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Li W, Pi Y, Xu J. Association between atopic dermatitis and prurigo nodularis: a systematic review and meta-analysis. Int J Dermatol 2024. [PMID: 39344011 DOI: 10.1111/ijd.17493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 08/10/2024] [Accepted: 09/05/2024] [Indexed: 10/01/2024]
Abstract
Atopic dermatitis (AD) and prurigo nodularis (PN) are chronic dermatological conditions marked by severe itching and the presence of eczematous lesions such as papules and nodules. Both diseases can pose significant physical and psychological harm, leading to poor quality of life. Notably, AD and PN were clinically linked in the past, with suggestions by researchers that PN might be a distinct clinical phenotype of AD. However, the extent of their relationship had not been fully quantified until our recent investigations. Through a meticulous systematic review and meta-analysis adhering to the PRISMA guidelines, we extensively searched databases, including PubMed, EMBASE, Scopus, and the Cochrane Library, up to February 18, 2024. Our random effects meta-analysis presented a strikingly increased risk of AD in patients suffering from PN as opposed to control groups (pooled unadjusted odds ratio [OR], 16.85; 95% confidence interval [CI], 6.13-46.31; I2 = 100%). Correspondingly, an elevated prevalence of PN was identified in subjects with AD (2.00%; 95% CI, 1.62-2.37%). These findings underscore the close association between AD and PN, suggesting a multifaceted overlap and potential bi-directionality in developing these skin conditions. However, further comprehensive studies are essential to validate these associations and understand their precise clinical implications, with the ultimate goal of refining patient management strategies.
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Affiliation(s)
- Wei Li
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunze Pi
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiwei Xu
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Bahloul D, Hudson R, Balogh O, Mathias E, Heywood B, Hubbuck E, Diribe O, McDonald R, Bewley A. Prevalence, incidence and treatment patterns of prurigo nodularis in England: a retrospective database analysis. Br J Dermatol 2024; 191:548-555. [PMID: 38832950 DOI: 10.1093/bjd/ljae207] [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] [Received: 01/06/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Prurigo nodularis (PN) is a pruritic skin disease characterized by multiple intensely itchy skin nodules in symmetrically distributed areas of the extremities. There are limited studies on the epidemiology and treatment pathways of PN, especially moderate-to-severe PN, from England. OBJECTIVES To assess the epidemiology and treatment pathways of mild and moderate-to-severe PN in England. METHODS This retrospective cohort study used data from the Clinical Practice Research Datalink and Hospital Episode Statistics in England. Adult patients (aged ≥ 18 years) with a PN-specific diagnosis code allocated any time between 1 April 2007 and 1 March 2019 (patient identification period) were selected. Patients were included if their first PN diagnostic code (index diagnosis date; IDD) was recorded during the identification period, with data available 6 months before and ≥ 12 months after the IDD. Patients were classified as having moderate-to-severe PN (MSPN) or mild PN (MiPN), based on the presence or absence of a prescription record, post-IDD, for either a systemic immunosuppressant or a gabapentinoid. Patients with MSPN and MiPN were matched 1 : 1 according to age, sex and IDD. Prevalence and incidence were calculated for each year from 2007 to 2019. Drugs prescribed post-IDD were analysed. RESULTS A total of 8933 patients (MSPN, n = 2498; MiPN, n = 6435) were included in the study; 2462 patients with MiPN and 2462 with MSPN were included for the comparative analysis. The presence of atopic dermatitis, asthma and eosinophilic oesophagitis were significantly higher (all P < 0.001) in patients with MSPN compared with those with MiPN. The overall prevalence of cases of PN increased during the study period. The incidence rate also showed a similar trend. The rates of prescription of potent and super-potent topical corticosteroids (TCS), topical calcineurin inhibitors, first- and second-generation antihistamines, oral and injectable systemic corticosteroids, methotrexate, antidepressants and tacrolimus were significantly higher (all P < 0.001) in patients with MSPN compared with those with MiPN. CONCLUSIONS The epidemiology of PN was consistent with that found in other European studies. Patients with MSPN received a significantly higher number of prescriptions for potent TCS and systemic drugs compared with patients with MiPN.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anthony Bewley
- Dermatology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
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3
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Yosipovitch G, Kim BS, Kwatra SG, Mollanazar NK, Ständer S, Satoh T, Mendes-Bastos P, Tsai TF, Laws E, Nivens MC, Maloney J, Shi G, Bansal A, Dubost-Brama A. Dupilumab improves pruritus and skin lesions in patients with prurigo nodularis: Pooled results from 2 phase 3 trials (LIBERTY-PN PRIME and PRIME2). JAAD Int 2024; 16:163-174. [PMID: 39006917 PMCID: PMC11246003 DOI: 10.1016/j.jdin.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 07/16/2024] Open
Abstract
Background Phase 3 PRIME/PRIME2 trials independently demonstrated efficacy and an acceptable safety profile of dupilumab adults with moderate-to-severe prurigo nodularis. Objective To obtain a more precise estimate of onset and magnitude of treatment effect using PRIME/PRIME2 pooled data. Methods In PRIME/PRIME2, patients were randomized to dupilumab or placebo for 24 weeks. Pooled analysis assessed proportion of patients achieving clinically meaningful improvement in itch, clear/almost-clear skin, or both; at weeks 12 and 24; overall and by demographic subgroups and changes from baseline to week 24 in symptoms, signs, and quality of life. Results Patients receiving dupilumab (n = 153) vs placebo (n = 158) experienced significant improvements in all tested endpoints. At week 24, 90 (58.8%) dupilumab-treated vs 30 (19.0%) placebo-treated patients achieved clinically meaningful improvement in itch, 71 (46.4%) vs 27 (17.1%) clear/almost clear skin, and 54 (35.3%) vs 14 (8.9%) achieved both (P < .0001 for all). Treatment benefits were independent of baseline demographics. Safety to week 36 was generally consistent with the known dupilumab safety profile. Limitations On-treatment data limited to 24 weeks. Conclusions Pooled analysis confirmed improvements reported in individual trials and revealed earlier effect onset in itch and skin pain. Dupilumab treatment showed benefits across demographics.
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Affiliation(s)
- Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami, Miami, Florida
| | - Brian S Kim
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Mϋnster, Germany
| | - Takahiro Satoh
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | | | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei City, Taiwan
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Kwatra SG, Ständer S, Yosipovitch G, Kim BS, Levit NA, O'Malley JT. Pathophysiology of Prurigo Nodularis: Neuroimmune Dysregulation and the Role of Type 2 Inflammation. J Invest Dermatol 2024:S0022-202X(24)01875-X. [PMID: 39217537 DOI: 10.1016/j.jid.2024.06.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/18/2024] [Indexed: 09/04/2024]
Abstract
Prurigo nodularis (PN) is a chronic, inflammatory skin condition characterized by multiple, intensely pruritic, distinctive nodular lesions. Subsequent scratching can further intensify the pruritus, culminating in a self-reinforcing itch-scratch cycle, which drives lesion development. The latest data indicate dysregulation of the neuroimmune axis in PN pathogenesis, including the involvement of sensory neurons, key effector immune cells, proinflammatory cytokines, dermal fibroblasts, and pruritogens. In this review, we highlight evidence supporting the role of type 2 immune axis dysregulation in driving the clinical presentation of PN and discuss how related signaling pathways may offer effective therapeutic targets to control PN signs and symptoms.
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Affiliation(s)
- Shawn G Kwatra
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA; Maryland Itch Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Gil Yosipovitch
- Miami Itch Center, Dr. Philip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, Florida, USA
| | - Brian S Kim
- Mark Lebwohl Center for Neuroinflammation and Sensation, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Noah A Levit
- Dermatology Physicians of Connecticut, Fairfield, Connecticut, USA
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Kwatra SG, Bordeaux ZA, Parthasarathy V, Kollhoff AL, Alajmi A, Pritchard T, Cornman HL, Kambala A, Lee KK, Manjunath J, Ma EZ, Dillen C, Kwatra MM. Efficacy and Safety of Abrocitinib in Prurigo Nodularis and Chronic Pruritus of Unknown Origin: A Nonrandomized Controlled Trial. JAMA Dermatol 2024; 160:717-724. [PMID: 38837144 PMCID: PMC11154357 DOI: 10.1001/jamadermatol.2024.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/10/2024] [Indexed: 06/06/2024]
Abstract
Importance Prurigo nodularis (PN) and chronic pruritus of unknown origin (CPUO) are chronic pruritic diseases that dramatically impair quality of life, but therapeutic options are limited. Abrocitinib, a Janus kinase 1 inhibitor, represents a promising therapy for both conditions. Objective To assess the efficacy and safety of 200-mg oral abrocitinib administered once daily in adults with moderate to severe PN or CPUO. Design, Setting, and Participants This phase 2, open-label, nonrandomized controlled trial conducted between September 2021 and July 2022 took place at a single center in the US. A total of 25 adult patients with moderate to severe PN or CPUO were screened. Ten patients with PN and 10 patients with CPUO were enrolled. All 20 patients completed the 12-week treatment period, 18 of whom completed the 4-week follow-up period. Intervention Abrocitinib, 200 mg, by mouth once daily for 12 weeks. Main Outcomes and Measures The primary efficacy end point was the percent change in weekly Peak Pruritus Numerical Rating Scale (PP-NRS) scores from baseline to week 12. Key secondary end points included the percentage of patients achieving at least a 4-point reduction in weekly PP-NRS score from baseline to week 12 and the percent change in Dermatology Life Quality Index (DLQI) scores. Results A total of 10 patients with PN (mean [SD] age, 58.6 [13.1] years; all were female) and 10 patients with CPUO (mean [SD] age, 70.7 [5.6] years; 2 were female) enrolled in the study. The mean (SD) baseline PP-NRS score was 9.2 (1.0) for PN and 8.2 (1.2) for CPUO. PP-NRS scores decreased by 78.3% in PN (95% CI, -118.5 to -38.1; P < .001) and 53.7% in CPUO (95% CI, -98.8 to -8.6; P = .01) by week 12. From baseline to week 12, 8 of 10 patients with PN and 6 of 10 patients with CPUO achieved at least a 4-point improvement on the PP-NRS. Both groups experienced significant improvement in quality of life as demonstrated by percent change in DLQI scores (PN: -53.2% [95% CI, -75.3% to -31.1%]; P = .002; CPUO: -49.0% [95% CI, -89.6% to -8.0%]; P = .02). The most common adverse event among patients was acneiform eruption in 2 of 20 patients (10%). No serious adverse events occurred. Conclusions and Relevance The results of this nonrandomized controlled trial suggest that abrocitinib monotherapy may be effective and tolerated well in adults with PN or CPUO. Randomized, double-blind, placebo-controlled trials are warranted to validate these findings. Trial Registration ClinicalTrials.gov Identifier: NCT05038982.
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Affiliation(s)
- Shawn G. Kwatra
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Zachary A. Bordeaux
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Varsha Parthasarathy
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Alexander L. Kollhoff
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Alajmi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hannah L. Cornman
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Anusha Kambala
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kevin K. Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaya Manjunath
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Emily Z. Ma
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Carly Dillen
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
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Thünemann J, Müller S, Steinbrink K, Ständer S, Zeidler C. Chronische Prurigo. J Dtsch Dermatol Ges 2024; 22:813-824. [PMID: 38857094 DOI: 10.1111/ddg.15317_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/30/2023] [Indexed: 06/11/2024]
Abstract
ZusammenfassungDie chronische Prurigo (CPG) ist eine neuroinflammatorische Dermatose, die durch langanhaltenden Pruritus von mehr als 6 Wochen, pruriginösen Hautläsionen und wiederholtem Kratzen gekennzeichnet ist. Patienten mit CPG leiden unter erheblichen psychischen Belastungen und deutlich spürbarer Beeinträchtigung ihrer Lebensqualität. Der am häufigsten vorkommende Subtyp der CPG ist die chronisch noduläre Prurigo (CNPG; auch Prurigo nodularis genannt).Neben den klinischen Merkmalen der CPG und der Krankheitslast bietet dieser CME‐Artikel einen Überblick über die bedeutenden Fortschritte im Verständnis der Pathophysiologie, einschließlich der damit verbundenen therapeutischen Optionen der CPG. Dupilumab ist die erste zugelassene Therapie für die moderate und schwere CNPG, die bisher von der Europäischen Arzneimittelagentur (EMA) und der US‐amerikanischen Food & Drug Administration (FDA) zugelassen wurde. Des Weiteren werden weitere Wirkstoffe hervorgehoben, die derzeit in klinischen, randomisierten, placebokontrollierten Phase‐II‐ und Phase‐III‐Studien untersucht werden. Dazu gehören Biologika wie Nemolizumab (Anti‐IL‐31‐RA‐mAk), Vixarelimab/KPL‐716 (Anti‐Oncostatin‐M Rezeptor β‐mAk) und Barzolvolimab/CDX‐0159 (Anti‐KIT‐mAK), Januskinase‐Inhibitoren wie Povorcitinib/INCB054707 und Abrocitinib sowie Opiodmodulatoren wie Nalbuphin.
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Affiliation(s)
- Julia Thünemann
- Klinik für Dermatologie und Kompetenzzentrum chronischer Juckreiz (KCP), Universitätsklinikum Münster
| | - Svenja Müller
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Bonn
| | - Kerstin Steinbrink
- Klinik für Dermatologie und Kompetenzzentrum chronischer Juckreiz (KCP), Universitätsklinikum Münster
| | - Sonja Ständer
- Klinik für Dermatologie und Kompetenzzentrum chronischer Juckreiz (KCP), Universitätsklinikum Münster
| | - Claudia Zeidler
- Klinik für Dermatologie und Kompetenzzentrum chronischer Juckreiz (KCP), Universitätsklinikum Münster
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7
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Thünemann J, Müller S, Steinbrink K, Ständer S, Zeidler C. Chronic Prurigo. J Dtsch Dermatol Ges 2024; 22:813-823. [PMID: 38722190 DOI: 10.1111/ddg.15317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/30/2023] [Indexed: 06/11/2024]
Abstract
Chronic prurigo (CPG) is a neuroinflammatory dermatosis characterized by prolonged pruritus lasting more than 6 weeks, pruriginous skin lesions, and repeated scratching. Patients with CPG suffer significantly from psychological distress and a marked impairment in their quality of life. The most common subtype of CPG is chronic nodular prurigo (CNPG, also called prurigo nodularis). In addition to the clinical features of CPG and the burden of disease, this CME article provides an overview of the significant advances in understanding the pathophysiology, including the associated therapeutic options for CPG. Dupilumab is the first approved therapy for moderate and severe CNPG to date from the European Medicines Agency (EMA) and the US Food & Drug Administration (FDA). It also highlights other agents currently being studied in Phase II and Phase III clinical, randomized, placebo-controlled trials. These include biologics such as nemolizumab (anti-IL-31-RA-mAb), vixarelimab/KPL-716 (anti-Oncostatin-M receptor β-mAb), and barzolvolimab/CDX-0159 (anti-KIT-mAb), as well as Janus kinase inhibitors such as povorcitinib/INCB054707 and abrocitinib, and opioid modulators such as nalbuphine.
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Affiliation(s)
- Julia Thünemann
- Department of Dermatology and Competence Center for Chronic Pruritus (KCP), University Hospital Münster, Münster, Germany
| | - Svenja Müller
- Department of Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Kerstin Steinbrink
- Department of Dermatology and Competence Center for Chronic Pruritus (KCP), University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Competence Center for Chronic Pruritus (KCP), University Hospital Münster, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Competence Center for Chronic Pruritus (KCP), University Hospital Münster, Münster, Germany
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Brooks SG, Yosipovitch G. A critical evaluation of nemolizumab for prurigo nodularis. Expert Rev Clin Immunol 2024; 20:577-587. [PMID: 38217530 DOI: 10.1080/1744666x.2024.2306225] [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: 11/03/2023] [Accepted: 01/12/2024] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Prurigo nodularis (PN) is a chronic inflammatory skin condition that presents with intensely pruritic, hyperkeratotic nodules. The pathophysiology underlying PN is not entirely clear, making treatment challenging. Patients often require a multimodal approach, although many of the available therapies have low efficacy or adverse effects. AREAS COVERED In this review, we discuss the use of nemolizumab for the treatment of PN in adults. Nemolizumab is a biological therapy that reduces type 2 cytokines and the neuroimmune response implicated in the pathophysiology of PN. It also helps maintain skin barrier integrity, which may be damaged during the vicious itch-scratch cycle. Nemolizumab has demonstrated great efficacy in improving itch and clearing lesions in recent clinical trials with respectable tolerance. EXPERT OPINION Nemolizumab is a promising drug for PN that seems comparable to the recently approved dupilumab in terms of its therapeutic effect and excellent safety profile, although nemolizumab may work more rapidly on itch. JAK inhibitors are also emerging as competitors of biologics for PN, however, their safety profile in this population may differ. Trials evaluating these drugs are needed to assess which is preferable. Additional data on the durability and longevity of nemolizumab for PN treatment is highly anticipated.
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Affiliation(s)
- Sarah G Brooks
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Liao V, Cornman HL, Ma E, Kwatra SG. Prurigo nodularis: new insights into pathogenesis and novel therapeutics. Br J Dermatol 2024; 190:798-810. [PMID: 38345154 PMCID: PMC11099982 DOI: 10.1093/bjd/ljae052] [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] [Received: 08/30/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 05/18/2024]
Abstract
Prurigo nodularis (PN) is an inflammatory skin condition characterized by intensely pruritic nodules on the skin. Patients with PN suffer from an intractable itch-scratch cycle leading to impaired sleep, psychosocial distress and a significant disruption in quality of life. The pathogenesis of PN is associated with immune and neural dysregulation, mediated by inflammatory cytokines [such as interleukin (IL)-4, -13, -17, -22 and -31] and neuropeptides (such as substance P and calcitonin gene-related peptide). There is a role for type 2 inflammation in PN in addition to T-helper (Th)17 and Th22-mediated inflammation. The neuroimmune feedback loop in PN involves neuropeptides released from nerve fibres that cause vasodilation and further recruitment of inflammatory cells. Inflammatory cells, particularly mast cells and eosinophils, degranulate and release neurotoxins, as well as nerve growth factor, which may contribute to the neuronal hyperplasia seen in the dermis of patients with PN and neural sensitization. Recent studies have also indicated underlying genetic susceptibility to PN in addition to environmental factors, the existence of various disease endotypes centred around degrees of type 2 inflammation or underlying myelopathy or spinal disc disease, and significant race and ethnicity-based differences, with African Americans having densely fibrotic skin lesions. Dupilumab became the first US Food and Drug Administration-approved therapeutic for PN, and there are several other agents currently in development. The anti-IL-31 receptor A inhibitor nemolizumab is in late-stage development with positive phase III data reported. In addition, the oral Janus kinase (JAK) 1 inhibitors, abrocitinib and povorcitinib, are in phase II trials while a topical JAK1/2 inhibitor, ruxolitinib, is in phase III studies.
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Affiliation(s)
- Viviane Liao
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hannah L Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Ma
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shawn G Kwatra
- Department of Dermatology
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore, MD, USA
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10
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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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Olbrich H, Kridin K, Hernández G, Zirpel H, Sadik CD, Terheyden P, Thaçi D, Ludwig RJ, Boch K. Increased cardiovascular risks and mortality in prurigo nodularis: a global cohort study. EBioMedicine 2024; 103:105123. [PMID: 38631094 PMCID: PMC11035034 DOI: 10.1016/j.ebiom.2024.105123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Prurigo nodularis (PN) presents with intensely itchy hard nodules. Despite being limited to the skin, PN was noted to be associated with systemic diseases including diabetes and chronic renal failure. In previous smaller retrospective studies, several cardiac and vascular diseases were found more frequently in patients with PN. However, small cohort sizes, partially discrepant outcomes, missing data, and incomplete risk assessment limit these findings. METHODS Electronic health records (EHR)s of 64,801 patients (59.44% females) with PN and an equal sized propensity-matched control group were retrieved. In these cohorts, the risks to develop cardiac and vascular diseases and mortality following the diagnosis of PN were determined. Sub-analyses included stratification for sex, ethnicity, and treatments. FINDINGS PN was associated with a higher risk for a broad range of acute cardiac events including heart failure and myocardial infarction. For example, the hazard ratio of myocardial infarction was 1.11 (95%-CI: 1.041-1.184, p = 0.0015) following PN diagnosis. Also, all-cause mortality was higher in patients with PN. Further, chronic vascular as well as structural heart diseases, e.g., peripheral arterial disease, chronic ischaemic heart disease and valval disorders were found more frequently following a PN diagnosis. Risks were more pronounced in white and female patients. Having established an increased risk for death and cardiovascular disease, we next addressed if dupilumab that has been recently licenced for use in this indication can modulate these risks. The risk of death but not of any cardiovascular disease was slightly reduced in patients with PN treated with dupilumab as opposed to those treated with systemic therapies other than dupilumab. The study is limited by retrospective data collection and reliance on ICD10-disease classification. INTERPRETATION PN is associated with higher mortality and an increased risk for the development of a wide range of cardiac and vascular diseases. Health care professionals should take this into account when managing patients with PN. FUNDING This work was supported by the University of Lübeck, the Deutsche Forschungsgemeinschaft and the State of Schleswig-Holstein.
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Affiliation(s)
- Henning Olbrich
- Department of Dermatology, University of Lübeck, Lübeck, Germany.
| | - Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Henner Zirpel
- Comprehensive Center for Inflammation Medicine, University-Hospital Schleswig-Holstein, Lübeck, Germany
| | | | | | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University-Hospital Schleswig-Holstein, Lübeck, Germany
| | - Ralf J Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel; Comprehensive Center for Inflammation Medicine, University-Hospital Schleswig-Holstein, Lübeck, Germany
| | - Katharina Boch
- Department of Dermatology, University of Kiel, Kiel, Germany
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12
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Cornman HL, Manjunath J, Reddy SV, Adams J, Rajeh A, Samuel C, Bao A, Zhao R, Ma EZ, Shumsky J, Pritchard TW, Imo BU, Kollhoff AL, Lee KK, Lu W, Yossef S, Kwatra MM, Kwatra SG. Comprehensive plasma cytokine and chemokine profiling in prurigo nodularis reveals endotypes in Type 2 inflammation. Sci Rep 2024; 14:8098. [PMID: 38582943 PMCID: PMC10998852 DOI: 10.1038/s41598-024-58013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/25/2024] [Indexed: 04/08/2024] Open
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease that is associated with variability in peripheral blood eosinophil levels and response to T-helper 2 targeted therapies (Th2). Our objective was to determine whether circulating immune profiles with respect to type 2 inflammation differ by race and peripheral blood eosinophil count. Plasma from 56 PN patients and 13 matched healthy controls was assayed for 54 inflammatory biomarkers. We compared biomarker levels between PN and HCs, among PN patients based on absolute eosinophil count, and across racial groups in PN. Eleven biomarkers were elevated in PN versus HCs including interleukin (IL)-12/IL-23p40, tumor necrosis factor-alpha (TNF-α), Thymic stromal lymphopoietin (TSLP), and macrophage-derived chemokine (MDC/CCL22). Additionally, PN patients with AEC > 0.3 K cells/μL had higher Th2 markers (eotaxin, eotaxin-3, TSLP, MCP-4/CCL13), and African American PN patients had lower eosinophils, eotaxin, and eotaxin-3 versus Caucasian and Asian PN patients (p < 0.05 for all). Dupilumab responders had higher AEC (p < 0.01), were more likely to be Caucasian (p = 0.02) or Asian (p = 0.05) compared to African Americans, and more often had a history of atopy (p = 0.08). This study suggests that blood AEC > 0.3 K and Asian and Caucasian races are associated with Th2 skewed circulating immune profiles and response to Th2 targeted therapies.
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Affiliation(s)
- Hannah L Cornman
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jaya Manjunath
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Sriya V Reddy
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Jackson Adams
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Ahmad Rajeh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Christeen Samuel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Aaron Bao
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Ryan Zhao
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Emily Z Ma
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason Shumsky
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Thomas W Pritchard
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brenda Umenita Imo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Alexander L Kollhoff
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Kevin K Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Weiying Lu
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Selina Yossef
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Shawn G Kwatra
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA.
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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13
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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] [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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14
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Kim B, Rothenberg ME, Sun X, Bachert C, Artis D, Zaheer R, Deniz Y, Rowe P, Cyr S. Neuroimmune interplay during type 2 inflammation: Symptoms, mechanisms, and therapeutic targets in atopic diseases. J Allergy Clin Immunol 2024; 153:879-893. [PMID: 37634890 PMCID: PMC11215634 DOI: 10.1016/j.jaci.2023.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/17/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
Type 2 inflammation is characterized by overexpression and heightened activity of type 2 cytokines, mediators, and cells that drive neuroimmune activation and sensitization to previously subthreshold stimuli. The consequences of altered neuroimmune activity differ by tissue type and disease; they include skin inflammation, sensitization to pruritogens, and itch amplification in atopic dermatitis and prurigo nodularis; airway inflammation and/or hyperresponsiveness, loss of expiratory volume, airflow obstruction and increased mucus production in asthma; loss of sense of smell in chronic rhinosinusitis with nasal polyps; and dysphagia in eosinophilic esophagitis. We describe the neuroimmune interactions that underlie the various sensory and autonomic pathologies in type 2 inflammatory diseases and present recent advances in targeted treatment approaches to reduce type 2 inflammation and its associated symptoms in these diseases. Further research is needed to better understand the neuroimmune mechanisms that underlie chronic, sustained inflammation and its related sensory pathologies in diseases associated with type 2 inflammation.
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Affiliation(s)
- Brian Kim
- Kimberly and Eric J. Waldman Department of Dermatology, Mark Lebwohl Center for Neuroinflammation and Sensation, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Xin Sun
- Department of Pediatrics, University of California, San Diego, Calif
| | - Claus Bachert
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Muenster, Muenster, Germany; First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China
| | - David Artis
- Jill Roberts Institute for Research in Inflammatory Bowel Disease, Friedman Center for Nutrition and Inflammation, Joan and Sanford I. Weill Department of Medicine, Department of Microbiology and Immunology, Weill Cornell Medicine, Cornell University, New York, NY
| | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Tarrytown, NY
| | | | - Sonya Cyr
- Regeneron Pharmaceuticals, Tarrytown, NY
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15
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Patel J, Deng J, Kambala A, Lee KK, Cornman HL, Parthasarathy V, Pritchard T, Chen S, Hernandez AG, Shin S, Oladipo OO, Kwatra MM, Ho WJ, Kwatra SG. Spatial Mass Cytometry-Based Single-Cell Imaging Reveals a Disrupted Epithelial-Immune Axis in Prurigo Nodularis. J Invest Dermatol 2024:S0022-202X(24)00202-1. [PMID: 38522569 DOI: 10.1016/j.jid.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 03/26/2024]
Abstract
Prurigo nodularis (PN) is a chronic, inflammatory skin condition that disproportionately affects African Americans and features intensely pruritic, hyperkeratotic nodules on the extremities and trunk. PN is understudied compared with other inflammatory skin diseases, with the spatial organization of the cutaneous infiltrate in PN yet to be characterized. In this work, we employ spatial imaging mass cytometry to visualize PN lesional skin inflammation and architecture with single-cell resolution through an unbiased machine learning approach. PN lesional skin has increased expression of caspase 3, NF-kB, and phosphorylated signal transducer and activator of transcription 3 compared with healthy skin. Keratinocytes in lesional skin are subdivided into CD14+CD33+, CD11c+, CD63+, and caspase 3-positive innate subpopulations. CD14+ macrophage populations expressing phosphorylated extracellular signal-regulated kinase 1/2 correlate positively with patient-reported itch (P = .006). Hierarchical clustering reveals a cluster of patients with PN with greater atopy, increased NF-kB+ signal transducer and activator of transcription 3-positive phosphorylated extracellular signal-regulated kinase 1/2-positive monocyte-derived myeloid dendritic cells, and increased vimentin expression (P < .05). Neighborhood analysis finds interactions between CD14+ macrophages, CD3+ T cells, monocyte-derived myeloid dendritic cells, and keratinocytes expressing innate immune markers. These findings highlight phosphorylated extracellular signal-regulated kinase-positive CD14+ macrophages as contributors to itch and suggest an epithelial-immune axis in PN pathogenesis.
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Affiliation(s)
- Jay Patel
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA; Maryland Itch Center, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Dermatology, University of Rochester, Rochester, New York, USA
| | - Junwen Deng
- Department of Dermatology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anusha Kambala
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kevin K Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hannah L Cornman
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA; Maryland Itch Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas Pritchard
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA; Maryland Itch Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shihua Chen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexei G Hernandez
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Shin
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olusola O Oladipo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Won Jin Ho
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA; Convergence Institute, Johns Hopkins University, Baltimore, Maryland, USA; Mass Cytometry Facility, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shawn G Kwatra
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA; Maryland Itch Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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16
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Murota H, Arima K, Yoshida T, Fujita H. Disease burden and treatment satisfaction in patients with prurigo nodularis in Japan. J Dermatol 2024; 51:223-233. [PMID: 38066728 DOI: 10.1111/1346-8138.17045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 11/02/2023] [Indexed: 02/04/2024]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disorder with a high disease burden. In this cross-sectional, web-based survey, Global Questions (GQ), the Numerical Rating Scales (NRS) for pruritus, burning sensation and sleep disturbance, the Short-Form-8 (SF-8) Health Survey, Dermatology Life Quality Index (DLQI), Patient Health Questionnaire 9 (PHQ-9), Work Productivity and Activity Impairment (WPAI), and Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) scores were used to assess the current disease burden and treatment satisfaction among patients with PN in Japan. In total, 97 patients were included (55.7% male, median age 51 years, median duration of PN 36 months). Based on GQ scores, 35.1% of patients had mild disease, 50.5% moderate, and 14.4% severe disease. Disease burden increased as the severity of PN increased, as indicated by worsening of pruritus NRS scores and quality of life (DLQI, PHQ-9, WPAI presenteeism, work productivity loss, and activity impairment scores). Patients with comorbid atopic dermatitis (AD) also had more intense pruritus than those without AD. Mean ± standard deviation TSQM-9 scores for effectiveness, convenience, and global satisfaction were 54.7 ± 18.1%, 62.4 ± 15.2%, and 57.4 ± 15.9%, respectively. TSQM-9 scores were lowest in patients receiving the most intensive guideline-directed treatment (i.e., topical corticosteroids + systemic oral corticosteroids or cyclosporine), highlighting an unmet need for more effective treatment options for patients with PN. In summary, Japanese patients with PN reported increased disease burden and reduced treatment satisfaction with increased disease severity, despite the use of guideline-recommended therapies.
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Affiliation(s)
- Hiroyuki Murota
- Department of Dermatology, Nagasaki University School of Medical Sciences, Nagasaki, Japan
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17
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Marani M, Madan V, Le TK, Deng J, Lee KK, Ma EZ, Kwatra SG. Dysregulation of the Skin-Liver Axis in Prurigo Nodularis: An Integrated Genomic, Transcriptomic, and Population-Based Analysis. Genes (Basel) 2024; 15:146. [PMID: 38397136 PMCID: PMC10887737 DOI: 10.3390/genes15020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/06/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
Pruritus has long been linked to hepatic dysfunction; however, there are limited data characterizing the association between liver disease and prurigo nodularis (PN), a chronic inflammatory skin disease featuring severe pruritis. We thus conducted a cross-sectional analysis of hepatic comorbidities in PN patients using TriNetX, a large global health research network. This analysis revealed that PN patients had a higher risk (p < 0.001) of developing liver cirrhosis, acute and subacute hepatic failure, inflammatory liver disease, chronic hepatitis, nonalcoholic steatohepatitis, portal hypertension, fatty liver, chronic passive congestion of the liver, and hepatocellular carcinoma compared with healthy controls. The cumulative incidence of liver disease was about three times higher in PN patients compared with healthy controls. These findings provided the basis for translational studies to investigate a genetic mechanism for this association. Cutaneous transcriptomic analysis performed on PN patients revealed the dysregulation of genes related to hepatic failure in lesional PN compared with both nonlesional PN and control skin. Similarly, gene set variation analysis (GSVA) revealed a significantly increased (p < 0.05) activation of liver metabolism, chronic hepatic failure, acute hepatic failure, cholestatic liver disease, polycystic liver disease, and hepatocellular carcinoma pathways in lesional PN compared with control skin. A subsequent genome-wide association study (GWAS) identified shared single-nucleotide polymorphisms (SNPs) in the genes AR, EDIL3, MACROD2, PCSK5, RUNX1T1, TENM4, and ZEB2 between PN and liver disease from the FinnGen cohort. Significant dysregulation of the skin-liver axis in PN patients may explain the increased incidence and severity of hepatic comorbidities and help identify future therapeutic targets for PN.
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Affiliation(s)
| | | | | | | | | | | | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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18
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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] [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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19
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Cornman HL, Deng J, Kambala A, Parthasarathy V, Reddy SV, Kwatra SG. Clinical utility of peripheral blood laboratory testing in the diagnostic workup of prurigo nodularis: A multicenter cohort study. JAAD Int 2023; 13:74-82. [PMID: 37711338 PMCID: PMC10497789 DOI: 10.1016/j.jdin.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
Background Prurigo nodularis (PN) is a chronic inflammatory skin disease associated with several systemic comorbidities. However, there is lack of evidence supporting specific laboratory testing in the diagnostic workup of PN patients. Objective To characterize the frequency and severity of clinical laboratory abnormalities in PN patients compared to controls. Methods Cross-sectional study of adult patients between October, 2015 and August, 2021 using TriNetX, a global health records database encompassing over 74 million patients. Results A total of 12,157 PN patients were matched to 12,157 controls. Significantly, greater proportions of PN patients had moderate-to-severely decreased hemoglobin, elevated transaminases, decreased albumin, increased bilirubin, increased serum creatinine, decreased estimated glomerular filtration rate, higher hemoglobin A1c levels, and alterations in thyroid stimulating hormone. Limitations Our data identifies associated laboratory abnormalities in PN patients but is unable to support a causal relationship. Conclusion PN patients are more likely to have laboratory abnormalities on renal, hepatic, hematologic, endocrine, and metabolic laboratory testing, demonstrating a role for systemic testing in the diagnostic workup of PN patients.
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Affiliation(s)
- Hannah L. Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Junwen Deng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sriya V. Reddy
- 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
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20
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Vasavda C, Wan G, Szeto MD, Marani M, Sutaria N, Rajeh A, Lu C, Lee KK, Nguyen NTT, Adawi W, Deng J, Parthasarathy V, Bordeaux ZA, Taylor MT, Alphonse MP, Kwatra MM, Kang S, Semenov YR, Gusev A, Kwatra SG. A Polygenic Risk Score for Predicting Racial and Genetic Susceptibility to Prurigo Nodularis. J Invest Dermatol 2023; 143:2416-2426.e1. [PMID: 37245863 PMCID: PMC11290854 DOI: 10.1016/j.jid.2023.04.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/30/2023]
Abstract
Prurigo nodularis (PN) is an understudied inflammatory skin disease characterized by pruritic, hyperkeratotic nodules. Identifying the genetic factors underlying PN could help to better understand its etiology and guide the development of therapies. In this study, we developed a polygenic risk score that predicts a diagnosis of PN (OR = 1.41, P = 1.6 × 10-5) in two independent and continentally distinct populations. We also performed GWASs, which uncovered genetic variants associated with PN, including one near PLCB4 (rs6039266: OR = 3.15, P = 4.8 × 10-8) and others near TXNRD1 (rs34217906: OR = 1.71, P = 6.4 × 10-7; rs7134193: OR = 1.57, P = 1.1 × 10-6). Finally, we discovered that Black patients have over a two-times greater genetic risk of developing PN (OR = 2.63, P = 7.8 × 10-4). Combining the polygenic risk score and self-reported race together was significantly predictive of PN (OR = 1.32, P = 4.7 × 10-3). Strikingly, this association was more significant with race than after adjusting for genetic ancestry. Because race is a sociocultural construct and not a genetically bound category, our findings suggest that genetics, environmental influence, and social determinants of health likely affect the development of PN and may contribute to clinically observed racial disparities.
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Affiliation(s)
- Chirag Vasavda
- The Solomon H. Snyder Department of Neuroscience, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guihong Wan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mindy D Szeto
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Melika Marani
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ahmad Rajeh
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chenyue Lu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin K Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nga T T Nguyen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Waleed Adawi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Junwen Deng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zachary A Bordeaux
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew T Taylor
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martin P Alphonse
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexander Gusev
- Division of Genetics, Brigham & Women's Hospital, Boston, Massachusetts, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
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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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22
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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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23
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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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24
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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: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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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25
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Joel MZ, Hydol-Smith J, Kambala A, Cornman HL, Kwatra SG. Prevalence and comorbidity burden of prurigo nodularis in United States adults enrolled in the All of Us research program. J Am Acad Dermatol 2023; 89:1056-1058. [PMID: 37422017 DOI: 10.1016/j.jaad.2023.06.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Marina Z Joel
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jourdan Hydol-Smith
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hannah L Cornman
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland.
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26
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Kwatra SG, Yosipovitch G, Legat FJ, Reich A, Paul C, Simon D, Naldi L, Lynde C, De Bruin-Weller MS, Nahm WK, Sauder M, Gharib R, Barbarot S, Szepietowski JC, Conrad C, Fleischer A, Laquer VT, Misery L, Serra-Baldrich E, Lapeere H, Ahmad F, Jabbar Lopez ZK, Piketty C, Ständer S. Phase 3 Trial of Nemolizumab in Patients with Prurigo Nodularis. N Engl J Med 2023; 389:1579-1589. [PMID: 37888917 DOI: 10.1056/nejmoa2301333] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Prurigo nodularis is a chronic, debilitating, and severely pruritic neuroimmunologic skin disease. Nemolizumab, an interleukin-31 receptor alpha antagonist, down-regulates key pathways in the pathogenesis of prurigo nodularis. METHODS In this phase 3, double-blind, multicenter, randomized trial, we assigned adults with moderate-to-severe prurigo nodularis to receive an initial 60-mg dose of nemolizumab followed by subcutaneous injections of 30 mg or 60 mg (depending on baseline weight) every 4 weeks for 16 weeks or matching placebo. The primary end points were an itch response (a reduction of ≥4 points on the Peak Pruritus Numerical Rating Scale [PP-NRS; scores range from 0 to 10, with higher scores indicating more severe itch]) and an Investigator's Global Assessment (IGA) response (a score of 0 [clear] or 1 [almost clear] on the IGA [scores range from 0 to 4] and a reduction from baseline to week 16 of ≥2 points). There were five key secondary end points. RESULTS A total of 274 patients underwent randomization; 183 were assigned to the nemolizumab group, and 91 to the placebo group. Treatment efficacy was shown with respect to both primary end points at week 16; a greater percentage of patients in the nemolizumab group than in the placebo group had an itch response (56.3% vs. 20.9%; strata-adjusted difference, 37.4 percentage points; 95% confidence interval [CI], 26.3 to 48.5), and a greater percentage in the nemolizumab group had an IGA response (37.7% vs. 11.0%; strata-adjusted difference, 28.5 percentage points; 95% CI, 18.8 to 38.2) (P<0.001 for both comparisons). Benefits were observed for the five key secondary end points: itch response at week 4 (41.0% vs. 7.7%), PP-NRS score of less than 2 at week 4 (19.7% vs. 2.2%) and week 16 (35.0% vs. 7.7%), and an improvement of 4 or more points on the sleep disturbance numerical rating scale (range, 0 [no sleep loss] to 10 [unable to sleep at all]) at week 4 (37.2% vs. 9.9%) and week 16 (51.9% vs. 20.9%) (P<0.001 for all comparisons). The most common individual adverse events were headache (6.6% vs. 4.4%) and atopic dermatitis (5.5% vs. 0%). CONCLUSIONS Nemolizumab monotherapy significantly reduced the signs and symptoms of prurigo nodularis. (Funded by Galderma; ClinicalTrials.gov number, NCT04501679; EudraCT number, 2019-004789-17.).
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Affiliation(s)
- Shawn G Kwatra
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Gil Yosipovitch
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Franz J Legat
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Adam Reich
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Carle Paul
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Dagmar Simon
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Luigi Naldi
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Charles Lynde
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Marjolein S De Bruin-Weller
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Walter K Nahm
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Maxwell Sauder
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Rola Gharib
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Sebastien Barbarot
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Jacek C Szepietowski
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Curdin Conrad
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Alan Fleischer
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Vivian T Laquer
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Laurent Misery
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Esther Serra-Baldrich
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Hilde Lapeere
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Faiz Ahmad
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Zarif K Jabbar Lopez
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Christophe Piketty
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
| | - Sonja Ständer
- From Johns Hopkins Itch Center, Johns Hopkins University School of Medicine, Baltimore (S.G.K.); the Miami Itch Center, Miller School of Medicine at the University of Miami, Miami (G.Y.); the Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria (F.J.L.); the Department of Dermatology, University of Rzeszow, Rzeszow (A.R.), and the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw (J.C.S.) - both in Poland; the Department of Dermatology, Medical University of Toulouse, Toulouse (C.P.), the Department of Dermatology, University Hospital, Nantes (S.B.), and the Department of Dermatology, University Hospital of Brest, Brest (L.M.) - all in France; the Department of Dermatology, Bern University Hospital, Bern (D.S.), the Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, (C.C.), and Galderma, Zug (Z.K.J.L., C.P.) - all in Switzerland; the Academic Research Center, Centro Studi GISED, Bergamo, Italy (L.N.); the Lynde Institute for Dermatology & Lynderm Research and the Division of Dermatology, Department of Medicine (C.L.), University of Toronto, Toronto (C.L., M.S.); the Department of Dermatology and Allergology, Utrecht University-UMC, Utrecht, the Netherlands (M.S.D.B.-W.); the University Dermatology Group, University of California, San Diego, San Diego (W.K.N.), and First OC Dermatology Research, Fountain Valley (V.T.L.) - both in California; West Virginia Research Institute, Morgantown (R.G.); the Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati (A.F.); Hospital de la Santa Creu i Sant Pau, Barcelona (E.S-B.); the Department of Dermatology, Ghent University Hospital, Ghent, Belgium (H.L.); Galderma R&D, Dallas (F.A.); and the Center for Chronic Pruritus, University Hospital, Munster, Germany (S.S.)
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27
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Rajeh A, Cornman HL, Gupta A, Szeto MD, Kambala A, Oladipo O, Parthasarathy V, Deng J, Wheelan S, Pritchard T, Kwatra MM, Semenov YR, Gusev A, Yegnasubramanian S, Kwatra SG. Somatic mutations reveal hyperactive Notch signaling and racial disparities in prurigo nodularis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.25.23295810. [PMID: 37808834 PMCID: PMC10557842 DOI: 10.1101/2023.09.25.23295810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease that disproportionately affects African Americans and is characterized by pruritic skin nodules of unknown etiology. Little is known about genetic alterations in PN pathogenesis, especially relating to somatic events which are often implicated in inflammatory conditions. We thus performed whole-exome sequencing on 54 lesional and nonlesional skin biopsies from 17 PN patients and 10 atopic dermatitis (AD) patients for comparison. Somatic mutational analysis revealed that PN lesional skin harbors pervasive somatic mutations in fibrotic, neurotropic, and cancer-associated genes. Nonsynonymous mutations were most frequent in NOTCH1 and the Notch signaling pathway, a regulator of cellular proliferation and tissue fibrosis, and NOTCH1 mutations were absent in AD. Somatic copy-number analysis, combined with expression data, showed that recurrently deleted and downregulated genes in PN lesional skin are associated with axonal guidance and extension. Follow-up immunofluorescence validation demonstrated increased NOTCH1 expression in PN lesional skin fibroblasts and increased Notch signaling in PN lesional dermis. Finally, multi-center data revealed a significantly increased risk of NOTCH1-associated diseases in PN patients. In characterizing the somatic landscape of PN, we uncover novel insights into its pathophysiology and identify a role for dysregulated Notch signaling in PN.
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Affiliation(s)
- Ahmad Rajeh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hannah L. Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anuj Gupta
- The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Mindy D. Szeto
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olusola Oladipo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Junwen Deng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Wheelan
- Present affiliation: National Human Genome Research Institute, National Institute of Health, Bethesda, MD, USA
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Yevgeniy R. Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Alexander Gusev
- Division of Genetics, Brigham & Women’s Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Srinivasan Yegnasubramanian
- The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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28
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Gan C, Mahil S, Pink A, Rodrigues M. Atopic dermatitis in skin of colour. Part 2: considerations in clinical presentation and treatment options. Clin Exp Dermatol 2023; 48:1091-1101. [PMID: 37119261 DOI: 10.1093/ced/llad162] [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] [Received: 12/10/2022] [Revised: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Recent advances in atopic dermatitis (AD) present the condition as a heterogeneous disease of distinct endotypes across ethnic groups. AD in people with skin of colour may appear psoriasiform, lichenoid, scaly or papular, with a violaceous colour and there is a higher prevalence of post-inflammatory dyspigmentation compared with affected individuals of White ethnicity. These differences in clinical presentation may limit the use of AD assessment tools in people with skin of colour, leading to the potential for misdiagnosis and underestimation of severity, particularly in relation to assessment of erythema. Recent targeted therapies for AD have been studied in multiple ethnic groups; however, ethnicity-based subgroup analysis is often not performed. Further research is required to understand whether treatment responses or safety may differ among ethnic groups.
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Affiliation(s)
- Christian Gan
- Department of Dermatology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Dermatology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Satveer Mahil
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
| | - Andrew Pink
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
| | - Michelle Rodrigues
- Department of Dermatology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Chroma Dermatology, Pigment and Skin of Colour Centre, VIC, Australia
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29
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Kolkhir P, Akdis CA, Akdis M, Bachert C, Bieber T, Canonica GW, Guttman-Yassky E, Metz M, Mullol J, Palomares O, Renz H, Ständer S, Zuberbier T, Maurer M. Type 2 chronic inflammatory diseases: targets, therapies and unmet needs. Nat Rev Drug Discov 2023; 22:743-767. [PMID: 37528191 DOI: 10.1038/s41573-023-00750-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/03/2023]
Abstract
Over the past two decades, significant progress in understanding of the pathogenesis of type 2 chronic inflammatory diseases has enabled the identification of compounds for more than 20 novel targets, which are approved or at various stages of development, finally facilitating a more targeted approach for the treatment of these disorders. Most of these newly identified pathogenic drivers of type 2 inflammation and their corresponding treatments are related to mast cells, eosinophils, T cells, B cells, epithelial cells and sensory nerves. Epithelial barrier defects and dysbiotic microbiomes represent exciting future drug targets for chronic type 2 inflammatory conditions. Here, we review common targets, current treatments and emerging therapies for the treatment of five major type 2 chronic inflammatory diseases - atopic dermatitis, chronic prurigo, chronic urticaria, asthma and chronic rhinosinusitis with nasal polyps - with a high need for targeted therapies. Unmet needs and future directions in the field are discussed.
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Affiliation(s)
- Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) Davos, University of Zürich, Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) Davos, University of Zürich, Davos, Switzerland
| | - Claus Bachert
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Division of ENT diseases, Karolinska Hospital, Stockholm, Sweden
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
- Davos Biosciences, Davos, Switzerland
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic Barcelona, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - Harald Renz
- Institute of Laboratory Medicine, member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center (UGMLC), Philipps-University Marburg, Marburg, Germany
- Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Sonja Ständer
- Section Pruritus Medicine, Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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30
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Mahmoud O, Choragudi S, Nwaopara A, Yosipovitch G. Prevalence of Chronic Pruritus in Elderly Black and White Inpatients: A Comparative Population Study. J Clin Med 2023; 12:5025. [PMID: 37568427 PMCID: PMC10420273 DOI: 10.3390/jcm12155025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Black and geriatric patients were reported in small scale studies to have more intense chronic pruritus (CP). Studies comparing itch across geriatric racial groups are lacking. OBJECTIVES To compare the prevalence of CP in Black and White inpatients ≥ 65 years old as well as the top primary diagnoses of these populations. METHODS We used data from the National Inpatient Sample from 2016-2019 to analyze CP prevalence and ICD10-CM to identify diseases. The top five primary diagnoses were calculated for a subpopulation with CP. Sample characteristics were described, and the data was pooled and analyzed using IBM SPSS® Complex Sample modules. RESULTS Among hospitalized Black inpatients ≥ 65 years old, the prevalence of CP was 0.26% while in the White cohort it was 0.22%. The top five primary diagnoses in the Black population with itch were sepsis (4.2%); hypertensive heart and chronic kidney disease (CKD) with heart failure (HF) and stage 1-4 CKD, or unspecified CKD (4.1%); acute kidney failure (4.0%); hypertensive heart and CKD with HF with stage 5 CKD, or end-stage renal disease (2.1%); and hypertensive heart disease with HF (1.7%). The top five primary diagnoses in the White population were sepsis (4.25%); acute kidney failure (3.0%); hypertensive heart and CKD with HF and stage 1-4 CKD, or unspecified CKD (2.5%); cellulitis of left lower limb (1.9%); and unilateral primary osteoarthritis, right knee (1.9%). CONCLUSIONS Geriatric hospitalized Black patients demonstrated a higher prevalence of chronic itch compared with the White cohort, which may be related to the higher prevalence of chronic kidney disease in different stages of severity in this population.
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Affiliation(s)
| | | | | | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (O.M.); (S.C.); (A.N.)
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31
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Abstract
Atopic dermatitis (AD) is a pruritic inflammatory skin disease that disproportionately affects skin of color patients. African American, Asian, and Hispanic patients carry disproportionate disease burdens, with increased prevalence, disease severity, and health care utilization. AD has a unique clinical presentation in skin of color patients, often with greater extensor involvement, dyspigmentation, and papular and lichenified presentations. Erythema is also more difficult to appreciate and can result in an underappreciation of disease severity in skin of color patients. In this review, we highlight the important manifestations of AD across all skin types, including nuances in treatment.
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Affiliation(s)
- Waleed Adawi
- Department of Dermatology, Johns Hopkins University School of Medicine
| | - Hannah Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine
| | - Shanae Henry
- Department of Dermatology, Johns Hopkins University School of Medicine
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine.
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32
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Mann C, Gorai S, Staubach-Renz P, Goldust M. Sleep disorders in dermatology - a comprehensive review. J Dtsch Dermatol Ges 2023. [PMID: 37235517 DOI: 10.1111/ddg.14992] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/20/2022] [Indexed: 05/28/2023]
Abstract
Sleep is a normal physiological process that accounts for approximately one third of a person's life. Disruption of the normal sleep cycle, which maintains physiological homeostasis, can lead to pathology. It is not known whether sleep disturbance causes skin disease or skin disease causes sleep impairment, but a bidirectional influence is suspected. We have compiled the data from published articles on "sleep disorders in dermatology" in PubMed Central from July 2010 to July 2022 (with the option "full text available") and provide an overview of sleep disorders associated with dermatological conditions and certain drugs used in dermatology as well as sleep disturbances for which some drugs used can cause itch or dermatological issues. Atopic dermatitis, eczema and psoriasis have been shown to be exacerbated by sleep problems and vice versa. Sleep deprivation, night-time pruritus and disrupted sleep cycles are often used to assess treatment response and quality of life in these conditions. Some medications used primarily for dermatological conditions have also been associated with alterations in the sleep-wake cycle. Addressing patients sleep disorders should be an integral part of the management of dermatological conditions. More studies are needed to further investigate the influence of sleep and skin disorders.
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Affiliation(s)
- Caroline Mann
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Surajit Gorai
- Department of Dermatology, Apollo Multispeciality Hospital (formerly Gleneagles), Kolkata, India
| | | | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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33
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Yosipovitch G, Mollanazar N, Ständer S, Kwatra SG, Kim BS, Laws E, Mannent LP, Amin N, Akinlade B, Staudinger HW, Patel N, Yancopoulos GD, Weinreich DM, Wang S, Shi G, Bansal A, O'Malley JT. Dupilumab in patients with prurigo nodularis: two randomized, double-blind, placebo-controlled phase 3 trials. Nat Med 2023; 29:1180-1190. [PMID: 37142763 DOI: 10.1038/s41591-023-02320-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/24/2023] [Indexed: 05/06/2023]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease with intensely pruritic nodules. The LIBERTY-PN PRIME and PRIME2 phase 3 trials enrolled adults with PN with ≥20 nodules and severe itch uncontrolled with topical therapies. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin (IL)-4 and IL-13. Patients were randomized 1:1 to 300 mg dupilumab or placebo subcutaneously every 2 weeks for 24 weeks. The primary endpoint was pruritus improvement, measured by proportion of patients with a ≥4-point reduction in Worst Itch Numeric Rating Scale (WI-NRS) from baseline at week 24 (PRIME) or week 12 (PRIME2). Key secondary endpoints included nodule number reduction to ≤5 at week 24. PRIME and PRIME2 enrolled 151 and 160 patients, respectively. Both trials met all the pre-specified primary and key secondary endpoints. A ≥4-point WI-NRS reduction at week 24 in the dupilumab and placebo arms was achieved by 60.0% and 18.4% of patients, respectively, in PRIME (95% confidence interval (CI), 27.8-57.7 for the difference, P < 0.001) and at week 12 by 37.2% and 22.0% of patients, respectively, in PRIME2 (95% CI, 2.3-31.2; P = 0.022). Dupilumab demonstrated clinically meaningful and statistically significant improvements in itch and skin lesions versus placebo in PN. Safety was consistent with the known dupilumab safety profile.ClinicalTrials.gov identifiers: NCT04183335 and NCT04202679 .
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Affiliation(s)
| | - Nicholas Mollanazar
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Shawn G Kwatra
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian S Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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34
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Tutka K, Żychowska M, Żaczek A, Maternia-Dudzik K, Pawełczyk J, Strapagiel D, Lach J, Reich A. Skin Microbiome in Prurigo Nodularis. Int J Mol Sci 2023; 24:ijms24087675. [PMID: 37108838 PMCID: PMC10146575 DOI: 10.3390/ijms24087675] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Prurigo nodularis (PN) is a chronic condition characterized by the presence of nodular lesions accompanied by intense pruritus. The disease has been linked to several infectious factors, but data on the direct presence of microorganisms in the lesions of PN are scarce. The aim of this study was to evaluate the diversity and composition of the bacterial microbiome in PN lesions by targeting the region V3-V4 of 16S rRNA. Skin swabs were obtained from active nodules in 24 patients with PN, inflammatory patches of 14 patients with atopic dermatitis (AD) and corresponding skin areas of 9 healthy volunteers (HV). After DNA extraction, the V3-V4 region of the bacterial 16S rRNA gene was amplified. Sequencing was performed using the Illumina platform on the MiSeq instrument. Operational taxonomic units (OTU) were identified. The identification of taxa was carried out using the Silva v.138 database. There was no statistically significant difference in the alpha-diversity (intra-sample diversity) between the PN, AD and HV groups. The beta-diversity (inter-sample diversity) showed statistically significant differences between the three groups on a global level and in paired analyses. Staphylococcus was significantly more abundant in samples from PN and AD patients than in controls. The difference was maintained across all taxonomic levels. The PN microbiome is highly similar to that of AD. It remains unclear whether the disturbed composition of the microbiome and the domination of Staphylococcus in PN lesions may be the trigger factor of pruritus and lead to the development of cutaneous changes or is a secondary phenomenon. Our preliminary results support the theory that the composition of the skin microbiome in PN is altered and justify further research on the role of the microbiome in this debilitating condition.
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Affiliation(s)
- Klaudia Tutka
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland
| | - Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland
| | - Anna Żaczek
- Department of Microbiology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland
| | - Karolina Maternia-Dudzik
- Department of Microbiology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland
| | - Jakub Pawełczyk
- Laboratory of Genetics and Physiology of Mycobacterium, Institute of Medical Biology, Polish Academy of Sciences, 90-235 Łódź, Poland
| | - Dominik Strapagiel
- Biobank Laboratory, Department of Oncobiology and Epigenetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-235 Łódź, Poland
| | - Jakub Lach
- Biobank Laboratory, Department of Oncobiology and Epigenetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-235 Łódź, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland
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Jing W, Yang D, Liu X, Li L, Lu T, Li X. Dupilumab Therapy of Prurigo Nodularis: A Single-Center, Real-Life Observational Study. Dermatol Ther 2023. [DOI: 10.1155/2023/3835433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by severe itching accompanied by multiple nodules throughout the body. There is currently no effective drug-targeted treatment for PN. Dupilumab is a fully human monoclonal antibody which can suppress the Th2 inflammatory reaction. We aimed to assess the efficacy and safety of dupilumab in PN. There were 29 PN patients who received dupilumab treatment for four months. Serum total immunoglobulin E (Ig E), eosinophil counts, dermatology life quality index (DLQI), and numeric rating scale (NRS) were assessed on patients before and after treatment. We count the vaccination of novel coronavirus pneumonia (COVID-19) in patients and the impact on PN and treatment measures after vaccination. Plotting was performed using GraphPad Prism8, and the statistical analysis was performed using PASW Statistics18. The eosinophil counts in patients higher decreased to normal, and the Ig E levels gradually decreased and tended to normal levels after receiving dupilumab injection. The average DLQI score at the baseline was 23.93 ± 0.66 and decreased to 11.66 ± 0.55 (
) and 1.83 ± 0.22 (
) at 1-month and 6-monthfollow-up of treatment, respectively. The average NRS score at the baseline was 9.79 ± 0.08 and decreased to 3.52 ± 0.23 (
) and 0.31 ± 0.15 (
) at the 1-month and 6-monthfollow-up of treatment, respectively. Our study shows that dupilumab has achieved good efficacy in PN with few adverse reactions and high safety. We can recommend that patients follow the advice of specialists to be vaccinated and under the condition of stable disease, separated from dupilumab treatment for one week.
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Shao Y, Zhu Y, Xiao Z, Shen Y, Dai B, Tang H, Wang D. RNA sequencing reveals the transcriptome profile of the atopic prurigo nodularis with severe itching. Exp Dermatol 2023; 32:30-40. [PMID: 36134503 DOI: 10.1111/exd.14678] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 01/06/2023]
Abstract
Prurigo nodularis (PN), characterized by inevitable chronicity and severe pruritus, is most frequently associated with atopy compared with other origins. However, the skin transcriptomic profiling of PN arising from atopic dermatitis (AD), so-called atopic PN (APN), remains unclear. We sought to explore the cutaneous transcriptome of APN with severe pruritus and compare it with classic AD. RNA sequencing was performed on the lesional skin from 13 APN to 11 AD patients with severe pruritus (itch numerical rating scale score ≥ 7) and normal skin from 11 healthy subjects. Quantitative real-time polymerase chain reaction and immunochemistry were used for validation. We detected 1085 and 1984 differentially expressed genes (DEGs) in lesional APN skin and lesional AD skin versus normal skin, respectively. In total, 142 itch/inflammation-related DEGs were identified. Itch/inflammation-related DEGs, such as IL-6, IL-10, IL-13, oncostatin M, and IL-4 receptor, had elevated gene transcript levels in both diseases. The itch/inflammation-related DEGs that increased only in APN were mainly neuroactive molecules, while many inflammatory mediators such as T helper 22-related genes were found to be increased only in AD. Both disorders showed mixed Th1/Th2/Th17 polarisation and impaired skin barrier. In contrast to AD, M1/M2 macrophage activation, tumor necrosis factor production, fibrosis, revascularization and neural dysregulation are unique features of APN. The study findings broaden our understanding of the pathogenesis underlying APN, which provides insights into novel pathogenesis with potential therapeutic implications.
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Affiliation(s)
- Yixin Shao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiqi Zhu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zijing Xiao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanyun Shen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Beiying Dai
- Center for New Drug Safety Evaluation and Research, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Hui Tang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Duoqin Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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Deng J, Parthasarathy V, Marani M, Bordeaux Z, Lee K, Trinh C, Cornman HL, Kambala A, Pritchard T, Chen S, Sutaria N, Oladipo OO, Kwatra MM, Alphonse MP, Kwatra SG. Extracellular matrix and dermal nerve growth factor dysregulation in prurigo nodularis compared to atopic dermatitis. Front Med (Lausanne) 2022; 9:1022889. [PMID: 36619628 PMCID: PMC9810753 DOI: 10.3389/fmed.2022.1022889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Prurigo nodularis (PN) is a chronic, pruritic, inflammatory skin disease characterized by hyperkeratotic nodules on the trunk and extremities. While there is growing research on the immunological basis of PN, the neuropathic and structural components of PN lesions are unknown. This study examines the inflammatory, neuropathic, and structural pathways in PN compared to atopic dermatitis (AD) using RNA-sequencing of the lesional and non-lesional skin tissue of PN and AD patients, as well as immunohistochemistry analysis of nerve growth factor (NGF), a neurotrophic factor that regulates nerve development. Transcriptomic analysis of skin biopsies revealed that compared to lesional AD skin, lesional PN skin had significantly increased expression of NGF, matrix metalloproteinases, OSM, MCEMP1, IL1α, IL1β, CXCL2, CXCL5, CXCL8, and insulin-like growth factors in PN compared to AD, and decreased expression of CCL13, CCL26, EPHB1, and collagens (COL4/6). Gene set enrichment analysis demonstrated higher enrichment of keratinization, cornified envelope, myelin sheath, TGF-beta signaling, extracellular matrix disassembly, metalloendopeptidase activity, and neurotrophin-TRK receptor signaling pathways in PN. On immunohistochemistry, PN lesions demonstrated higher dermal NGF expression compared to AD. We present novel findings demonstrating increased neurotrophic and extracellular matrix remodeling signatures in PN compared to AD, possibly explaining the morphological differences in their lesions. These signatures may therefore be important components of the PN pathogenesis and may serve as therapeutic targets.
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Affiliation(s)
- Junwen Deng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Melika Marani
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zachary Bordeaux
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kevin Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Chi Trinh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hannah L. Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shihua Chen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Olusola O. Oladipo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States
| | - Martin P. Alphonse
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Shawn G. Kwatra,
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Parvizi MM, Salami MH, Moini Jazani A, Javaheri R, Jaladat AM, Handjani F. Complementary and integrative remedies in the treatment of chronic pruritus: A review of clinical trials. J Cosmet Dermatol 2022; 21:5360-5369. [PMID: 35579366 DOI: 10.1111/jocd.15094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/02/2022] [Accepted: 05/14/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic pruritus is one of the most common conditions in dermatology and a common manifestation in many systemic diseases. Since the etiology of chronic pruritus remains somewhat unknown, hence, conventional medications may not always show a good therapeutic response. This finding has led both investigators and patients to use herbal and complementary remedies for its treatment. The aim of this study was to review clinical trials in which herbal and complementary medicine was used in the control and treatment of chronic pruritus. MATERIALS AND METHODS In this study, we reviewed related articles in this domain, from 2000 to 2020. The search involved electronic databases including PubMed, Scopus, Web of Science, Cochrane, Google Scholar, and SID databases using the keywords "pruritus," "itch," "herb," "complementary medicine," "traditional medicine," "integrative medicine," and their related MeSH terms. Finally, we extracted the pertinent information from these articles and summarized the results. RESULTS The findings of this study showed that 17 clinical trials have been conducted till date in order to evaluate the efficacy of herbal remedies and complementary medicines in the treatment of chronic pruritus. Herbal remedies including turmeric, Fumaria parviflora, Avena sativa, capsaicin, sweet almond oil, peppermint oil, violet oil, vinegar, as well as manual therapies including aromatherapy, auricular acupressure, and acupuncture, were significantly effective in the treatment of chronic pruritus. CONCLUSION There are only a few studies published on the therapeutic efficacy of herbal remedies and complementary medicine in the treatment of chronic pruritus. Some have shown promising results. Therefore, more evidence-based studies are needed in order to determine if herbal remedies and complementary medicine could be an effective alternative or adjuvant treatment modality in chronic pruritus.
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Affiliation(s)
- Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Arezoo Moini Jazani
- Traditional medicine and hydrotherapy research center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Rojan Javaheri
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Mohammad Jaladat
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Handjani
- Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Dermatology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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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: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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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Prurigo Nodularis: A Review of IL-31RA Blockade and Other Potential Treatments. Dermatol Ther (Heidelb) 2022; 12:2039-2048. [PMID: 35986886 PMCID: PMC9464280 DOI: 10.1007/s13555-022-00782-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/14/2022] [Indexed: 11/03/2022] Open
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Ujiie H, Rosmarin D, Schön MP, Ständer S, Boch K, Metz M, Maurer M, Thaci D, Schmidt E, Cole C, Amber KT, Didona D, Hertl M, Recke A, Graßhoff H, Hackel A, Schumann A, Riemekasten G, Bieber K, Sprow G, Dan J, Zillikens D, Sezin T, Christiano AM, Wolk K, Sabat R, Kridin K, Werth VP, Ludwig RJ. Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases. Front Med (Lausanne) 2022; 9:875492. [PMID: 35755063 PMCID: PMC9218547 DOI: 10.3389/fmed.2022.875492] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
An estimated 20-25% of the population is affected by chronic, non-communicable inflammatory skin diseases. Chronic skin inflammation has many causes. Among the most frequent chronic inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis suppurativa, driven by a complex interplay of genetics and environmental factors. Autoimmunity is another important cause of chronic skin inflammation. The autoimmune response may be mainly T cell driven, such as in alopecia areata or vitiligo, or B cell driven in chronic spontaneous urticaria, pemphigus and pemphigoid diseases. Rare causes of chronic skin inflammation are autoinflammatory diseases, or rheumatic diseases, such as cutaneous lupus erythematosus or dermatomyositis. Whilst we have seen a significant improvement in diagnosis and treatment, several challenges remain. Especially for rarer causes of chronic skin inflammation, early diagnosis is often missed because of low awareness and lack of diagnostics. Systemic immunosuppression is the treatment of choice for almost all of these diseases. Adverse events due to immunosuppression, insufficient therapeutic responses and relapses remain a challenge. For atopic dermatitis and psoriasis, a broad spectrum of innovative treatments has been developed. However, treatment responses cannot be predicted so far. Hence, development of (bio)markers allowing selection of specific medications for individual patients is needed. Given the encouraging developments during the past years, we envision that many of these challenges in the diagnosis and treatment of chronic inflammatory skin diseases will be thoroughly addressed in the future.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, MA, United States
| | - Michael P. Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
- Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Martin Metz
- Institute for Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute for Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Diamant Thaci
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Connor Cole
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Kyle T. Amber
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Alexander Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Schumann
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Gant Sprow
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Joshua Dan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Tanya Sezin
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Angela M. Christiano
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Centre, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Victoria P. Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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Han J, Palomino A, Estupinan B, Wozniak A, Swan J. Psychiatric Comorbidity in Prurigo Nodularis and the Impact of Socioeconomic Status. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:53-58. [PMID: 35783571 PMCID: PMC9239124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We sought to investigate the relationship between psychiatric comorbidity, socioeconomic status (SES), and mental health utilization among patients with prurigo nodularis (PN). METHODS We conducted a retrospective cohort study of patients with PN from 2007 to 2019. SES was approximated using zip codes; per capita income data was compared to the Livable Income Threshold. RESULTS 288 patients were included. Patients were predominantly female (57%) and significantly more likely to have a psychiatric disorder than men (p=0.001). 44.1 percent of patients had at least one psychiatric comorbidity, with mood (74.8%) and anxiety (63.0%) disorders being most common. Patients with PN in lower SES groups had a higher incidence of psychiatric disorder (p=0.566) and utilization of mental health services (p=0.617). 40.9 percent of patients with a diagnosed psychiatric disorder had no record of seeing a psychiatrist or psychologist. LIMITATIONS Patient records were retrospectively reviewed for encounters with a psychiatrist or psychologist, but did not account for other forms of mental health services. Per capita income used to determine SES may not be an accurate representation of an individual's income, nor did it account for the number of people within a household. CONCLUSION Psychiatric comorbidity was common among patients with PN and many went without receiving mental health services. Further studies with larger sample sizes are needed to better understand the impact of SES on these factors.
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Affiliation(s)
- Jane Han
- Drs. Han, Palomino and Swan are with the Stritch School of Medicine at Loyola University in Maywood, Illinois
| | - Angelina Palomino
- Drs. Han, Palomino and Swan are with the Stritch School of Medicine at Loyola University in Maywood, Illinois
| | - Blanca Estupinan
- Drs. Estupinan and Swan are with the Division of Dermatology at Loyola University Medical Center in Maywood, Illinois
| | - Amy Wozniak
- Dr. Wozniak is with the Department of Biostatistics at Loyola University in Maywood, Illinois
| | - James Swan
- Drs. Han, Palomino and Swan are with the Stritch School of Medicine at Loyola University in Maywood, Illinois
- Drs. Estupinan and Swan are with the Division of Dermatology at Loyola University Medical Center in Maywood, Illinois
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Prurigo crónico: actualización. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:563-574. [DOI: 10.1016/j.ad.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/29/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
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Docampo-Simón A, Sánchez-Pujol M, Silvestre-Salvador J. [Translated article] Update on Chronic Prurigo. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T563-T574. [DOI: 10.1016/j.ad.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
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Sutaria N, Semenov YR, Kwatra SG. Understanding racial disparities in prurigo nodularis. J Am Acad Dermatol 2022; 87:e111-e112. [PMID: 35577228 DOI: 10.1016/j.jaad.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kolkhir P, Pyatilova P, Ashry T, Jiao Q, Abad-Perez AT, Altrichter S, Vera Ayala CE, Church MK, He J, Lohse K, Metz M, Scheffel J, Türk M, Frischbutter S, Maurer M. Mast cells, cortistatin, and its receptor, MRGPRX2, are linked to the pathogenesis of chronic prurigo. J Allergy Clin Immunol 2022; 149:1998-2009.e5. [DOI: 10.1016/j.jaci.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
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Sonkoly E. Reversal of the disease signature in prurigo nodularis by blocking the itch cytokine. J Allergy Clin Immunol 2022; 149:1213-1215. [PMID: 35189125 DOI: 10.1016/j.jaci.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Enikö Sonkoly
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Dermatology and Venereology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.
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Racial differences in dysregulation of the renin-angiotensin-aldosterone system in patients with prurigo nodularis. J Dermatol Sci 2022; 105:130-136. [DOI: 10.1016/j.jdermsci.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/16/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022]
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Roh YS, Choi J, Sutaria N, Kwatra SG. Itch: Epidemiology, clinical presentation, and diagnostic workup. J Am Acad Dermatol 2022; 86:1-14. [PMID: 34428534 PMCID: PMC8678917 DOI: 10.1016/j.jaad.2021.07.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
Itch, or pruritus, is the uncomfortable sensation underlying the desire to scratch. Itch is a very common complaint in the general population that can result from dermatologic, systemic (eg, renal, hepatobiliary, endocrine), paraneoplastic, neuropathic, and psychogenic etiologies. Chronic itch is associated with significant sleep disturbances and profoundly reduces overall quality of life. Certain populations, including elderly and African Americans, are at increased risk of experiencing heightened burden of itch. Because of the variable clinical presentation and wide-ranging etiologies, itch presents a challenge for clinicians. The initial evaluation should include a complete blood count, with differential, hepatic, renal, and thyroid function testing along with diabetes screening. Further testing should be guided by history and physical examination findings. There should be a heightened concern for underlying malignancy in individuals older than 60 years of age who have a history of liver disease and diffuse itch less than 12 months of duration. For individuals with chronic pruritus of unknown origin, increased blood eosinophils may serve as a biomarker of T helper cell type 2 polarization and response to immunomodulator therapies. In this first part of a 2-part continuing medical education series, we describe the broader epidemiology and specific conditions associated with itch and the clinical presentation and diagnostic workup for patients with itch.
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Affiliation(s)
- Youkyung S. Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- 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.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Epidemiology, Comorbidities, and Prescription Patterns of Korean Prurigo Nodularis Patients: A Multi-Institution Study. J Clin Med 2021; 11:jcm11010095. [PMID: 35011837 PMCID: PMC8745727 DOI: 10.3390/jcm11010095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/17/2022] Open
Abstract
Prurigo nodularis (PN) is a chronic dermatosis typified by extraordinarily itchy nodules. However, little is known of the nature and extent of PN in Asian people. This study aimed to describe the epidemiology, comorbidities, and prescription pattern of PN in Koreans based on a large dermatology outpatient cohort. Patients with PN were identified from the Catholic Medical Center (CMC) clinical data warehouse. Anonymized data on age, sex, diagnostic codes, prescriptions, visitation dates, and other relevant parameters were collected. Pearson correlation analysis was used to calculate the correlation between PN prevalence and patient age. Conditional logistic regression modeling was adopted to measure the comorbidity risk of PN. A total of 3591 patients with PN were identified at the Catholic Medical Center Health System dermatology outpatient clinic in the period 2007–2020. A comparison of the study patients with age- and sex-matched controls (dermatology outpatients without PN) indicated that PN was associated with various comorbidities including chronic kidney disease (adjusted odds ratio (aOR), 1.48; 95% confidence interval (CI), 1.29–1.70), dyslipidemia (aOR, 1.88; 95% CI, 1.56–2.27), type 2 diabetes mellitus (aOR, 1.37; 95% CI, 1.22–1.54), arterial hypertension (aOR, 1.50; 95% CI, 1.30–1.73), autoimmune thyroiditis (aOR, 2.43; 95% CI, 1.42–4.16), non-Hodgkin’s lymphoma (aOR, 1.95; 95% CI, 1.23–3.07), and atopic dermatitis (aOR, 2.16, 95% CI, 1.91–2.45). Regarding prescription patterns, topical steroids were most favored, followed by topical calcineurin inhibitors; oral antihistamines were the most preferred systemic agent for PN. PN is a relatively rare but significant disease among Korean dermatology outpatients with a high comorbidity burden compared to dermatology outpatients without PN. There is great need for breakthroughs in PN treatment.
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