment of PN, with early studies reporting promising results. EXPERT OPINION Dupilumab is becoming the drug of choice for the treatment of PN and may also be effective in treating patients with systemic underlying causes of their PN, although more studies are needed to assess this. Trials evaluating the long-term efficacy and durability of dupilumab in PN are also of interest.
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Affiliation(s)
- Georgia Biazus Soares
- Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gil Yosipovitch
- Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, United States
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Kyvayko R, Fachler-Sharp T, Greenberger S, Horev A, Molho-Pessach V. Characterization of Paediatric Prurigo Nodularis: A Multicentre Retrospective, Observational Study. Acta Derm Venereol 2024; 104:adv15771. [PMID: 38299231 PMCID: PMC10847973 DOI: 10.2340/actadv.v104.15771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Rotem Kyvayko
- Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Tahel Fachler-Sharp
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Shoshana Greenberger
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Horev
- Pediatric Dermatology Service, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vered Molho-Pessach
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.
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Metz M, Zeidler C, Hawro T, Pereira M, Maurer M, Bonnekoh H, Krause K, Pritchard T, Kwatra SG, Ständer S, Weller K. Development and Validation of a Patient-Reported Outcome Measure to Assess Disease Control in Chronic Prurigo. JAMA Dermatol 2024; 160:187-193. [PMID: 38231506 PMCID: PMC10794972 DOI: 10.1001/jamadermatol.2023.5519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/08/2023] [Indexed: 01/18/2024]
Abstract
Importance Chronic prurigo (CPG), including prurigo nodularis, is a difficult disease to treat and considerably affects patients' quality of life. Helping patients obtain control of CPG is a major treatment goal. Objective To develop and validate the Prurigo Control Test (PCT), a tool for assessing disease control in CPG, and to identify a cutoff value for controlled disease to aid treatment decisions. Design, Setting, and Participants This qualitative study followed the current recommendations for patient-reported outcome measure development in the generation and validation of the PCT. The final PCT was obtained after item generation, followed by reduction and selection, and was then tested for internal consistency and test-retest reliability, convergent validity, known-group validity, screening accuracy, and banding. The item-generation phase resulted in an unselected list of 69 potential PCT items. Impact analysis, interitem correlation, and review for content (face) validity resulted in final set of 5 PCT items. The validation study was performed among patients across 2 expert centers in Germany. Data were analyzed from February 2017 to November 2019. Main Outcomes and Measures A 5-item PCT with a recall period of 2 weeks was developed. A cutoff value of 10 points or higher was determined as suitable for identifying patients with well-controlled vs poorly controlled CPG. Results Of the 95 patients included in the validation study, the median (range) age was 63 (19-87) years, 50 patients (53%) were women, and the median (range) disease duration was 72 (9-774) months. The validation study yielded good internal consistency reliability (Cronbach α, 0.86) and a high degree of convergent validity. The PCT demonstrated good known-group validity and could discriminate between patients who differed in prurigo control. Test-retest reliability was high, and the intraclass correlation coefficient was 0.94, indicating excellent reproducibility. Conclusions and Relevance This qualitative study showed that the PCT is able to assess disease control in patients with CPG. Its retrospective approach, brevity, and simple scoring likely make the PCT suitable for clinical practice and trials.
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Affiliation(s)
- Martin Metz
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Claudia Zeidler
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Tomasz Hawro
- Institute and Comprehensive Centre for Inflammation Medicine, Department of Dermatology, Allergology and Venereology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Manuel Pereira
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Hanna Bonnekoh
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Karoline Krause
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Karsten Weller
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Müller S, Zeidler C, Ständer S. Chronic Prurigo Including Prurigo Nodularis: New Insights and Treatments. Am J Clin Dermatol 2024; 25:15-33. [PMID: 37717255 PMCID: PMC10796623 DOI: 10.1007/s40257-023-00818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/19/2023]
Abstract
Chronic prurigo (CPG) is a neuroinflammatory, fibrotic dermatosis that is defined by the presence of chronic pruritus (itch lasting longer than 6 weeks), scratch-associated pruriginous skin lesions and history of repeated scratching. Patients with CPG experience a significant psychological burden and a notable impairment in their quality of life. Chronic prurigo of nodular type (CNPG; synonym: prurigo nodularis) represents the most common subtype of CPG. As CNPG is representative for all CPG subtypes, we refer in this review to both CNPG and CPG. We provide an overview of the clinical characteristics and assessment of CPG, the burden of disease and the underlying pathophysiology including associated therapeutic targets. The information provided results from a PubMed search for the latest publications and a database search for current clinical trials (ClinicalTrials.gov, EU Clinical Trials Register [European Medicines Agency]; using the following terms or combinations of terms: 'chronic prurigo', 'prurigo', 'prurigo nodularis', 'pathophysiology', 'therapy', 'biologics', 'treatment'). Dupilumab is the first authorized systemic therapy by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) for CNPG to date. Topical and systemic agents that are currently under investigation in clinical randomized, placebo-controlled phase II and III trials such as biologics (e.g., nemolizumab, vixarelimab/KPL-716, barzolvolimab/CDX-0159), small molecules (ruxolitinib cream, povorcitinib/INCB054707, abrocitinib) and the opioid modulator nalbuphine are highlighted. In the last past 15 years, several milestones have been reached regarding the disease understanding of CPG such as first transcriptomic analysis, first terminology, first guideline, and first therapy approval in 2022, which contributed to improved medical care of affected patients. The broad range of identified targets, current case observations and initiated trials offers the possibility of more drug approvals in the near future.
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Affiliation(s)
- Svenja Müller
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Claudia Zeidler
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, 48149, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, 48149, Münster, Germany.
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Issa NT, Riva H, Jafferany M. INDIVIDUAL ARTICLE: Prurigo Nodularis: Current Clinicopathologic Overview and Psychodermatological Perspectives. J Drugs Dermatol 2023; 22:SF365502s6-SF365502s11. [PMID: 38051853 DOI: 10.36849/jdd.sf365502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Prurigo nodularis (PN) is a quintessential neurocutaneous condition characterized by neural sensitization and intractable itch leading to intense scratching. This causes the formation of nodules with epidermal thickening and further release of pro-inflammatory mediators that recruit immune cells and increase dermal nerve proliferation and hypertrophy perpetuating the itch-scratch cycle. Those with PN have a significant quality-of-life (QoL) burden due to itch, anxiety, and sleep disturbance. In addition, PN exhibits psychiatric comorbidities that affect mental wellbeing such as depression, mood disorders, and substance abuse. This paper serves as an overview of the clinicopathologic aspects of PN, the burden of PN on QoL, and the psychodermatological aspects of the disease state. J Drugs Dermatol. 2023;22:12(Suppl 2):s6-11.
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Hanly A, Watsky KL. Prurigo Nodularis: Moving Forward. Cutis 2023; 112:262-263. [PMID: 38290066 DOI: 10.12788/cutis.0903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Ailish Hanly
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Kalman L Watsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Yaliwal RG, Biradar A, Konin A, Tejaswi Reddy S. Prurigo of pregnancy. BMJ Case Rep 2023; 16:e255351. [PMID: 38050393 PMCID: PMC10693858 DOI: 10.1136/bcr-2023-255351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
A primigravida in her 20s, with 38 weeks period of gestation, came to the emergency ward of obstetrics wing with complaints of extensive itching over the extremities. On local examination, there were multiple, discrete, hyperpigmented papules topped with depigmentation and excoriations on upper and lower extremities. These are of 0.5-1 cm in size and some have central crusts . On clinical findings and exclusion of other pathologies, it was diagnosed as prurigo of pregnancy. The patient had an uneventful follow-up period.
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Affiliation(s)
| | - Aruna Biradar
- Obstetrics and Gynaecology, BLDE Deemed to be University, Vijayapura, Karnataka, India
| | - Ashwini Konin
- Obstetrics and Gynaecology, BLDE Deemed to be University, Vijayapura, Karnataka, India
| | - Sona Tejaswi Reddy
- Obstetrics and Gynaecology, BLDE Deemed to be University, Vijayapura, Karnataka, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rodriguez D, Kwatra SG, Dias-Barbosa C, Zeng F, Jabbar Lopez ZK, Piketty C, Puelles J. Patient Perspectives on Living With Severe Prurigo Nodularis. JAMA Dermatol 2023; 159:1205-1212. [PMID: 37728897 PMCID: PMC10512162 DOI: 10.1001/jamadermatol.2023.3251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/07/2023] [Indexed: 09/22/2023]
Abstract
Importance Because of a paucity of qualitative research on prurigo nodularis (PN), the symptoms and impacts of PN that are most important to patients are poorly understood. Objective To explore patients' perspectives on their PN symptoms and to understand the impacts of the condition. Design, Setting, and Participants One-on-one qualitative telephone interviews were held with English-speaking US adults aged 18 years or older with a confirmed diagnosis of PN, severe pruritus, and moderate to severe sleep disturbance. Participants were recruited via patient associations, patient panels, and social media posts. Interviews took place between September 10, 2020, and March 16, 2021. Main Outcomes and Measures The main symptoms of PN and their impacts on quality of life were identified by content analysis of deidentified interview transcripts. Results A total of 21 adults with PN (mean [SD] age, 53.1 [11.8] years; 15 [71%] female; 2 African American or Black patients [10%], 1 Asian patient [5%], and 18 White patients [86%]; of these, 1 patient [ 5%] had Hispanic or Latino ethnicity) participated in the interviews. All participants reported itch, pain associated with PN, bleeding or scabbing, and dry skin. Other frequently reported symptoms included lumps or bumps (95%), having a crust on the skin (95%), burning (90%), stinging (90%), lesions or sores (86%), skin discoloration (86%), and raw skin (81%). Of the 17 participants who indicated what their worst symptoms were, 15 (88%) identified itching as the worst or 1 of the worst symptoms. The most frequently reported impacts of PN for quality of life were changes in sleep (100%), daily life (100%), feelings or mood (95%), relationships (95%), social life (81%), and work or school (71%). Overall, the worst impact of PN was its association with impaired feelings or mood. Conclusions and Relevance This qualitative study suggests the importance of itching, sleep disturbance, and other symptoms and impacts of PN. This information can be used to guide end point selection in clinical trials and to inform patient-centric decision-making in clinical practice.
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Affiliation(s)
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kim HS, Keum HL, Chung IY, Nattkemper L, Head CR, Koh A, Sul WJ, Pastar I, Yosipovitch G. Characterization of a Perturbed Skin Microbiome in Prurigo Nodularis and Lichen Simplex Chronicus. J Invest Dermatol 2023; 143:2082-2085.e5. [PMID: 37044259 DOI: 10.1016/j.jid.2023.03.1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hye Lim Keum
- Systems Microbial Ecology Laboratory, Department of Systems Biotechnology, Chung-Ang University, Seoul, South Korea
| | - In-Young Chung
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, South Korea
| | - Leigh Nattkemper
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Cheyanne R Head
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ara Koh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, South Korea
| | - Woo Jun Sul
- Systems Microbial Ecology Laboratory, Department of Systems Biotechnology, Chung-Ang University, Seoul, South Korea
| | - Irena Pastar
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.
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13
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Kashem SW, Fassett MS. Can Serum Biomarkers for Prurigo Nodularis Expose Pathophysiology or Just Treatment Response? JAMA Dermatol 2023; 159:915-917. [PMID: 37556170 DOI: 10.1001/jamadermatol.2023.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
- Sakeen W Kashem
- Department of Dermatology, University of California, San Francisco
- Department of Anatomy, University of California, San Francisco
| | - Marlys S Fassett
- Department of Dermatology, University of California, San Francisco
- Department of Microbiology and Immunology, University of California, San Francisco
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Michor-Tscharre C, D’Alì L, Cota C, Fink-Puches R, Cerroni L. Clinical and Pathological Spectrum of Prurigo Pigmentosa in Central European Individuals. JAMA Dermatol 2023; 159:864-869. [PMID: 37436763 PMCID: PMC10339223 DOI: 10.1001/jamadermatol.2023.1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 07/13/2023]
Abstract
Importance Based on early studies, prurigo pigmentosa (PP) was considered a rare inflammatory dermatosis affecting primarily Asian individuals. However, several case reports subsequently showed that the disease is not restricted to those of Asian origin. Large studies on PP in central European individuals, on the other hand, are missing. Objective To increase awareness of PP by describing the clinical, histopathological, and immunohistochemical features in central European individuals. Design, Setting, and Participants This observational, retrospective case series analyzed clinicopathological features of 20 central European patients diagnosed with PP. Data collection was performed by means of archive material, including physician's letters, clinical photographs, and histopathological records, at the Department of Dermatology at the Medical University of Graz in Austria from January 1998 to January 2022. Main Outcomes and Measures Demographic, clinical, histopathological, and immunohistochemical characteristics for patients diagnosed with PP were recorded. Results Of the 20 patients included, 15 (75%) were female, and the mean (range) age was 24.1 (15-51) years. The study cohort consisted entirely of European patients. The most common site of involvement of PP was the breast, followed by the neck and back. Other involved clinical sites were the abdomen, shoulders, face, head, axillae, arms, and genital region and groin. Clinically, lesions were characterized by a symmetric pattern in 90% (n = 18) of all cases. Marked hyperpigmentation was observed only in 25% (n = 5) of patients. In some cases, triggers such as malnutrition, long-term pressure, and friction were noted. Histologic findings revealed presence of neutrophils in all cases and necrotic keratinocytes in 67% (n = 16) of cases. Immunohistochemistry results showed predominance of CD8+ lymphocytes in the epidermis, as well as the presence of plasmacytoid dendritic cells and myeloid cell nuclear differentiation antigen-positive neutrophil precursors. Conclusions and Relevance This case series found that most clinical features observed in Asian patients were also observed in central European patients, but hyperpigmentation was primarily mild to moderate. Histopathological features were similar to those reported in the literature with the additional presence of myeloid cell nuclear differentiation antigen-positive precursor neutrophils. These results expand previous knowledge about PP in central European individuals.
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Affiliation(s)
| | - Lorenzo D’Alì
- Department of Pathology, University Hospital of Udine, Udine, Italy
| | - Carlo Cota
- Dermatopathology Unit, San Gallicano Dermatological Institute, Rome, Italy
| | | | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
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Zhou Y, Zhou X, Feng X, Xia D, Qian H, Liu H, Li X, Li W. Case Report: Prurigo nodularis-like linear IgA/IgG bullous dermatosis: a case report and literature review. Front Immunol 2023; 14:1201163. [PMID: 37325615 PMCID: PMC10265503 DOI: 10.3389/fimmu.2023.1201163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
Linear IgA/IgG bullous dermatosis (LAGBD) is a rare autoimmune subepidermal bullous disorder characterized by linear deposition of concurrent IgA and IgG autoantibodies along the basement membrane zone (BMZ). The clinical features of LAGBD can be diverse, including tense blisters, erosions, erythema, crusting and mucosa involvement, while papules or nodules are generally absent. In this study, we present a unique case of LAGBD, which showed prurigo nodularis-like clinical appearance on physical examination, linear deposition of IgG and C3 along the basement membrane zone (BMZ) in direct immunofluorescence (DIF), IgA autoantibodies against the 97-kDa and 120-kDa of BP180 and IgG autoantibodies against the 97-kDa of BP180 by immunoblotting (IB), while BP180 NC16a domain, BP230, and laminin 332 were negative by enzyme-linked immunosorbent assay (ELISA). After administration of minocycline, the skin lesions improved. We performed a literature review of LAGBD cases with heterogeneous autoantibodies and found clinical presentations of most cases resemble bullous pemphigoid (BP) and linear IgA bullous disease (LABD), which is consistent with previous reported findings. We aim to increase our understanding of this disorder and to enhance the importance of applying immunoblot analyses and other serological detection tools in clinic for precise diagnosis as well as accurate treatment strategy of various autoimmune bullous dermatoses.
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Affiliation(s)
- Yuxi Zhou
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingli Zhou
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xun Feng
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dengmei Xia
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua Qian
- Department of Laboratory Medicine, Chronic Disease Research Center, Medical College, Dalian University, Dalian, China
| | - Hongjie Liu
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoguang Li
- Department of Laboratory Medicine, Chronic Disease Research Center, Medical College, Dalian University, Dalian, China
| | - Wei Li
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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16
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Föhr J, Gschnell M, Cunha T, Hertl M, Didona D. Complete remission of prurigo pigmentosa after oral doxycycline. Dermatol Ther 2022; 35:e15908. [PMID: 36205101 DOI: 10.1111/dth.15908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Julia Föhr
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Martin Gschnell
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Tomas Cunha
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
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17
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Kim HS, Kim HJ, Ahn HS. Impact of Chronic Kidney Disease Severity on the Risk of Prurigo Nodularis: A Population-Based Cohort Study. Acta Derm Venereol 2022; 102:adv00781. [PMID: 35971831 PMCID: PMC9677257 DOI: 10.2340/actadv.v102.2227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
While dialysis is linked with prurigo nodularis, little is known about the impact of non-dialysis chronic kidney disease on prurigo nodularis. The influence of chronic kidney disease on development of prurigo nodularis was measured using the Korean National Health Insurance and National Health Screening Program data, identifying 17,295,576 individuals without prior prurigo nodularis. Chronic kidney disease severity was determined by the estimated glomerular filtration rate (in ml/min/1.73 m2) calculated from serum creatinine, and proteinuria detected with urine dipstick. Prurigo nodularis incidence during follow-up was determined. Over a median follow-up period of 9.72 years, 58,599 individuals developed prurigo nodularis, with an incidence rate of 3.59 per 10,000 person-years. Among different variables, estimated glomerular filtration rate was the strongest risk factor for prurigo nodularis. Compared with estimated glomerular filtration rate ≥ 90, estimated glomerular filtration rate 15–29 (hazard ratio 1.31, 95% confidence interval 1.05–1.62) and end-stage renal disease (hazard ratio 1.46, 95% confidence interval 1.25–1.69) were associated with higher risks. The presence of proteinuria independently increased the risk of prurigo nodularis, increased risks associated with estimated glomerular filtration rate 15–29 and endstage renal disease, and caused risk associated with estimated glomerular filtration rate 30–59 to become significant. With differential impact of chronic kidney disease severity on the risk of prurigo nodularis, preservation of renal function would potentially translate into lower risk of prurigo nodularis.
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Affiliation(s)
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-gu, Seoul 02841, Korea.
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18
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Affiliation(s)
- Louise Lönndahl
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
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19
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Affiliation(s)
- Lai-Ying Lu
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung branch, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung branch, Taiwan; Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
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20
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Zhang Y, Feng L. Visual Dermatology: Prurigo Pigmentosa. J Cutan Med Surg 2021; 26:441. [PMID: 34878938 DOI: 10.1177/12034754211064313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ying Zhang
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine, China
| | - Lin Feng
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine, China
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21
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Wallengren J. Prurigo Simplex or "Itchy Red Bump" Disease: Review and Case Series. Acta Derm Venereol 2021; 101:adv00539. [PMID: 34436622 PMCID: PMC9425620 DOI: 10.2340/00015555-3912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Prurigo simplex or “itchy red bump” disease is a controversial pruritic papular eruption. The objective of this study was to delineate the diagnostic criteria for this disease. A PubMed search was performed for: “prurigo simplex”, “prurigo simplex subacuta”, “subacute prurigo”, “chronic papular dermatitis in adults” and “itchy red bump disease”. Medical charts of patients with prurigo diagnoses in a university setting were analysed. The literature search revealed 32 relevant studies (431 patients) on different aspects of the disease. Out of 50 patients with prurigo diagnoses, 5 patients (4 women, mean age at onset 54 years) matched the description in literature. Small, severely itchy papules without secondary skin lesions continued to appear for years (mean 5.6 years). Skin biopsies revealed lymphocytic perivascular infiltrates, few eosinophils and occasionally spongiosis. Treatment with long-term methotrexate or cyclosporine cleared the symptoms. Some major and minor diagnostic criteria for prurigo simplex are proposed and compared with chronic prurigo.
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Affiliation(s)
- Joanna Wallengren
- Department of Clinical Sciences Lund, Dermatology and Venereology, Lund University, Skane University Hospital, SE-221 85 Lund, Sweden
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22
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Wikström K, Verkko H, Sinikumpu SP, Jokelainen J, Tasanen K, Huilaja L. Comorbidities of Prurigo Nodularis in Finland Between 1996 and 2019. Acta Derm Venereol 2021; 101:adv00508. [PMID: 34230981 PMCID: PMC9413652 DOI: 10.2340/00015555-3872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Gwillim EC, Nattkemper L, Yosipovitch G. Impact of Itch on Sleep Disturbance in Patients with Prurigo Nodularis. Acta Derm Venereol 2021; 101:adv00424. [PMID: 33704503 PMCID: PMC9366710 DOI: 10.2340/00015555-3778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Eran C Gwillim
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 33136 Miami, FL, USA
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24
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Zeidler C, Pereira MP, Augustin M, Spellman M, Ständer S. Investigator's Global Assessment of Chronic Prurigo: A New Instrument for Use in Clinical Trials. Acta Derm Venereol 2021; 101:adv00401. [PMID: 33236125 PMCID: PMC9366679 DOI: 10.2340/00015555-3701] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic prurigo is a pruritic disease characterized by the development of pruriginous lesions due to scratching. The number of lesions is representative of the stage of the disease, while the presence of excoriations reflects the scratching activity. Aim of this study was to validate a new developed tool for the objective assessment of chronic prurigo. Investigator’s Global Assessment scales for stage and activity were completed for 187 patients with chronic prurigo, who also reported patient-reported outcomes for itch intensity and quality of life. To assess the reliability and objectivity of the Investigator’s Global Assessment, 5 independent raters completed the Investigator’s Global Assessment scales for 8 patients twice. The scores increased with increased intensity of pruritus. The Investigator’s Global Assessment stage scales correlated strongly with each other (Kendall’s-tau-b 0.62) and moderately with the Investigator’s Global Assessment activity scale (Kendall’s-tau-b 0.47). Intra-rater test–retest reliability was excellent for all items, while the congruence among raters was very good for Investigator’s Global Assessment – chronic prurigo activity (Kendall’s W 0.84) and good for Investigator’s Global Assessment stage scales (Kendall’s W 0.747). Investigator’s Global Assessment – chronic prurigo stage and activity are thus the best Investigator’s Global Assessment instruments for use in assessing chronic prurigo.
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Affiliation(s)
- Claudia Zeidler
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Von- Esmarch-Str. 58, DE-48149 Münster, Germany. E-mail:
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25
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Pereira MP, Zeidler C, Wallengren J, Halvorsen JA, Weisshaar E, Garcovich S, Misery L, Brenaut E, Şavk E, Potekaev N, Lvov A, Bobko S, Szepietowski JC, Reich A, Bozek A, Legat FJ, Metz M, Streit M, Serra-Baldrich E, Gonçalo M, Storck M, Nau T, Hoffmann V, Steinke S, Greiwe I, Dugas M, Augustin M, Ständer S. Chronic Nodular Prurigo: A European Cross-sectional Study of Patient Perspectives on Therapeutic Goals and Satisfaction. Acta Derm Venereol 2021; 101:adv00403. [PMID: 33320272 PMCID: PMC9366694 DOI: 10.2340/00015555-3726] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic nodular prurigo is characterized by recalcitrant itch. Patient perspectives on therapeutic goals, satisfaction with therapy and efficacy of therapeutic regimens for this condition are unknown. This questionnaire study examined these issues in 406 patients with chronic nodular prurigo from 15 European dermatological centres. Improvements in itch, skin lesions and sleep were the most important goals. Emollients, topical corticosteroids and antihistamines were the most frequently used treatments, while a minority of patients were prescribed potent medications, such as systemic immunosuppressants and gabapentinoids. Most patients were not satisfied with their previous therapy (56.8%), while 9.8% did not receive any therapy despite having active disease. A substantial number of respondents (28.7%) considered none of the therapeutic options effective. Although chronic nodular prurigo is a severe disease, most patients were not treated with potent systemic drugs, which may contribute to the high levels of dissatisfaction and disbelief in available therapies. Specific guidelines for chronic nodular prurigo and the development of novel therapies are necessary to improve care.
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Affiliation(s)
- Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von- Esmarch-Str. 58, DE-48149 Münster, Germany. E-mail:
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26
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Hashimoto T, Nattkemper LA, Kim HS, Kursewicz CD, Fowler E, Shah SM, Nanda S, Fayne RA, Romanelli P, Yosipovitch G. Dermal Periostin: A New Player in Itch of Prurigo Nodularis. Acta Derm Venereol 2021; 101:adv00375. [PMID: 33236123 PMCID: PMC9309858 DOI: 10.2340/00015555-3702] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Takashi Hashimoto
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, 33136 Miami, USA
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Ständer S, Ketz M, Kossack N, Akumo D, Pignot M, Gabriel S, Chavda R. Epidemiology of Prurigo Nodularis compared with Psoriasis in Germany: A Claims Database Analysis. Acta Derm Venereol 2020; 100:adv00309. [PMID: 33021323 PMCID: PMC9309863 DOI: 10.2340/00015555-3655] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prurigo nodularis is an itchy skin disease with unknown epidemiology. This study aimed to describe the epidemiology of prurigo nodularis compared with that of psoriasis. The German sickness fund claims database, with 2,783,175 continuously insured patients, included 1,720 patients diagnosed with prurigo nodularis and 51,390 with psoriasis. Patients with prurigo nodularis were averagely 8 years older than psoriasis patients and more often were women (p < 0.001). Annual incidence was a constant 0.02% in prurigo nodularis, and decreased steadily from 0.53 to 0.42% in psoriasis; cumulative incidence was 0.1% for prurigo nodularis and 1.9% for psoriasis. Prevalence was 0.1% for prurigo nodularis and 4.7% for psoriasis, with a one-year mortality of 5.4% for prurigo nodularis and 1.2% for psoriasis (p < 0.001). The most frequent pre-existing comorbidities in patients with prurigo nodularis were inflammatory dermatoses and depression. This epidemiological study found a low prevalence of prurigo nodularis, manifesting different demographics and comorbidities compared with psoriasis.
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Affiliation(s)
- Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, DE-48149 Münster, Germany. E-mail:
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Gründel S, Pereira MP, Storck M, Osada N, Schneider G, Ständer S, Zeidler C. Analysis of 325 Patients with Chronic Nodular Prurigo: Clinics, Burden of Disease and Course of Treatment. Acta Derm Venereol 2020; 100:adv00269. [PMID: 32556359 PMCID: PMC9234994 DOI: 10.2340/00015555-3571] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic nodular prurigo presents with multiple pruriginous nodules and severe pruritus. This study aims to explore the treatment course and regimens in patients with chronic nodular prurigo and to analyse predictive factors contributing to therapeutic success. A total of 325 patients with chronic nodular prurigo (male 37.5%) were analysed concerning demographic data, pruritus intensity, medical history, psychological impairment, quality of life, treatment duration, regimens and outcome. These parameters were compared with 325 sex- and age-matched patients with chronic pruritus on non-lesional skin. Treatment success was dependent on duration and regime of treatment and independent of age, sex and initial itch intensity. Non-responders displayed a higher percentage of inflamed nodules, a higher portion of excoriated nodules and a higher impairment of quality of life and mood factors before initiation of treatment. Gabapentinoids and immunosuppressants proved to be the most successful therapeutic agents. Compared with patients with chronic pruritus, those with chronic nodular prurigo needed longer duration of therapy.
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Affiliation(s)
- Sonja Gründel
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
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29
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Affiliation(s)
- Charles Dervout
- Department of Dermatology, University Hospital of Brest, 2 Avenue Foch, FR-29200 Brest, France. E-mail:
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Abstract
Prurigo nodularis is a chronic skin condition that presents significant challenges for treatment and quality of life, with little known about disease prevalence. This study assessed the prevalence of prurigo nodularis in Poland using publicly maintained database case records and diagnostic codes for prurigo nodularis (L28.1) and other prurigo (L28.2). For the period 2016–18, the prevalence of prurigo nodularis increased from 5.82 to 6.52 cases per 100,000 population. The total prevalence of all prurigo diagnoses over the same period remained relatively stable, with a small increase from 9.04 to 9.26 cases per 100,000 population. Regional data largely followed the overall trend. In an analysis of 58 prurigo nodularis cases identified at the Department of Dermatology at the University of Rzeszów, 43.1% of patients were initially misdiagnosed by the referring physician. Thus, more than one-third of patients with prurigo nodularis may initially be misdiagnosed.
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Affiliation(s)
- Anna Ryczek
- Department of Dermatology, University of Rzeszow, Szopena street 2, PL-35-055 Rzeszów, Poland
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31
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Williams KA, Huang AH, Belzberg M, Kwatra SG. Prurigo nodularis: Pathogenesis and management. J Am Acad Dermatol 2020; 83:1567-1575. [PMID: 32461078 DOI: 10.1016/j.jaad.2020.04.182] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022]
Abstract
Prurigo nodularis is a chronic skin condition characterized by severely pruritic nodules that cause a profound negative impact on quality of life. The second article in this 2-part continuing medical education series focuses on reviewing the pathogenesis of prurigo nodularis and exploring management algorithms for this condition. In addition, we discuss some emerging and novel therapies for treating prurigo nodularis. The first article in this 2-part series describes the broader epidemiology, patient demographics, physical examination findings, and symptoms to aid in the timely recognition and diagnosis of prurigo nodularis.
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Affiliation(s)
- Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy H Huang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Micah Belzberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
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32
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Huang AH, Williams KA, Kwatra SG. Prurigo nodularis: Epidemiology and clinical features. J Am Acad Dermatol 2020; 83:1559-1565. [PMID: 32454098 DOI: 10.1016/j.jaad.2020.04.183] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by intensely pruritic, hyperkeratotic nodules that favor the extensor surfaces of the extremities and the trunk. In addition to its significant impact on quality of life, many patients with PN are recalcitrant to therapy because there are currently no therapies approved by the US Food and Drug Administration. In the first article of this 2-part continuing medical education series, we describe the broader epidemiology, patient demographics, physical examination findings, and symptoms to aid in the timely recognition and diagnosis of PN. Furthermore, we quantify the burden of comorbidities in PN by discussing the broad spectrum of systemic diseases and mental health conditions that have been associated with this condition. The second article of this 2-part series focuses on the pathogenesis of PN and provides detailed algorithms for comprehensive work-up and management.
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Affiliation(s)
- Amy H Huang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
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Almustafa ZZ, Weller K, Autenrieth J, Maurer M, Metz M. Dupilumab in Treatment of Chronic Prurigo: A Case Series and Literature Review. Acta Derm Venereol 2019; 99:905-906. [PMID: 31233177 DOI: 10.2340/00015555-3243] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Zaid Z Almustafa
- Department of Dermatology, Venereology and Allergology, Charité - Universitäätsmedizin Berlin, Berlin, Germany
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Tanis R, Ferenczi K, Payette M. Dupilumab Treatment for Prurigo Nodularis and Pruritis. J Drugs Dermatol 2019; 18:940-942. [PMID: 31524352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prurigo nodularis (PN) is a disease in which chronic scratching and picking of the skin due to intense pruritis results in papulonodules, notably in areas that are accessible to the patient. The pathophysiology is hypothesized to be mediated by a Th2 helper cell response, similar to that seen in atopic dermatitis, therefore, treatment of PN with dupilumab would be expected to elicit a therapeutic response. We demonstrated that treatment of PN with dupilumab significantly decreased pruritis and the size and number of new lesions after 2 months of treatment. J Drugs Dermatol. 2019;18(9):940-942.
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Al-Dawsari NA, Al-Essa A, Shahab R, Raslan W. Prurigo pigmentosa following laparoscopic gastric sleeve. Dermatol Online J 2019; 25:13030/qt2b20c2w8. [PMID: 31220898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 06/09/2023] Open
Abstract
Prurigo pigmentosa is an uncommon inflammatory skin disease predominately affecting young women. Clinically the disease presents with erythematous and urticarial papules arranged in a reticular pattern. Lesions heal with reticulated hyperpigmentation. Strict ketogenic diet is one of many factors that might trigger the disease. In this article, we present a case of prurigo pigmentosa following a complicated laparoscopic gastric sleeve with the resolution of the rash after improvement of the patient's diet.
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Tsianakas A, Zeidler C, Riepe C, Borowski M, Forner C, Gerss J, Metz M, Staubach P, Raap U, Kaatz M, Urban M, Luger TA, Ständer S. Aprepitant in Anti-histamine-refractory Chronic Nodular Prurigo: A Multicentre, Randomized, Double-blind, Placebo-controlled, Cross-over, Phase-II trial (APREPRU). Acta Derm Venereol 2019; 99:379-385. [PMID: 30653242 DOI: 10.2340/00015555-3120] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this multicentre, randomized, double-blind, placebo-controlled, cross-over, phase-II study was to determine the antipruritic effect of aprepitant vs. placebo in 58 patients with anti-histamine-refractory chronic pruritus in chronic nodular prurigo. Patients were randomized to receive either first oral aprepitant 80 mg/day or placebo for 4 weeks. Following a 2-week wash-out phase, the patients were crossed-over to receive the other treatment for 4 weeks. Primary efficacy criterion was the intra-individual difference between mean itch intensity (visual analogue scale) at baseline compared with the end of treatment period. Prurigo lesions, pruritus course, quality of life, patient benefits, and safety were secondary parameters. No significant differences were found between aprepitant treatment and placebo for any of the parameters investigated. Under the experimental conditions of the study, aprepitant, 80 mg daily for 4 weeks, did not have an antipruritic effect in patients with chronic prurigo. (DRKS00005594; EudraCT Number: 2013-001601-85).
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Affiliation(s)
- Athanasios Tsianakas
- Department of Dermatology, University Hospital Muenster, Von-Esmarch-Str. 58, DE-48149 Münster, Germany
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Affiliation(s)
- O Maincent
- Service de dermatologie-vénéréologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - B Husson
- Service de dermatologie-vénéréologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - J Kieffer
- Service de dermatologie-vénéréologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - A Durlach
- Service d'anatomo-pathologie, hôpital Maison-Blanche, 51092 Reims, France
| | - B Cribier
- Service de dermatologie, CHRU de Strasbourg, 67091 Strasbourg, France
| | - M Viguier
- Service de dermatologie-vénéréologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France.
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Hartman M, Fuller B, Heaphy MR. Prurigo pigmentosa induced by ketosis: resolution through dietary modification. Cutis 2019; 103:E10-E13. [PMID: 31039240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Bruce Fuller
- Fuller Dermatology, St. Petersburg, Florida, USA
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Werbel T, Hinds BR, Cohen PR. Scabies presenting as cutaneous nodules or malar erythema: reports of patients with scabies surrepticius masquerading as prurigo nodularis or systemic lupus erythematosus. Dermatol Online J 2018; 24:13030/qt5bn8k4vx. [PMID: 30677831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 06/09/2023] Open
Abstract
Scabies surrepticius is a unifying term that represents non-classical presentations of scabies mite infestation. A patient with scabies surrepticius is described: a man with scabies masquerading as prurigo nodularis. The 91-year-old man had metastatic prostate cancer and presented with diffuse pruritic nodules. Prurigo nodularis was suspected; however, the biopsy revealed scabies mites in the stratum corneum. He was successfully treated with topical permethrin 5% cream and oral ivermectin. In addition, the features of a woman with scabies mimicking systemic lupus erythematosus are summarized. The 47-year-old woman had idiopathic thrombocytopenic purpura and presented with malar erythema and a positive antinuclear antibody (titer 1:320). A diagnosis of systemic lupus erythematous was entertained until skin scraping and mineral oil preparation revealed scabies mites; she was successfully treated with oral ivermectin. In conclusion, Sarcoptes scabiei infestation can present with atypical clinical morphology and an absence of classical lesions such as burrows conventionally distributed in the interdigital web spaces, volar wrists, periumbilical area, or genitalia. Scabies surrepticius is a term that has been designated to describe these unusual presentations. Prurigo nodularis and systemic lupus erythematosus can be added to the litany of conditions masquerading as scabies and are included amongst the guises of scabies surrepticius.
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Affiliation(s)
- Tyler Werbel
- School of Medicine, University of California San Diego, La Jolla, California.
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Temple R, Rogers T. Body-wide, pruritic, papular rash · scalp lesion · excoriation · Dx? J Fam Pract 2018; 67:429-430. [PMID: 29989616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Wong M, Lee E, Wu Y, Lee R. Treatment of Prurigo Pigmentosa with Diet Modification: A Medical Case Study. Hawaii J Med Public Health 2018; 77:114-117. [PMID: 29761029 PMCID: PMC5945928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prurigo pigmentosa is a rare inflammatory dermatitis first described in 1971. While the etiology of Prurigo pigmentosa is yet unknown, conditions associated with ketosis often accompany this rash. Prurigo pigmentosa is successfully treated with antibiotics and by resolution of ketosis. However, there is no dietary treatment option to successfully treat the rash without sacrificing ketosis. We report two cases successfully treated with increase of dietary carbohydrate intake. The second case suggests that cessation of ketosis may not be necessary to resolve Prurigo pigmentosa.
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Affiliation(s)
- Miki Wong
- Nutrition Services, Shriners Hospitals for Children, Honolulu, HI (MW)
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (EL)
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (YW)
- Medical Staff Department, Shriners Hospitals for Children, Honolulu, HI (EL, RL)
| | - Erica Lee
- Nutrition Services, Shriners Hospitals for Children, Honolulu, HI (MW)
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (EL)
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (YW)
- Medical Staff Department, Shriners Hospitals for Children, Honolulu, HI (EL, RL)
| | - Yolanda Wu
- Nutrition Services, Shriners Hospitals for Children, Honolulu, HI (MW)
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (EL)
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (YW)
- Medical Staff Department, Shriners Hospitals for Children, Honolulu, HI (EL, RL)
| | - Ryan Lee
- Nutrition Services, Shriners Hospitals for Children, Honolulu, HI (MW)
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (EL)
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (YW)
- Medical Staff Department, Shriners Hospitals for Children, Honolulu, HI (EL, RL)
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Abstract
Prurigo nodularis (PN) is a subtype of chronic prurigo presenting single to multiple symmetrically distributed, hyperkeratotic and intensively itching papules and nodules. PN evolves along with chronic pruritus in the context of diverse dermatological, systemic, neurological or psychiatric conditions. Permanent scratching is possibly a major trigger of PN, although its exact pathophysiology remains unclear. Current state-of-the-art therapy for PN consists of topical steroids, capsaicin, calcineurin inhibitors, ultraviolet (UV) therapy, systemic administration of gabapentinoids, μ-opioid receptor antagonists, antidepressants or immunosuppressants. Novel treatment concepts, such as inhibitors of neurokinin-1, opioid and interleukin-31 receptors, have been developed and are currently being clinically tested.
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Affiliation(s)
- Claudia Zeidler
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Von- Esmarch-Str. 58, DE-48149 Münster, Germany.
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Pennesi CM, Neely J, Marks AG, Basak SA. Use of Isoquercetin in the Treatment of Prurigo Nodularis. J Drugs Dermatol 2017; 16:1156-1158. [PMID: 29141065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
<p>Atopic dermatitis and prurigo nodularis result from complex interactions between the skin, the immune system, and the external environment. The pruritus associated with these conditions greatly impacts patients' quality of life and lacks uniformly effective treatment. A 57-year-old patient presented with severe atopic dermatitis and subsequent prurigo nodularis refractory to numerous standard therapies. The supplement isoquercetin was initiated and he noted significant, sustained reduction in his pruritus after only four weeks. Isoquercetin is a glycoside derivative with antihistamine properties of quercetin, a natural polyphenol flavonoid found in many plants. It may offer itch relief in patients who have failed more conventional therapies.</p> <p><em>J Drugs Dermatol. 2017;16(11):1156-1158.</em></p>.
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Gawin A, Lyon C, Khodaee M. Mildly pruritic palmar rash. J Fam Pract 2016; 65:823-826. [PMID: 28087868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
After taking azithromycin and prednisone for lower respiratory symptoms, this patient developed a rash. The way it spread provided a diagnostic clue.
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Affiliation(s)
- Amanda Gawin
- University of Colorado School of Medicine, Department of Family Medicine, Denver, CO, USA
| | - Corey Lyon
- University of Colorado School of Medicine, Department of Family Medicine, Denver, CO, USA
| | - Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine, Denver, CO, USA.
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Affiliation(s)
- Jon Anders Halvorsen
- Department of Dermatology, Oslo University Hospital Rikshospitalet, University of Oslo, NO-0027 Oslo, Norway.
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Saco M, Cohen G. Prurigo nodularis: Picking the right treatment. J Fam Pract 2015; 64:221-226. [PMID: 25973448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Most patients with localized nodules should receive topical treatment first. But disappointing results or specific findings described here could necessitate additional or alternative options.
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Affiliation(s)
- Michael Saco
- Department of Dermatology & Cutaneous Surgery, University of South Florida, Tampa, FL, USA.
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Jones AC, McGuff HS, Huber M. Oral and Maxillofacial Pathology. Case of the Month. Actinic prurigo. Tex Dent J 2015; 132:168-213. [PMID: 26234110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Tan SK, Tay YK. Localised dermatitic nodules but no itch. Ann Acad Med Singap 2015; 44:71-72. [PMID: 25797820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Siew Kiang Tan
- Department of Dermatology, Changi General Hospital, Singapore
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50
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Affiliation(s)
- Hui Li Kwong
- Department of Dermatology, Changi General Hospital, 2 Simei Street, 529889 Singapore, Singapore.
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