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Murota H, Matsumoto M, Arima K, Yoshida T, Fujita H. Current clinical practice of prurigo nodularis in Japan: A cross-sectional web-survey among dermatologists. J Dermatol 2024. [PMID: 39225549 DOI: 10.1111/1346-8138.17400] [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: 03/06/2024] [Revised: 06/28/2024] [Accepted: 07/12/2024] [Indexed: 09/04/2024]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease associated with intense pruritic nodules. The unclear patho-etiological mechanisms of PN cause difficulty in disease management; and there is a paucity of information on the current diagnosis and treatment options for PN in Japan. To describe the current management from a dermatologists' perspective we conducted a web-based survey (UMIN Clinical Trial Registry UMIN000047643) in 2022 among dermatologists from a Japanese commercially available physician panel, who had seen at least one patient with PN within the last 3 months. The survey included 117 dermatologists. The dermatologists diagnosed PN mainly by confirming clinical signs and patient interviews, while to assess the severity of PN, the number of pruritic nodules and the degree of itching were primarily utilized. Topical corticosteroids and antihistamines were the most used drugs, as recommended in the current guidelines on the diagnosis and treatment of prurigo. Dermatologists' treatment satisfaction decreased with increasing assumed severity of PN; almost 65% dermatologists were not satisfied with the treatment of severe PN. These results suggest the need of more effective medications and diagnostic tools for better management of PN in Japan.
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Affiliation(s)
- Hiroyuki Murota
- Department of Dermatology, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Mai Matsumoto
- Department of Dermatology, Nagasaki University, Nagasaki, Nagasaki, Japan
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Criado PR, Ianhez M, Criado RFJ, Nakano J, Lorenzini D, Miot HA. Prurigo: review of its pathogenesis, diagnosis, and treatment. An Bras Dermatol 2024; 99:706-720. [PMID: 38493053 PMCID: PMC11342992 DOI: 10.1016/j.abd.2023.11.003] [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: 10/09/2023] [Revised: 11/05/2023] [Accepted: 11/23/2023] [Indexed: 03/18/2024] Open
Abstract
Prurigo is a reactive, hyperplastic skin condition characterized by pruritic papules, plaques, and/or nodules. The temporal classification includes acute/subacute and chronic disease (≥ 6 weeks), with different clinical variants, synonymies, and underlying etiological factors. The immunology of chronic prurigo shows similarities with atopic dermatitis due to the involvement of IL-4 and IL-13, IL-22, and IL-31. Treatment includes antihistamines, topical steroids, dupilumab, and JAK inhibitors. Several conditions manifest clinically as prurigo-like lesions, and the correct clinical diagnosis must precede correct treatment. Furthermore, chronic prurigos represent a recalcitrant and distressing dermatosis, and at least 50% of these patients have atopic diathesis, the treatment of which may induce adverse effects, especially in the elderly. The quality of life is significantly compromised, and topical treatments are often unable to control symptoms and skin lesions. Systemic immunosuppressants, immunobiologicals, and JAK inhibitors, despite the cost and potential adverse effects, may be necessary to achieve clinical improvement and quality of life. This manuscript reviews the main types of prurigo, associated diseases, their immunological bases, diagnosis, and treatment.
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Affiliation(s)
- Paulo Ricardo Criado
- Centro Universitário ABC Faculty of Medicine, Santo André, SP, Brazil; Faculdade de Ciências Médicas de Santos (Fundação Lusíada), Santos, SP, Brazil.
| | - Mayra Ianhez
- Department of Dermatology, Hospital de Doenças Tropicais de Goiás, Goiânia, GO, Brazil
| | - Roberta Fachini Jardim Criado
- Centro Universitário ABC Faculty of Medicine, Santo André, SP, Brazil; Alergoskin Alergia e Dermatologia, UCARE Center and ADCARE, Santo André, SP, Brazil
| | - Juliana Nakano
- Dermatology Outpatient Clinic, Santa Casa de Misericórdia de São Paulo, Brazil
| | - Daniel Lorenzini
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Hélio Amante Miot
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Bona J, Pippin M, Atkins L, Al-Quraishi M. A Fleshy Mystery: Prurigo Nodularis. Cureus 2024; 16:e65125. [PMID: 39171012 PMCID: PMC11338647 DOI: 10.7759/cureus.65125] [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] [Received: 05/19/2024] [Accepted: 07/01/2024] [Indexed: 08/23/2024] Open
Abstract
Prurigo nodularis is a chronic dermatologic condition typically presenting as firm, dome-shaped pruritic nodules of various sizes that are often symmetrically distributed on extensor surfaces of the extremities. The diagnosis is clinical and based on a history of chronic, severe pruritis in the setting of characteristic, excoriated lesions. Treatment is difficult and aimed at reducing skin irritation and pruritus. Quality of life is impacted due to the chronic, intractable, and relapsing nature of the disease. Here, we report a case of prurigo nodularis diagnosed in the outpatient clinic setting. This paper aims to report the patient's clinical history, presentation, and histopathologic findings, as well as present a literature review to determine the significance of this case and the approach to ongoing management.
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Affiliation(s)
- Jianna Bona
- Family Medicine, Louisiana State University (LSU) Health Shreveport/Rapides Regional Medical Center, Alexandria, USA
| | - Micah Pippin
- Family Medicine, Louisiana State University (LSU) Health Shreveport/Rapides Regional Medical Center, Alexandria, USA
| | - Logan Atkins
- Family Medicine, Louisiana State University (LSU) Health Shreveport/Rapides Regional Medical Center, Alexandria, USA
| | - Majeed Al-Quraishi
- Pathology, Louisiana State University (LSU) Health Shreveport/Rapides Regional Medical Center, Alexandria, USA
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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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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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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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8
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Pestoni Porvén C, Vieira Dos Santos V, Del Pozo Losada J. New Laser Treatment for Prurigo Nodularis. Dermatol Surg 2024; 50:495-497. [PMID: 38289658 DOI: 10.1097/dss.0000000000004100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Carmela Pestoni Porvén
- All authors are affiliated with the Salud Galicia, Dermatología y laserterapia, A Coruña, Spain
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9
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Ständer S, Ketz M, Akumo D, Kossack N, Pignot M, Chavda R, Gabriel S. Comorbidities, healthcare resource utilization & treatment pattern among patients with prurigo nodularis, compared to a benchmark in Germany: A real-world evidence claims data study. J Eur Acad Dermatol Venereol 2024; 38:883-894. [PMID: 38078642 DOI: 10.1111/jdv.19700] [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: 04/27/2023] [Accepted: 10/25/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Prurigo nodularis (PN) is a rare chronic inflammatory skin disease with a high disease burden, but data on clinical and economic burden are still scarce. OBJECTIVE To describe the real-world epidemiologic, clinical and therapeutic characteristics and related economic burden of patients with PN compared to a benchmark population in Germany. METHODS This retrospective study was based on an excerpt of German Statutory Health Insurance data of patients with an initial PN diagnosis between 2012 and 2016. PN cohort contained no record of PN in eight quarters before the index quarter and was followed up for eight quarters (unless deceased). Benchmark cohort without PN was calculated using direct standardization and 1:1 matching to PN cohort. RESULTS Out of 4,536,002 insured patients, 2309 incident patients with PN were identified and matched to the benchmark cohort out of 3,018,382 patients without PN. Patients were mostly between 45 and 80 years when diagnosed with PN. Higher comorbidity rates were reported for PN than benchmark, with a rising disease burden at follow-up. Most patients with PN (91.3%) were diagnosed outpatient and had >50% more outpatient visits than the benchmark cohort. Hospitalization rates were higher in PN (53.9%) versus benchmark (35.1%), yielding twice longer mean hospital stays for PN (12 days) compared to benchmark (6 days) (p < 0.001). The most common initial therapy for patients with PN was topical corticosteroids (47.6%); ≥10% of patients were treated with antidepressants, antihistamines or systemic corticosteroids. Therapy rates were higher for PN compared to benchmark (p < 0.001). Mean initial costs were twofold higher in PN versus benchmark for outpatient, inpatient and drugs. During follow-up, an increase of >70% in mean PN costs compared to benchmark was identified for outpatient, inpatient and concomitant treatments (p < 0.001). CONCLUSION This study highlights the significantly higher clinical and economic burden incurred by PN compared to benchmark patients in Germany, reflecting the unmet medical need for PN.
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Affiliation(s)
- Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital of Münster, Münster, Germany
| | - Miriam Ketz
- DtoD - Data to Decision - Corp, Hamburg, Germany
| | - Divine Akumo
- ZEG - Berlin Center for Epidemiology and Health Research Ltd, Berlin, Germany
| | - Nils Kossack
- WIG2 Ltd. - Scientific Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Marc Pignot
- ZEG - Berlin Center for Epidemiology and Health Research Ltd, Berlin, Germany
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Ortiz de Frutos J, Serra Baldrich E, Tribó Boixareu MJ, Armario Hita JC, Carrascosa Carrillo JM, Nart IF, Menéndez ÁF, Pinto PH, Francisco Silvestre J. Consensus on the diagnostic algorithm for chronic nodular prurigo. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00342-9. [PMID: 38663729 DOI: 10.1016/j.ad.2024.03.035] [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: 01/29/2024] [Revised: 03/08/2024] [Accepted: 03/17/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic nodular prurigo (CNP) is a chronic dermatological disease characterized by the presence of chronic pruritus and pruritic nodular lesions. The aim of this study was to reach consensus among a group of experts based on a non-systematic literature review and an algorithm for the clinical diagnosis of CNP. The resulting algorithm is structured in 3 blocks: 1) early identification of the patient with a possible diagnosis of CNP; 2) diagnosis and assessment of CNP; and 3) categorization of CNP (identification of the underlying causes or associated comorbidities). We believe that this clinical algorithm can facilitate the correct diagnosis of patients with CNP. Additionally, it raises awareness on the need for a multidisciplinary approach and specific treatment of CNP, steps of paramount importance to make better therapeutic decisions.
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Affiliation(s)
| | | | | | | | - J M Carrascosa Carrillo
- Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona (UAB), Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, España
| | | | - Á Flórez Menéndez
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | | | - J Francisco Silvestre
- Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
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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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Biazus Soares G, Yosipovitch G. A critical review of dupilumab for adult patients with prurigo nodularis. Expert Rev Clin Immunol 2024; 20:249-254. [PMID: 37811660 DOI: 10.1080/1744666x.2023.2268291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Prurigo nodularis (PN) is a chronic inflammatory skin condition that presents with pruritus and hyperkeratotic nodules. These symptoms impact patients' quality of life and mental health. Treating prurigo nodularis is challenging, and many of the available topical and systemic therapies have limited efficacy and a myriad of adverse effects. AREAS COVERED In this article, we discuss the use of dupilumab for adult patients with prurigo nodularis. Dupilumab is a biologic that inhibits Th2-mediated inflammation and has been successfully used to treat a variety of dermatologic disorders. Dupilumab has revolutionized the management of PN, with recent clinical trials showing its efficacy in treating both pruritus and prurigo nodules, as well as improving quality of life. It has a favorable safety profile and is well tolerated. Other novel treatments are also currently under investigation for the treatment of PN, with early studies reporting promising results. EXPERT OPINION Dupilumab is becoming the drug of choice for the treatment of PN and may also be effective in treating patients with systemic underlying causes of their PN, although more studies are needed to assess this. Trials evaluating the long-term efficacy and durability of dupilumab in PN are also of interest.
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Affiliation(s)
- Georgia Biazus Soares
- Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gil Yosipovitch
- Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, United States
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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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Yun DK, Yeom K, Shon U, Park BC, Choi MS, Kim MH. Successful Treatment of Refractory Prurigo Nodularis with Alitretinoin and Methotrexate Combination Therapy. Ann Dermatol 2023; 35:S388-S389. [PMID: 38061756 PMCID: PMC10727905 DOI: 10.5021/ad.21.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 06/26/2022] [Accepted: 08/02/2022] [Indexed: 12/20/2023] Open
Affiliation(s)
- Dea Kwan Yun
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
| | - Kyujin Yeom
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
| | - Uri Shon
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
| | - Byung Cheol Park
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
| | - Mi Soo Choi
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
| | - Myung Hwa Kim
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea.
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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: 15] [Impact Index Per Article: 15.0] [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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16
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Budu-Aggrey A, Kilanowski A, Sobczyk MK, Shringarpure SS, Mitchell R, Reis K, Reigo A, Mägi R, Nelis M, Tanaka N, Brumpton BM, Thomas LF, Sole-Navais P, Flatley C, Espuela-Ortiz A, Herrera-Luis E, Lominchar JVT, Bork-Jensen J, Marenholz I, Arnau-Soler A, Jeong A, Fawcett KA, Baurecht H, Rodriguez E, Alves AC, Kumar A, Sleiman PM, Chang X, Medina-Gomez C, Hu C, Xu CJ, Qi C, El-Heis S, Titcombe P, Antoun E, Fadista J, Wang CA, Thiering E, Wu B, Kress S, Kothalawala DM, Kadalayil L, Duan J, Zhang H, Hadebe S, Hoffmann T, Jorgenson E, Choquet H, Risch N, Njølstad P, Andreassen OA, Johansson S, Almqvist C, Gong T, Ullemar V, Karlsson R, Magnusson PKE, Szwajda A, Burchard EG, Thyssen JP, Hansen T, Kårhus LL, Dantoft TM, Jeanrenaud ACSN, Ghauri A, Arnold A, Homuth G, Lau S, Nöthen MM, Hübner N, Imboden M, Visconti A, Falchi M, Bataille V, Hysi P, Ballardini N, Boomsma DI, Hottenga JJ, Müller-Nurasyid M, Ahluwalia TS, Stokholm J, Chawes B, Schoos AMM, Esplugues A, Bustamante M, Raby B, Arshad S, German C, Esko T, Milani LA, Metspalu A, Terao C, Abuabara K, Løset M, Hveem K, Jacobsson B, Pino-Yanes M, Strachan DP, Grarup N, Linneberg A, Lee YA, Probst-Hensch N, Weidinger S, Jarvelin MR, Melén E, Hakonarson H, Irvine AD, Jarvis D, Nijsten T, Duijts L, Vonk JM, Koppelmann GH, Godfrey KM, Barton SJ, Feenstra B, Pennell CE, Sly PD, Holt PG, Williams LK, Bisgaard H, Bønnelykke K, Curtin J, Simpson A, Murray C, Schikowski T, Bunyavanich S, Weiss ST, Holloway JW, Min JL, Brown SJ, Standl M, Paternoster L. European and multi-ancestry genome-wide association meta-analysis of atopic dermatitis highlights importance of systemic immune regulation. Nat Commun 2023; 14:6172. [PMID: 37794016 PMCID: PMC10550990 DOI: 10.1038/s41467-023-41180-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/24/2023] [Indexed: 10/06/2023] Open
Abstract
Atopic dermatitis (AD) is a common inflammatory skin condition and prior genome-wide association studies (GWAS) have identified 71 associated loci. In the current study we conducted the largest AD GWAS to date (discovery N = 1,086,394, replication N = 3,604,027), combining previously reported cohorts with additional available data. We identified 81 loci (29 novel) in the European-only analysis (which all replicated in a separate European analysis) and 10 additional loci in the multi-ancestry analysis (3 novel). Eight variants from the multi-ancestry analysis replicated in at least one of the populations tested (European, Latino or African), while two may be specific to individuals of Japanese ancestry. AD loci showed enrichment for DNAse I hypersensitivity and eQTL associations in blood. At each locus we prioritised candidate genes by integrating multi-omic data. The implicated genes are predominantly in immune pathways of relevance to atopic inflammation and some offer drug repurposing opportunities.
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Affiliation(s)
- Ashley Budu-Aggrey
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, England
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Anna Kilanowski
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians University Munich, Munich, Germany
| | - Maria K Sobczyk
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, England
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | | | - Ruth Mitchell
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, England
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Kadri Reis
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Anu Reigo
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Mari Nelis
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
- Core Facility of Genomics, University of Tartu, Tartu, Estonia
| | - Nao Tanaka
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ben M Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, 7030, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, 7600, Norway
- Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, 7030, Norway
| | - Laurent F Thomas
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, 7030, Norway
- Department of Clinical and Molecular Medicine, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- BioCore - Bioinformatics Core Facility, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pol Sole-Navais
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Flatley
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Antonio Espuela-Ortiz
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Esther Herrera-Luis
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Jesus V T Lominchar
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Jette Bork-Jensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Ingo Marenholz
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Aleix Arnau-Soler
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ayoung Jeong
- Swiss Tropical and Public Health Institute, CH-4123, Basel, Switzerland
- University of Basel, CH-4001, Basel, Switzerland
| | - Katherine A Fawcett
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Hansjorg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Elke Rodriguez
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Ashish Kumar
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Solna, Sweden
| | - Patrick M Sleiman
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Rhythm Pharmaceuticals, 222 Berkley Street, Boston, 02116, USA
| | - Xiao Chang
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Carolina Medina-Gomez
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Chen Hu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cheng-Jian Xu
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
- Centre for Individualized Infection Medicine, CiiM, a joint venture between Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Cancan Qi
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - Sarah El-Heis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Philip Titcombe
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Elie Antoun
- Faculty of Medicine, University of Southampton, Southampton, UK
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - João Fadista
- Department of Bioinformatics & Data Mining, Måløv, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Sciences, Lund University Diabetes Centre, Malmö, Sweden
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Carol A Wang
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Baojun Wu
- Center for Individualized and Genomic Medicine Research (CIGMA), Department of Medicine, Henry Ford Health, Detroit, MI, 48104, USA
| | - Sara Kress
- Environmental Epidemiology of Lung, Brain and Skin Aging, IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Dilini M Kothalawala
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Latha Kadalayil
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jiasong Duan
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Sabelo Hadebe
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Thomas Hoffmann
- Institute for Human Genetics, UCSF, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, 94158, USA
| | | | - Hélène Choquet
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Neil Risch
- Institute for Human Genetics, UCSF, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, 94158, USA
| | - Pål Njølstad
- Center for Diabetes Research, Department of Clinical Science, University of Bergen, NO-5020, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, NO-5021, Bergen, Norway
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, 0450, Oslo, Norway
| | - Stefan Johansson
- Center for Diabetes Research, Department of Clinical Science, University of Bergen, NO-5020, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, NO-5021, Bergen, Norway
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Vilhelmina Ullemar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Robert Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Agnieszka Szwajda
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Esteban G Burchard
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Line L Kårhus
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Thomas M Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Alexander C S N Jeanrenaud
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ahla Ghauri
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Arnold
- Clinic and Polyclinic of Dermatology, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Susanne Lau
- Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Norbert Hübner
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, CH-4123, Basel, Switzerland
- University of Basel, CH-4001, Basel, Switzerland
| | - Alessia Visconti
- Department of Twin Research & Genetics Epidemiology, Kings College London, London, UK
| | - Mario Falchi
- Department of Twin Research & Genetics Epidemiology, Kings College London, London, UK
| | - Veronique Bataille
- Department of Twin Research & Genetics Epidemiology, Kings College London, London, UK
- Dermatology Department, West Herts NHS Trust, Watford, UK
| | - Pirro Hysi
- Department of Twin Research & Genetics Epidemiology, Kings College London, London, UK
| | - Natalia Ballardini
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Solna, Sweden
| | - Dorret I Boomsma
- Dept Biological Psychology, Netherlands Twin Register, VU University, Amsterdam, the Netherlands
- Institute for Health and Care Research (EMGO), VU University, Amsterdam, the Netherlands
| | - Jouke J Hottenga
- Dept Biological Psychology, Netherlands Twin Register, VU University, Amsterdam, the Netherlands
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- IBE, Faculty of Medicine, LMU Munich, Munich, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Tarunveer S Ahluwalia
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Marie M Schoos
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
| | - Ana Esplugues
- Nursing School, University of Valencia, FISABIO-University Jaume I-University of Valencia, Valencia, Spain
- Joint Research Unit of Epidemiology and Environmental Health, CIBERESP, Valencia, Spain
| | - Mariona Bustamante
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Benjamin Raby
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Syed Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | | | - Tõnu Esko
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Lili A Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Andres Metspalu
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan
- Department of Applied Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mari Løset
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, 7030, Norway
- Department of Dermatology, Clinic of Orthopaedy, Rheumatology and Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, 7030, Norway
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Pino-Yanes
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, La Laguna, Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Tecnologías Biomédicas (ITB), Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Young-Ae Lee
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, CH-4123, Basel, Switzerland
- University of Basel, CH-4001, Basel, Switzerland
| | - Stephan Weidinger
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health,Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Solna, Sweden
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Divisions of Human Genetics and Pulmonary Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Faculty of Medicine, University of Iceland, 101, Reykjavík, Iceland
| | - Alan D Irvine
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Deborah Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Medical Research Council and Public Health England Centre for Environment and Health, London, United Kingdom
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith M Vonk
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Gerard H Koppelmann
- University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sheila J Barton
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Craig E Pennell
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, 4101, Queensland, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, 4072, QLD, Australia
| | - Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - L Keoki Williams
- Center for Individualized and Genomic Medicine Research (CIGMA), Department of Medicine, Henry Ford Health, Detroit, MI, 48104, USA
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - John Curtin
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, England
| | - Angela Simpson
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, England
| | - Clare Murray
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, England
| | - Tamara Schikowski
- Environmental Epidemiology of Lung, Brain and Skin Aging, Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Supinda Bunyavanich
- Division of Allergy and Immunology, Department of Pediatrics, and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Josine L Min
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, England
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Sara J Brown
- Centre for Genomics and Experimental Medicine, Institute for Genetics and Cancer, University of Edinburgh, Crewe Road, Edinburgh, UK EH4 2XU, Scotland
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Lung Research (DZL), Munich, Germany
| | - Lavinia Paternoster
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, England.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England.
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17
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Wei L, Yin M, Yang X, Chen J, Wu R, Yang H, Dou X. Effectiveness of Dupilumab for Chronic Prurigo in Chinese Patients: A Real-World Case Series Study. Clin Drug Investig 2023; 43:799-805. [PMID: 37717240 DOI: 10.1007/s40261-023-01307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Treatment of chronic prurigo (CPG) is challenging. As an antagonist of IL-4R, dupilumab has shown effectiveness in treating CPG in several clinical studies. Recently, the US Food and Drug Administration (FDA) approved dupilumab for the treatment of prurigo nodularis (PN). OBJECTIVES The purpose of this study was to examine the efficacy of dupilumab in Chinese patients with CPG, and to analyze the difference in response between subtypes of CPG. METHODS This retrospective study included 18 patients with CPG who were treated with dupilumab for at least 16 weeks from March 2022 to October 2022. Disease severity and patient self-assessment questionnaires were assessed at baseline and each visit, including the peak Pruritus Visual Analogue Scale (PP-VAS), Prurigo Activity and Severity Score (PAS), Investigator Global Assessment (IGA), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS) and Itchy-specific Quality of Life questionnaire (ItchyQoL). RESULTS After 2 weeks of dupilumab treatment, pruritus scores were significantly reduced as measured by PP-VAS scores. Prurigo Activity and Severity scores decreased significantly at Week 2, whereas IGA improved significantly at Week 8. The DLQI, HADS, and ItchyQoL scores at Week 16 also showed significant improvement from baseline. Patients in all subtypes showed improvement in pruritus and lesion severity. CONCLUSIONS Dupilumab was effective in improving pruritus and lesions in patients with various subtypes of CPG.
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Affiliation(s)
- Lu Wei
- Department of Dermatology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China
- Shenzhen University Medical School, Shenzhen, 518061, People's Republic of China
| | - Mengting Yin
- Department of Dermatology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Xu Yang
- Department of Dermatology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Jiaying Chen
- Department of Dermatology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Ruimiao Wu
- Department of Dermatology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Heng Yang
- Department of Dermatology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China
| | - Xia Dou
- Department of Dermatology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Shenzhen, 518036, Guangdong, People's Republic of China.
- Anhui Medical University, Hefei, 230032, Anhui, People's Republic of China.
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18
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Ferreira BR, Misery L. Psychopathology Associated with Chronic Pruritus: A Systematic Review. Acta Derm Venereol 2023; 103:adv8488. [PMID: 37606153 PMCID: PMC10461306 DOI: 10.2340/actadv.v103.8488] [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: 01/27/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023] Open
Abstract
There are no previous studies of the psychopathology associated with different aetiologies of chronic pruritus. A systematic review was performed of cohort and case-control studies comparing healthy controls with patients with chronic pruritus related to primary dermatoses, systemic diseases, psychogenic pruritus, idiopathic pruritus, prurigo nodularis and/or lichen simplex chronicus. The review was registered in PROSPERO and performed according to the PRISMA statement, which allowed the inclusion of 26 studies. The quality of eligible studies was assessed using the modified Newcastle-Ottawa Scale. Most of the studies concern primary dermatoses and systemic diseases. Sleep disorders are a common comorbidity interrelated with pruritus, anxiety and depressive symptoms, in primary dermatoses. Sleep disorders are linked with pruritus and depressive symptoms in end-stage renal disease and hepatobiliary disease. Depressive and anxiety symptoms are associated with psychogenic pruritus. Psychogenic pruritus, lichen simplex chronicus and some primary dermatoses are linked with personality characteristics. Further studies are required to explore in depth the psychopathology linked with psychogenic pruritus and prurigo nodularis, as well as psychopathology linked with other primary dermatoses and systemic disorders associated with chronic pruritus, and to better differentiate psychogenic pruritus from psychopathological characteristics linked with other aetiologies of chronic pruritus, in order to improve the management of patients with chronic pruritus.
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Affiliation(s)
- Bárbara R Ferreira
- University Brest, Laboratoire interactions épithéliums-neurones (LIEN), Brest, France.
| | - Laurent Misery
- University Brest, Laboratoire interactions épithéliums-neurones (LIEN), Brest, France
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19
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Ueda Y, Uta D, Furue H, Ohtubo Y. An electrophysiological method for evaluation of topical antipruritic drugs on itch-related neuronal activities in the spinal cord in hairless mice. Eur J Pharmacol 2023; 952:175798. [PMID: 37207968 DOI: 10.1016/j.ejphar.2023.175798] [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: 12/28/2022] [Revised: 04/29/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
To evaluate the effects of antipruritic drugs, it is important to determine whether the neural responses induced by physiological itch stimuli are suppressed. Although there are several behavioral assessments for topical antipruritic drugs applied to the skin, there are few established methods at neuronal levels using in vivo electrophysiological recordings for predicting local efficacy of antipruritic drugs for cutaneous application. To establish an assessment of topical antipruritic drugs applied to skin using in vivo extracellular recording from neurons in the superficial dorsal horn, we examined the relationships between itch-related biting behavior and spinal neuronal responses elicited by intradermal injection of pruritogen serotonin (5-HT) in hairless mice. The efficacy of topical occlusive application of local anesthetics was also evaluated by an in vivo electrophysiological method. 5-HT significantly increased the firing frequency in spinal neurons. The spinal firing frequency time course was similar to that of the biting behavior after the 5-HT injections. The 5-HT-induced spinal responses were significantly decreased by topical occlusive application of lidocaine or a Nav 1.7 channel blocker to the calf. The intradermal 5-HT injection-induced spinal neuronal responses appeared to be suppressed by topical occlusive application of lidocaine or a Nav1.7 channel blocker. The electrophysiological method for evaluating topical antipruritic drugs may be beneficial in assessing local effects on the skin.
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Affiliation(s)
- Yuhki Ueda
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu, Japan; Drug Development Laboratories, Kyoto R&D Center, Drug Development Research Laboratories, Maruho Co., Ltd., Kyoto, Japan.
| | - Daisuke Uta
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
| | - Hidemasa Furue
- Department of Neurophysiology, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Yoshitaka Ohtubo
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu, Japan.
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20
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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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21
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Zhang Z, Li S, Wang Y, Zhao J. A real-world observational study of dupilumab treatment in adult patients with prurigo nodularis. An Bras Dermatol 2023:S0365-0596(23)00057-0. [PMID: 36966024 DOI: 10.1016/j.abd.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Prurigo nodularis (PN) is a chronic inflammatory skin condition that has a significant unmet needs for effective treatment options. OBJECTIVE To assess the efficacy and safety of dupilumab in adult patients with PN refractory to traditional therapies. METHODS This ongoing, real-life study examined dupilumab treatment in 8 adult patients diagnosed with PN for at least 6 months. The included patients were prescribed 300 mg dupilumab biweekly for at least 16 weeks. Efficacy was the primary outcome by means of multiple standardized scale measurements while safety was also reported. RESULTS PN patients treated with dupilumab showed notable clinical improvement. After 16 weeks of dupilumab treatment, the mean Investigator Global Assessment (IGA) score reduced from 3.75 to 1.50. Patients mean Numerical Rating Scale Itch Intensity (NRSI), Dermatology Life Quality Index (DLQI), and Hospital Anxiety and Depression Scale (HADS) ratings reduced from 8.625, 15.13, and 14.50 to 1.563, 4.625, and 1.000 respectively. The majority of the patients (87.5%) reported dupilumab as effective while no adverse events have been reported. STUDY LIMITATIONS This study was limited to a small cohort of adult PN patients and a short-time observation period. CONCLUSIONS Dupilumab is effective and tolerable in adult PN patients with significant improvement in skin lesions, itching, and quality of life.
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Affiliation(s)
- Zhixin Zhang
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Siyuan Li
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Yang Wang
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Jiahui Zhao
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Disease, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China.
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22
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Müller S, Merz WM, Lutz P, Ständer S, Wenzel J, Bieber T. Treatment of chronic nodular prurigo with intravenous naloxone during pregnancy. J Eur Acad Dermatol Venereol 2023. [PMID: 36883796 DOI: 10.1111/jdv.19016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Svenja Müller
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany.,Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany
| | - Philipp Lutz
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus (KCP), University Hospital Münster, Münster, Germany
| | - Jörg Wenzel
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany.,Christine Kühne-Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
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23
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Cao P, Xu W, Jiang S, Zhang L. Dupilumab for the treatment of prurigo nodularis: A systematic review. Front Immunol 2023; 14:1092685. [PMID: 36742321 PMCID: PMC9895771 DOI: 10.3389/fimmu.2023.1092685] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
Background Conventional treatment techniques have limited efficacy and more side effects in the treatment of prurigo nodularis. The better alternative treatment option for better outcomes of the disease is dupilumab. Objective The objective of this study was to systematically review dupilumab-related treatment outcomes in prurigo nodularis. Methods Several databases like Embase, PubMed, Web of Science, and Cochrane library were searched for data acquisition on October 8, 2022. Based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, 24 publications were included in this study. Results After 4,12,16 and more than 16 weeks of dupilumab treatment, 8.3% (n=5/60), 34.4% (n=11/32), 3.6% (n=2/56), and 45.3% (n=29/64) of patients had complete remission, respectively. In addition, 85.0% (n=51/60), 59.4% (n=19/32), 83.9% (n=47/56), and 43.8% (n=28/64) had partial remission, respectively. Moreover, 6.7% (n=4/60), 6.3% (n=2/32), 12.5% (n=7/56), and 10.9% (n=7/64) showed no remission, respectively, and significant reduction of numeric rating scale itch intensity (from 9.0 to 4.9, 2.1, 2.8, 0.9) was attained. There were no serious adverse events observed during treatment, but the most common event observed was conjunctivitis (12.6%, n=15/119). Conclusions Dupilumab has definite effectiveness and safety in prurigo nodularis treatment. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier (CRD42022365802).
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Affiliation(s)
- Peng Cao
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Wenjing Xu
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China.,Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shuyi Jiang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China.,Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Litao Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
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24
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Zhao P, Remington C, Flowers RH. Autosomal dominant albopapuloid epidermolysis bullosa pruriginosa. Int J Dermatol 2022. [DOI: 10.1111/ijd.16536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Patricia Zhao
- University of Virginia School of Medicine Charlottesville VA USA
| | - Courtney Remington
- Department of Dermatology University of Virginia Medical Center Charlottesville VA USA
| | - R. Hal Flowers
- Department of Dermatology University of Virginia Medical Center Charlottesville VA USA
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25
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Wong LS, Yen YT. Chronic Nodular Prurigo: An Update on the Pathogenesis and Treatment. Int J Mol Sci 2022; 23:ijms232012390. [PMID: 36293248 PMCID: PMC9604302 DOI: 10.3390/ijms232012390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Chronic nodular prurigo (CNPG) is a recalcitrant chronic itchy disorder that affects the quality of life. It can be triggered by multiple etiologies, such as atopic dermatitis, diabetes, and chronic renal diseases. The mechanisms of CNPG are complicated and involved the interaction of the cutaneous, immune, and nervous systems. Diverse immune cells, including eosinophils, neutrophils, T cells, macrophages, and mast cells infiltrated the lesional skin of CNPG, which initiated the inflammatory cytokines and pruritogens release. In addition, the interaction between the immune cells and activated peripheral sensory nerve fibers by neurotransmitters caused neuroinflammation in the skin and intractable itch. This itch-scratch vicious cycle of CNPG results in disease exacerbation. CNPG is difficult to treat with traditional therapies. Recently, great advances have been made in the pathophysiology of both inflammation and pruritus transmission in CNPG. In this review, we summarize the updated mechanisms and novel therapies for CNPG.
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Affiliation(s)
- Lai-San Wong
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Ta Yen
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Dermatology, Fooyin University Hospital, Pingtung 928, Taiwan
- Correspondence: ; Tel.: +886-8-832-3146
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26
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Ständer S, Yosipovitch G, Lacour J, Legat F, Paul C, Reich A, Chaouche K, Ahmad F, Piketty C. Nemolizumab efficacy in prurigo nodularis: onset of action on itch and sleep disturbances. J Eur Acad Dermatol Venereol 2022; 36:1820-1825. [PMID: 35766128 PMCID: PMC9796585 DOI: 10.1111/jdv.18377] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/02/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with prurigo nodularis (PN) have multiple itchy nodules, impaired quality of life and sleep deprivation. Prurigo nodularis patients have a high burden of disease, primarily due to the intensity of the itch. It is reasonable to expect that rapid relief of itch - and associated improvement of sleep - are highly valued clinical outcomes for patients. Nemolizumab is an IL-31A-receptor inhibitor that modulates the neuroimmune response with reported positive efficacy and safety data in a phase 2 study of PN. OBJECTIVES To evaluate the onset of action of nemolizumab on itch and sleep disturbances. METHODS Post hoc analysis of a phase 2 trial of nemolizumab 0.5 mg/kg SC vs. placebo in patients (n = 70) with moderate-to-severe PN (≥20 nodules) and severe pruritus (NRS ≥ 7). Time to significant reduction was assessed for peak pruritus (PP) and sleep disturbance (SD) using numerical rating scales (NRS), also assessed was scratching time during sleep. RESULTS Nemolizumab significantly reduced itch vs. placebo within 48 h (PP NRS -19.5% vs. -5.8%, respectively, P = 0.014). Significant difference between nemolizumab and placebo in reducing itch by ≥4 on PP NRS was achieved at Day 3 (23.5% vs. 0%, P < 0.001). A significant difference in SD NRS was reported by Day 4 (-24.0% vs. -4.3% placebo, P = 0.012). In addition, there was a separation between groups in SD responders (decrease of ≥4 points) in favour of nemolizumab by Day 2 (8.8% vs. 0%, P = 0.037). Sleep continued improving through Week 4, when there was a -56.0% reduction in SD NRS vs. -22.9% placebo (P < 0.001). Actigraphy data showed improvement in scratch/sleep duration for nemolizumab vs. placebo, respectively, by Week 1 (-32.15 vs. +28.15 min/h, P = 0.001). CONCLUSION Nemolizumab has a rapid and robust onset of action in PN with itch reduction and improvement of sleep within 48 h.
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Affiliation(s)
- S. Ständer
- Department of Dermatology and Center for Chronic PruritusUniversity Hospital MünsterMünsterGermany
| | - G. Yosipovitch
- Itch Center, Dr Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami HospitalMiamiFLUSA
| | - J.‐P. Lacour
- Department of DermatologyMedical University of NiceNiceFrance
| | - F.J. Legat
- Department of Dermatology and VenereologyMedical University of GrazGrazAustria
| | - C. Paul
- Department of DermatologyMedical University of ToulouseToulouseFrance
| | - A. Reich
- Department of DermatologyUniversity of RzeszowRzeszowPoland
| | | | - F. Ahmad
- Galderma Laboratories LPFort WorthTexasUSA
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27
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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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28
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Chaowattanapanit S, Wongjirattikarn R, Chaisuriya N, Ungarreevittaya P, Poosekeaw P, Winaikosol K, Choonhakarn C, Julanon N, Salao K. Increased IL-31 expression in serum and tissue protein in prurigo nodularis. Ther Adv Chronic Dis 2022; 13:20406223221112561. [PMID: 35875833 PMCID: PMC9301099 DOI: 10.1177/20406223221112561] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Prurigo nodularis (PN) is a chronic pruritic skin disease which can greatly
impact patients’ quality of life. Moreover, the pathogenesis remains
unclear, making it a difficult-to-treat condition. Aims: To investigate the expression of interleukin-31 (IL-31) in serum and skin
biopsy specimens of PN patients and healthy subjects and identify its
possible correlation to disease severity and itch intensity. Methods: Patients with PN and healthy volunteers were recruited for the study.
Expression levels of IL-31 were measured by enzyme-linked immunosorbent
assay and immunohistochemistry. Baseline characteristics, disease activity,
itch intensity, and related laboratory results were collected. Results: Forty-three PN patients and 31 healthy subjects participated in our study.
The PN patients had significantly higher mean serum IL-31 levels than the
healthy subjects (52.9 ± 18.2 versus 36.3 ± 10.7 pg/ml,
p < 0.001). Epidermal and dermal PN lesions also
exhibited significantly higher IL-31 expression compared with the healthy
skin (p < 0.001 and p = 0.01,
respectively). However, there was no significant difference in serum or
lesional expression of IL-31 by disease severity or itch intensity. Conclusion: Increased IL-31 expression in serum and PN lesions suggests that IL-31 has a
potential role in the pathogenesis of PN.
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Affiliation(s)
- Suteeraporn Chaowattanapanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Rachot Wongjirattikarn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nipon Chaisuriya
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Piti Ungarreevittaya
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pirawan Poosekeaw
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kengkart Winaikosol
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Charoen Choonhakarn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narachai Julanon
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kanin Salao
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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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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Gael M, Adam T, Mariano-Bourin M, Bursztejn AC. Efficacy of dupilumab in chronic prurigo and chronic idiopathic pruritus: A systematic review of current evidence and analysis of response predictors. J Eur Acad Dermatol Venereol 2022; 36:1541-1551. [PMID: 35569006 DOI: 10.1111/jdv.18221] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
Dupilumab has demonstrated a great reduction on chronic pruritus that is the hallmark of atopic dermatitis (AD). Underscoring relevant pathogenesis similarities emerging from AD, chronic idiopathic pruritus (CIP) and chronic prurigo (CP), several authors suggested the beneficial role of dupilumab in these conditions. The evidence on this subject is limited with no precise data available. In this study, we carried out a systematic literature review in order to evaluate the efficacy of dupilumab on both pruritus and skin manifestations in the two largest retrospective cohorts of patients with CP and CIP and tried to identify potential response predictors. Electronic searches were conducted on 4 databases. Our primary outcome was the improvement in pruritus measured by a reduction in patient's reported numerical rating scale of itch (NRSI) by > 4. Secondary outcomes included: proportion of patients with complete response at the end of treatment, reduction in the number of lesions by the Investigator Global Assessment (IGA), improvement in numerical rating scale of sleep (NRSS), improvement in quality of life measured by the Dermatology Life Quality Index (DLQI), time until patient perceived any improvement (Time-First) and time until patient reported absence of pruritus (Time-Final). Descriptive statistics were calculated for each demographic and clinical variable. Univariate logistic regression analyses were conducted to explore association between response to dupilumab and potential predictive factors. We included 25 articles in the analysis, counting a total of 153 patients. Based on CP patients' cohort (n=132), the mean NRSI at baseline was 8.79 ±0.86 and the NRSI final was 2.32 ±1.27. The mean time to first improvement was 5.18 ±3.13 weeks, while the time to complete improvement of pruritus (Time-final) was 13.6 ±12.0 weeks. Ninety patients out of 109 (83%) noticed improvement in pruritus before 4 weeks of dupilumab therapy. At the end of treatment, 18 patients out of 126 (14%) had a complete remission of pruritus and 110 patients out of 123 (89%) had a reduction of NRSI > 4. The reduction in NRSI was significantly greater in patients improving before 4 weeks of treatment (6.57 ±1.71) compared to patients improving in more than 4 weeks (5.49 ±1.39, p<0.001). Patients with history of AD and those who have been previously treated with cyclosporine or methotrexate had a significantly lower reduction in NRSI (e.g. 6.05 ±1.34 vs 7.08 ±1.90 p<0.01 for non-associated AD patients). Based on CIP patient's cohort (n=21), the mean NRSI at baseline was 8.33 ±0.80 and the NRSI final was 0.95 ±0.59. The mean time to first improvement was 2 ±0 weeks, while the time to complete improvement (Time-final) was 14.6 ±10 weeks. At the end of treatment, 3 patients out of 21 (14%) had a complete remission of pruritus and 100% of patients had a reduction of NRSI > 4. No serious treatment-emergent adverse events were reported. The most common adverse event was mild conjunctivitis (13 cases). We highlight the importance of one early sign of improvement as predictor of the future response to dupilumab: the improvement before 4 weeks of treatment that leads significantly to a greater final reduction in NRSI. Furthermore, patients with the presence or history of atopy appear to be less responsive to dupilumab than non-atopic patients and develop more side effects, in particular conjunctivitis.
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Affiliation(s)
- M Gael
- Department of Dermatology, CHRU de Nancy, 6 rue du Morvan, 54500 Vandœuvre lès, Nancy, France
| | - T Adam
- Department of Allergology, CHRU de Nancy, 6 rue du Morvan, 54500 Vandœuvre lès, Nancy, France
| | - M Mariano-Bourin
- Department of Dermatology, CHRU de Nancy, 6 rue du Morvan, 54500 Vandœuvre lès, Nancy, France
| | - A C Bursztejn
- Department of Dermatology, CHRU de Nancy, 6 rue du Morvan, 54500 Vandœuvre lès, Nancy, France
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Mitsuishi T, Tominaga M, Miyata K, Toyama S, Kimura U, Suga Y, Takamori K. Excimer light therapy with systemic corticosteroids improved severe chronic nodular prurigo and altered peripheral nerve fibers in the epidermis. Lasers Med Sci 2022; 37:3727-3731. [PMID: 35508565 DOI: 10.1007/s10103-022-03570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Tsuyoshi Mitsuishi
- Department of Dermatology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan. .,Department of Dermatology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, Japan.
| | - Mitsutoshi Tominaga
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Urayasu, Chiba, Japan
| | - Kazunori Miyata
- Department of Dermatology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Sumika Toyama
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Urayasu, Chiba, Japan
| | - Utako Kimura
- Department of Dermatology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yasushi Suga
- Department of Dermatology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Kenji Takamori
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Urayasu, Chiba, Japan.,Department of Dermatology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
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Weisshaar E, Szepietowski JC, Bernhard JD, Hait H, Legat FJ, Nattkemper L, Reich A, Sadoghi B, Sciascia TR, Zeidler C, Yosipovitch G, Ständer S. Efficacy and safety of oral nalbuphine extended release in prurigo nodularis: results of a phase 2 randomized controlled trial with an open-label extension phase. J Eur Acad Dermatol Venereol 2021; 36:453-461. [PMID: 34780095 DOI: 10.1111/jdv.17816] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/22/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Treatment of prurigo nodularis (PN) is challenging and new treatment options are needed. OBJECTIVE To evaluate the efficacy and safety of two oral doses of the kappa opioid agonist and mu opioid antagonist nalbuphine extended release (NAL-ER) tablets in a phase 2, multicentre, randomized, double-blind, placebo-controlled trial with an open-label, 50-week extension phase. METHODS Subjects with moderate-to-severe PN were randomized to NAL-ER 81 mg (NAL-ER81) or 162 mg (NAL-ER162) tablets twice-daily or placebo for 8 weeks of stable dosing following a 2-week titration period. Subjects completing Week 10 with a Worst Itch Numerical Rating Scale (WI-NRS) score ≥5 at the time of rollover (or during the observation period) were eligible for open-label treatment. RESULTS Of 63 randomized subjects, 62 were treated and comprised the modified intent-to-treat population (MITT), 50 completed 10 weeks of treatment. In the MITT analysis, 8 subjects (44.4%) treated with NAL-ER162 (P = 0.32) and 6 (27.3%) treated with NAL-ER81 (P = 0.78) achieved ≥30% reduction from baseline in 7-day WI-NRS at Week 10 (primary efficacy endpoint) vs. 8 (36.4%) in the placebo group. Itch reduction was significant among 8/12 (66.7%) subjects completing Week 10 treated with NAL-ER162 vs. placebo (8/20, 40.0%; P = 0.03). Additionally, 6 subjects (33.3%) treated with NAL-ER162 and 3 (13.6%) treated with NAL-ER81 achieved ≥50% reduction from baseline in 7-day WI-NRS at Week 10 (coprimary endpoint). Extended open-label treatment was associated with further improvements in itch reduction and favourable changes in PN lesion activity as assessed by Prurigo Activity Score. Adverse events occurred predominantly during dose titration and were of mild-to-moderate severity. The safety profile did not change with extended open-label treatment. CONCLUSION In adult subjects with PN, oral treatment with NAL-ER 162 mg twice daily provided measurable anti-pruritic efficacy in subjects completing ≥10 weeks of treatment and was well tolerated (ClinicalTrials.gov: NCT02174419).
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Affiliation(s)
- E Weisshaar
- Occupational Dermatology, Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - J D Bernhard
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - H Hait
- Trevi Therapeutics, Inc., New Haven, CT, USA
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - L Nattkemper
- Department of Dermatology, Miller School of Medicine and Miami Itch Center, Miami, FL, USA
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - B Sadoghi
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - G Yosipovitch
- Department of Dermatology, Miller School of Medicine and Miami Itch Center, Miami, FL, USA
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Murao S, Murao K. Multiple skin ulceration and itch-scratch cycle in a diabetic patient. J Diabetes Investig 2021; 12:2102-2103. [PMID: 33963823 PMCID: PMC8565415 DOI: 10.1111/jdi.13560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022] Open
Abstract
Diabetic patients sometimes present generalized pruritus. Severe itching can cause an itch-scratch cycle, resulting in distress and impaired quality of life, but skin ulceration is a rare manifestation.
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Affiliation(s)
- Satoshi Murao
- Department of Diabetes and EndocrinologyTakamatsu HospitalTakamatsuJapan
| | - Kazutoshi Murao
- Department of DermatologyTokushima University Graduate School of Medical ScienceTokushimaJapan
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Abstract
INTRODUCTION Prurigo nodularis (PN) or chronic prurigo of nodular type (CNPG) is a subtype of chronic prurigo with severe pruritus and neuroimmune underlying pathophysiology occurring in a plethora of dermatological, systemic, neurologic, and psychiatric conditions. AREAS COVERED We review the increasing repertoire of biologics in the treatment of CNPG focusing on those targeting interleukins 4, 13, 31, oncostatin M and IgE. Presented information is based on a database research on current clinical trials (clinicaltrials.gov, European Clinical Trials Database (EudraCT), US clinical trial registry ICH-GCP) and a PubMed search for latest publications conducted with the combinations of the terms 'chronic prurigo,' 'prurigo nodularis,' 'pathophysiology,' 'treatment,' 'therapy', and 'biologics.' EXPERT OPINION CNPG gets more and more attention as new therapeutic targets have been revealed in recent years, thus allowing the use of targeted approaches. The off-label advent of dupilumab offered advanced insight into the pathogenesis of CNPG and showed an impressive relief of pruritus in the vast majority of patients. New therapies including biologics (e.g. nemolizumab, tralokinumab, lebrikizumab), small molecules (e.g. neurokinin-1 receptor antagonists, janus kinase inhibitors) as well as mu-opioid receptor antagonists and nalbuphine, a μ-antagonist/κ-agonist, are in the pipeline and offer new hope for an improved future patient care.
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Affiliation(s)
- Svenja Müller
- Department of Dermatology and Allergy; Christine Kühne-Center for Allergy Research and Education (CK-CARE), University Hospital Bonn, Bonn, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy; Christine Kühne-Center for Allergy Research and Education (CK-CARE), University Hospital Bonn, Bonn, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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36
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Augustin M, Garbe C, Hagenström K, Petersen J, Pereira MP, Ständer S. Prevalence, incidence and presence of comorbidities in patients with prurigo and pruritus in Germany: A population-based claims data analysis. J Eur Acad Dermatol Venereol 2021; 35:2270-2276. [PMID: 34192369 DOI: 10.1111/jdv.17485] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are currently no published population-based data on prurigo and pruritus epidemiology in Germany. OBJECTIVES We present the prevalence, incidence and comorbidity frequency of prurigo and pruritus in Germany. METHODS This was a retrospective healthcare research study based on anonymized routine data from the German health insurance company DAK-Gesundheit. Evaluations were carried out for 2 006 003 adults who were insured as of 31 December 2010. Prurigo and pruritus diagnoses were based on International Classification of Diseases, Tenth Revision, German Modification (ICD-10-GM) codes. RESULTS Prevalence was determined to be 0.21% (adjusted for sex and age 0.19%) for prurigo and 2.21% (adjusted 2.14%) for pruritus in 2010. The adjusted rates extrapolated to the total German population in 2010 show that 130 685 adults would have received a prurigo diagnosis and 1 461 024 a diagnosis of pruritus. In 2011, incidence of new prurigo and pruritus cases was 0.13% (adjusted 0.12%, extrapolated 77 263 cases) and 1.51% (adjusted 1.46%, extrapolated 978 885), respectively. Adults with prurigo suffered most frequently from hypertension (35.16%), hyperlipidaemia (24.95%) and depression (21.97%); all were reported more frequently in patients with prurigo compared with the general population (P < 0.001). Similarly, adults with pruritus suffered most frequently from hypertension (31.28%), hyperlipidaemia (23.52%) and depression (18.91%) compared with patients without pruritus (P < 0.001). CONCLUSIONS Our data show that prurigo is a relatively rare but significant disease and that pruritus is frequent and very variable in appearance, and both have a high comorbidity burden.
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Affiliation(s)
- M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Garbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - K Hagenström
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Bergqvist C, Fiani C, Simantov A, Lebre C, Hua C, Ortonne N, Wolkenstein P, Chosidow O. Combined Methotrexate and Alitretinoin for the treatment of difficult-to-treat generalized prurigo nodularis: a case series. J Eur Acad Dermatol Venereol 2021; 35:e516-e519. [PMID: 33811403 DOI: 10.1111/jdv.17262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C Bergqvist
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - C Fiani
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - A Simantov
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - C Lebre
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - C Hua
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - N Ortonne
- Université Paris-Est Créteil, Créteil, France.,Department of Pathology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - P Wolkenstein
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - O Chosidow
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil, Créteil, France
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Girolomoni G, de Bruin-Weller M, Aoki V, Kabashima K, Deleuran M, Puig L, Bansal A, Rossi AB. Nomenclature and clinical phenotypes of atopic dermatitis. Ther Adv Chronic Dis 2021; 12:20406223211002979. [PMID: 33854747 PMCID: PMC8010850 DOI: 10.1177/20406223211002979] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Atopic dermatitis is a heterogeneous disease and resists classification. In this review, we discuss atopic dermatitis nomenclature and identify morphologic phenotypes, which will facilitate correct diagnoses and development of treatment strategies. We support using the term 'atopic dermatitis' rather than eczema, because it describes the allergic background and inflammation ('itis') as drivers of the disease. Atopic dermatitis has many morphologic manifestations that vary by topographic area affected, age, or race and require consideration in differential diagnosis. Different phenotypes based on morphology and topographic location, ethnicity, and age are discussed. A better-defined phenotype identification for atopic dermatitis will facilitate earlier and correct diagnosis of this complex condition and inform selection of the most appropriate treatment choice in an era in which targeted therapies may generate more individualized patient care.
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Affiliation(s)
- Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Piazzale A. Stefani 1, Verona, 37126, Italy
| | - Marjolein de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center, Utrecht, Netherlands
| | - Valeria Aoki
- Department of Dermatology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Williams KA, Roh YS, Brown I, Sutaria N, Bakhshi P, Choi J, Gabriel S, Chavda R, Kwatra SG. Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis. Expert Rev Clin Pharmacol 2020; 14:67-77. [PMID: 33191806 DOI: 10.1080/17512433.2021.1852080] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by intensely pruritic, hyperkeratotic nodules distributed on the trunk and extensor surfaces of the extremities. PN has a profoundly negative impact on sleep and quality of life in patients with PN. There are currently no U.S. Food and Drug Administration-approved agents and patients are often recalcitrant to current therapies, highlighting the importance of further research into this severely debilitating condition. Areas covered: A PubMed search was conducted to find available literature on the pathophysiology and clinical management of PN. In this review article, we discuss the current understanding of the pathophysiology, recommended diagnostic approach, and treatment options available for PN. Expert opinion/commentary: PN is an extremely difficult condition to treat, because there is a lack of effective therapies available due to our limited understanding of its pathophysiology. Currently, available treatment options are often multimodal due to the intersection of neuroimmune etiologic factors in the pathogenesis of PN. Fortunately, as our knowledge of PN expands, novel treatments targeting specific molecular biomarkers of PN are emerging, providing hope to this long-suffering patient population.
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Affiliation(s)
- Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Youkyung S Roh
- Department of Dermatology, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Isabelle Brown
- Department of Dermatology, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Pegah Bakhshi
- Department of Dermatology, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Sylvie Gabriel
- 27 Galderma Presciption GBU , La Tour-dePeilz, Switzerland
| | - Rajeev Chavda
- 27 Galderma Presciption GBU , La Tour-dePeilz, Switzerland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine , Baltimore, USA
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Ständer S, Augustin M, Berger T, Elmariah S, Korman NJ, Weisshaar E, Yosipovitch G. Prevalence of prurigo nodularis in the United States of America: A retrospective database analysis. JAAD Int 2020; 2:28-30. [PMID: 34409350 PMCID: PMC8362303 DOI: 10.1016/j.jdin.2020.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Berger
- Dermatology Clinic, University of California San Francisco Medical Center, San Francisco, California
| | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Gil Yosipovitch
- Department of Dermatology, Miller School of Medicine and Miami Itch Center, Miami, Florida
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41
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Arrieta A, Jaka A, Del Alcázar E, Blanco M, Carrascosa JM. Phototherapy for Prurigo Nodularis: Our Experience and a Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:339-344. [PMID: 33221272 DOI: 10.1016/j.ad.2020.11.007] [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: 09/18/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Prurigo nodularis is a chronic inflammatory skin disease characterized by highly pruritic nodular lesions that cause constant itching and scratching and significant quality-of-life impairment. It has been described in a range of conditions, including skin diseases (mainly atopic dermatitis) and metabolic, neurological, and psychiatric disorders. The pathophysiological mechanisms are largely unknown. Various modalities of phototherapy have been described as appropriate and safe treatments for achieving clinical control and alleviating symptoms. In this article, we describe our experience with phototherapy in patients with prurigo nodularis. MATERIAL AND METHODS Retrospective observational study of patients who received their first cycle of phototherapy to treat prurigo nodularis between March 2011 and October 2019. Information was collected on epidemiological and clinical characteristics, concomitant treatments, type and duration of phototherapy, maximum dose reached, and response to treatment. RESULTS We studied 44 patients (30 women and 14 men) with a median age of 65.5years. The most common form of phototherapy used was narrowband UV-B phototherapy (34 cycles, 77.27%) followed by a combination of UV-B and UV-A phototherapy (8 cycles). Response to treatment was considered satisfactory (clearance rate of ≥75%) in 24 patients (55.4%). CONCLUSIONS Phototherapy is a suitable treatment for prurigo nodularis in a considerable proportion of patients. It can be used as monotherapy or combined with other treatments.
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Affiliation(s)
- A Arrieta
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - A Jaka
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - E Del Alcázar
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - M Blanco
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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Janmohamed SR, Gwillim EC, Yousaf M, Patel KR, Silverberg JI. The impact of prurigo nodularis on quality of life: a systematic review and meta-analysis. Arch Dermatol Res 2020; 313:669-677. [PMID: 33108524 DOI: 10.1007/s00403-020-02148-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/11/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
Prurigo nodularis (PN) is a chronic, pruritic, debilitating disease. Previous studies found that chronic pruritus in general negatively affects patients' quality of life (QoL). However, results about the impact of PN on QoL are conflicting. Our objective was to assess the QoL burden of PN. A systematic review was conducted of all published studies that assessed QoL measures in PN. OVID MEDLINE, EMBASE, SCOPUS, and Web of Science were searched. Pooled meta-analysis (means) was performed using random-effects weighting. Overall, 13 studies met inclusion criteria. All studies identified QoL reductions in patients suffering from PN compared to control groups. The most common QoL instrument used was the Dermatology Life Quality Index [n = 9 studies; pooled mean (95% confidence interval): 13.8 (10.6-16.9), denoting a very large effect]. In particular, PN was associated with substantial impact on multiple domains of QoL. No publication bias was detected. In conclusion, QoL is negatively impacted in PN. Future studies are necessary to determine the best instruments of measuring QoL in PN patients, better understand this association, and assess the impact in males and females separately. PROSPERO CRD42019136193.
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Affiliation(s)
- Sherief R Janmohamed
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Jette, Belgium
| | - Eran C Gwillim
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Muhammad Yousaf
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin R Patel
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, 2150 Pennsylvania Avenue, Suite 2B-430, Washington, DC, 20037, USA.
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Maqbool T, Kraft JN. Alitretinoin for prurigo nodularis. Clin Exp Dermatol 2020; 46:362-363. [PMID: 33464627 DOI: 10.1111/ced.14385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- T Maqbool
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - J N Kraft
- Lynde Dermatology, Markham, ON, Canada
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Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus. J Am Acad Dermatol 2020; 84:747-760. [PMID: 32682025 DOI: 10.1016/j.jaad.2020.07.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prurigo nodularis (PN) is a chronic disease characterized by intensely pruritic, raised, nodular lesions. Because there are currently no United States Food and Drug Administration-approved therapies specifically for PN, management is highly variable, and no consensus exists on treatment regimens. OBJECTIVE To provide practical guidance to help United States dermatologists diagnose and effectively treat patients with PN. METHODS We participated in a roundtable discussion to develop consensus recommendations on diagnosis and treatment of PN from a United States perspective. RESULTS The core findings in PN are the presence of firm, nodular lesions; pruritus lasting at least 6 weeks; and a history or signs, or both, of repeated scratching, picking, or rubbing. The diagnostic workup involves a complete review of systems, considering potential systemic diseases, and assessment of disease severity, including disease burden and pruritus intensity. Treatment should be selected based on a patient's clinical presentation, comorbidities, and response to prior treatments and should address both neural and immunologic components of pruritus. LIMITATIONS Data on PN are from anecdotal or small clinical trials, and all treatments are currently used off-label. CONCLUSION An effective treatment approach for patients with PN should be based on clinical judgment and tailored to the individual needs of the patient.
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Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigo. J Am Acad Dermatol 2020; 83:39-45. [DOI: 10.1016/j.jaad.2020.03.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/18/2020] [Accepted: 03/18/2020] [Indexed: 11/18/2022]
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Reverte M, Pereira MP, Ständer S, Misery L, Brenaut E. [Clinical characteristics of patients with prurigo nodularis: A descriptive study]. Ann Dermatol Venereol 2020; 147:564-568. [PMID: 32475624 DOI: 10.1016/j.annder.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/12/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- M Reverte
- Service de dermatologie, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - M-P Pereira
- Service de dermatologie, centre de compétence du prurit chronique, hôpital universitaire de Münster, Münster, Allemagne
| | - S Ständer
- Service de dermatologie, centre de compétence du prurit chronique, hôpital universitaire de Münster, Münster, Allemagne
| | - L Misery
- Service de dermatologie, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France; Université de Brest, LIEN, 29200 Brest, France
| | - E Brenaut
- Service de dermatologie, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France; Université de Brest, LIEN, 29200 Brest, France.
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Williams KA, Huang AH, Belzberg M, Kwatra SG. Prurigo nodularis: Pathogenesis and management. J Am Acad Dermatol 2020; 83:1567-1575. [PMID: 32461078 DOI: 10.1016/j.jaad.2020.04.182] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022]
Abstract
Prurigo nodularis is a chronic skin condition characterized by severely pruritic nodules that cause a profound negative impact on quality of life. The second article in this 2-part continuing medical education series focuses on reviewing the pathogenesis of prurigo nodularis and exploring management algorithms for this condition. In addition, we discuss some emerging and novel therapies for treating prurigo nodularis. The first article in this 2-part series describes the broader epidemiology, patient demographics, physical examination findings, and symptoms to aid in the timely recognition and diagnosis of prurigo nodularis.
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Affiliation(s)
- Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy H Huang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Micah Belzberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
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