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Yokozeki H, Murota H, Matsumura T, Komazaki H. Efficacy and safety of nemolizumab and topical corticosteroids for prurigo nodularis: results from a randomized double-blind placebo-controlled phase II/III clinical study in patients aged ≥ 13 years. Br J Dermatol 2024; 191:200-208. [PMID: 38629497 DOI: 10.1093/bjd/ljae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Prurigo nodularis (PN), a chronic inflammatory skin condition, adversely affects the quality of life of affected individuals. Current treatment options for PN in Japan are limited. OBJECTIVES To evaluate the optimal dose, efficacy and safety of long-term treatment with nemolizumab in patients with PN in Japan. METHODS In a 16-week double-blind phase II/III study, patients aged ≥ 13 years with PN were randomly assigned (1 : 1 : 1) to nemolizumab 30-mg, 60-mg or placebo groups, with concomitant topical corticosteroids, every 4 weeks. The primary efficacy endpoint was the percentage change in the weekly mean Peak Pruritus Numerical Rating Scale (PP-NRS) score (range 0-10, with higher scores indicating worse itching) from baseline to week 16. Secondary efficacy endpoints assessed the impact of treatment on pruritus, PN severity, sleep and quality of life. RESULTS At week 16, the least-squares mean percentage change from baseline in the PP-NRS score was -61.1% in the nemolizumab 30-mg group (n = 77), -56.0% in the 60-mg group (n = 76), and -18.6% in the placebo group (n = 76). Differences between both nemolizumab groups and placebo were significant; the difference between the 30-mg and placebo groups was -42.5% [95% confidence interval (CI) -51.9 to -33.1; P < 0.0001], and between the 60-mg and placebo groups was -37.4% (95% CI -46.7 to -28.1; P < 0.0001). Patients treated with nemolizumab also had greater improvements in the number and severity of prurigo nodules, and in sleep and quality of life compared with the placebo group. Both nemolizumab doses were well tolerated. CONCLUSIONS Improvements in PN were greater following nemolizumab treatment, despite continuation of topical corticosteroids in both groups.
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Affiliation(s)
- Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kline SN, Saito Y, Archer NK. Staphylococcus aureus Proteases: Orchestrators of Skin Inflammation. DNA Cell Biol 2024. [PMID: 38957987 DOI: 10.1089/dna.2024.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Skin homeostasis relies on a delicate balance between host proteases and protease inhibitors along with those secreted from microbial communities, as disruption to this harmony contributes to the pathogenesis of inflammatory skin disorders, including atopic dermatitis and Netherton's syndrome. In addition to being a prominent cause of skin and soft tissue infections, the gram-positive bacterium Staphylococcus aureus is a key player in inflammatory skin conditions due to its array of 10 secreted proteases. Herein we review how S. aureus proteases augment the development of inflammation in skin disorders. These mechanisms include degradation of skin barrier integrity, immune dysregulation and pruritis, and impairment of host defenses. Delineating the diverse roles of S. aureus proteases has the potential to reveal novel therapeutic strategies, such as inhibitors of proteases or their cognate target, as well as neutralizing vaccines to alleviate the burden of inflammatory skin disorders in patients.
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Affiliation(s)
- Sabrina N Kline
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yoshine Saito
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Nathan K Archer
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kwatra SG, Bordeaux ZA, Parthasarathy V, Kollhoff AL, Alajmi A, Pritchard T, Cornman HL, Kambala A, Lee KK, Manjunath J, Ma EZ, Dillen C, Kwatra MM. Efficacy and Safety of Abrocitinib in Prurigo Nodularis and Chronic Pruritus of Unknown Origin: A Nonrandomized Controlled Trial. JAMA Dermatol 2024; 160:717-724. [PMID: 38837144 PMCID: PMC11154357 DOI: 10.1001/jamadermatol.2024.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/10/2024] [Indexed: 06/06/2024]
Abstract
Importance Prurigo nodularis (PN) and chronic pruritus of unknown origin (CPUO) are chronic pruritic diseases that dramatically impair quality of life, but therapeutic options are limited. Abrocitinib, a Janus kinase 1 inhibitor, represents a promising therapy for both conditions. Objective To assess the efficacy and safety of 200-mg oral abrocitinib administered once daily in adults with moderate to severe PN or CPUO. Design, Setting, and Participants This phase 2, open-label, nonrandomized controlled trial conducted between September 2021 and July 2022 took place at a single center in the US. A total of 25 adult patients with moderate to severe PN or CPUO were screened. Ten patients with PN and 10 patients with CPUO were enrolled. All 20 patients completed the 12-week treatment period, 18 of whom completed the 4-week follow-up period. Intervention Abrocitinib, 200 mg, by mouth once daily for 12 weeks. Main Outcomes and Measures The primary efficacy end point was the percent change in weekly Peak Pruritus Numerical Rating Scale (PP-NRS) scores from baseline to week 12. Key secondary end points included the percentage of patients achieving at least a 4-point reduction in weekly PP-NRS score from baseline to week 12 and the percent change in Dermatology Life Quality Index (DLQI) scores. Results A total of 10 patients with PN (mean [SD] age, 58.6 [13.1] years; all were female) and 10 patients with CPUO (mean [SD] age, 70.7 [5.6] years; 2 were female) enrolled in the study. The mean (SD) baseline PP-NRS score was 9.2 (1.0) for PN and 8.2 (1.2) for CPUO. PP-NRS scores decreased by 78.3% in PN (95% CI, -118.5 to -38.1; P < .001) and 53.7% in CPUO (95% CI, -98.8 to -8.6; P = .01) by week 12. From baseline to week 12, 8 of 10 patients with PN and 6 of 10 patients with CPUO achieved at least a 4-point improvement on the PP-NRS. Both groups experienced significant improvement in quality of life as demonstrated by percent change in DLQI scores (PN: -53.2% [95% CI, -75.3% to -31.1%]; P = .002; CPUO: -49.0% [95% CI, -89.6% to -8.0%]; P = .02). The most common adverse event among patients was acneiform eruption in 2 of 20 patients (10%). No serious adverse events occurred. Conclusions and Relevance The results of this nonrandomized controlled trial suggest that abrocitinib monotherapy may be effective and tolerated well in adults with PN or CPUO. Randomized, double-blind, placebo-controlled trials are warranted to validate these findings. Trial Registration ClinicalTrials.gov Identifier: NCT05038982.
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Affiliation(s)
- Shawn G. Kwatra
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Zachary A. Bordeaux
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Varsha Parthasarathy
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Alexander L. Kollhoff
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ali Alajmi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hannah L. Cornman
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Anusha Kambala
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kevin K. Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaya Manjunath
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Emily Z. Ma
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Carly Dillen
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
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4
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Witte F, Ständer S, Zeidler C. [Treatment of chronic prurigo: update and perspectives]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00105-024-05375-y. [PMID: 38869847 DOI: 10.1007/s00105-024-05375-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Despite the high burden in patients with chronic prurigo (CPG), the first and so far only approved systemic therapy for this disease, dupilumab, has only been available since 2022. Therefore, treatment is mostly based on expert recommendations for off-label therapies. We aim to provide an overview of current therapies and possible future therapeutic drugs for CPG patients, which are currently in clinical trials. MATERIALS AND METHODS For this review, a systematic literature and clinical trial search was conducted via PubMed and Clinical Trials using the terms "chronic prurigo", "chronic nodular prurigo", "prurigo nodularis" and "therapy". CONCLUSION Multiple new therapeutic agents are currently under investigation in clinical trials, providing promising results for future treatment options. Moreover, an annotated checklist was developed recently to improve therapeutic decision-making in daily clinical practice with CPG patients.
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Affiliation(s)
- F Witte
- Sektion Pruritusmedizin, Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - S Ständer
- Sektion Pruritusmedizin, Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - C Zeidler
- Sektion Pruritusmedizin, Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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5
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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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6
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Liao V, Cornman HL, Ma E, Kwatra SG. Prurigo nodularis: new insights into pathogenesis and novel therapeutics. Br J Dermatol 2024; 190:798-810. [PMID: 38345154 PMCID: PMC11099982 DOI: 10.1093/bjd/ljae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 05/18/2024]
Abstract
Prurigo nodularis (PN) is an inflammatory skin condition characterized by intensely pruritic nodules on the skin. Patients with PN suffer from an intractable itch-scratch cycle leading to impaired sleep, psychosocial distress and a significant disruption in quality of life. The pathogenesis of PN is associated with immune and neural dysregulation, mediated by inflammatory cytokines [such as interleukin (IL)-4, -13, -17, -22 and -31] and neuropeptides (such as substance P and calcitonin gene-related peptide). There is a role for type 2 inflammation in PN in addition to T-helper (Th)17 and Th22-mediated inflammation. The neuroimmune feedback loop in PN involves neuropeptides released from nerve fibres that cause vasodilation and further recruitment of inflammatory cells. Inflammatory cells, particularly mast cells and eosinophils, degranulate and release neurotoxins, as well as nerve growth factor, which may contribute to the neuronal hyperplasia seen in the dermis of patients with PN and neural sensitization. Recent studies have also indicated underlying genetic susceptibility to PN in addition to environmental factors, the existence of various disease endotypes centred around degrees of type 2 inflammation or underlying myelopathy or spinal disc disease, and significant race and ethnicity-based differences, with African Americans having densely fibrotic skin lesions. Dupilumab became the first US Food and Drug Administration-approved therapeutic for PN, and there are several other agents currently in development. The anti-IL-31 receptor A inhibitor nemolizumab is in late-stage development with positive phase III data reported. In addition, the oral Janus kinase (JAK) 1 inhibitors, abrocitinib and povorcitinib, are in phase II trials while a topical JAK1/2 inhibitor, ruxolitinib, is in phase III studies.
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Affiliation(s)
- Viviane Liao
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hannah L Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Ma
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shawn G Kwatra
- Department of Dermatology
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore, MD, USA
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7
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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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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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Criado PR, Ianhez M, Criado RFJ, Nakano J, Lorenzini D, Miot HA. Prurigo: review of its pathogenesis, diagnosis, and treatment. An Bras Dermatol 2024:S0365-0596(24)00028-X. [PMID: 38493053 DOI: 10.1016/j.abd.2023.11.003] [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: 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 (HDT-GO), 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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10
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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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Pareek A, Kumari L, Pareek A, Chaudhary S, Ratan Y, Janmeda P, Chuturgoon S, Chuturgoon A. Unraveling Atopic Dermatitis: Insights into Pathophysiology, Therapeutic Advances, and Future Perspectives. Cells 2024; 13:425. [PMID: 38474389 DOI: 10.3390/cells13050425] [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: 12/21/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Atopic dermatitis (AD) is an inflammatory skin condition that frequently develops before the onset of allergic rhinitis or asthma. More than 10% of children are affected by this serious skin condition, which is painful for the sufferers. Recent research has connected the environment, genetics, the skin barrier, drugs, psychological factors, and the immune system to the onset and severity of AD. The causes and consequences of AD and its cellular and molecular origins are reviewed in this paper. The exploration of interleukins and their influence on the immunological pathway in AD has been facilitated by using relevant biomarkers in clinical trials. This approach enables the identification of novel therapeutic modalities, fostering the potential for targeted translational research within the realm of personalized medicine. This review focuses on AD's pathophysiology and the ever-changing therapeutic landscape. Beyond the plethora of biologic medications in various stages of approval or development, a range of non-biologic targeted therapies, specifically small molecules, have emerged. These include Janus kinase (JAK) inhibitors like Baricitinib, Upadacitinib, and Abrocitinib, thus expanding the spectrum of therapeutic options. This review also addresses the latest clinical efficacy data and elucidates the scientific rationale behind each targeted treatment for atopic dermatitis.
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Affiliation(s)
- Ashutosh Pareek
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, India
| | - Lipika Kumari
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, Banasthali 304022, India
| | - Aaushi Pareek
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, India
| | - Simran Chaudhary
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, India
| | - Yashumati Ratan
- Department of Pharmacy, Banasthali Vidyapith, Banasthali 304022, India
| | - Pracheta Janmeda
- Department of Bioscience and Biotechnology, Banasthali Vidyapith, Banasthali 304022, India
| | - Sanam Chuturgoon
- Northdale Hospital, Department of Health, Pietermaritzburg 3200, South Africa
| | - Anil Chuturgoon
- Discipline of Medical Biochemistry, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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12
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Kline SN, Orlando NA, Lee AJ, Wu MJ, Zhang J, Youn C, Feller LE, Pontaza C, Dikeman D, Limjunyawong N, Williams KL, Wang Y, Cihakova D, Jacobsen EA, Durum SK, Garza LA, Dong X, Archer NK. Staphylococcus aureus proteases trigger eosinophil-mediated skin inflammation. Proc Natl Acad Sci U S A 2024; 121:e2309243121. [PMID: 38289950 PMCID: PMC10861893 DOI: 10.1073/pnas.2309243121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024] Open
Abstract
Staphylococcus aureus skin colonization and eosinophil infiltration are associated with many inflammatory skin disorders, including atopic dermatitis, bullous pemphigoid, Netherton's syndrome, and prurigo nodularis. However, whether there is a relationship between S. aureus and eosinophils and how this interaction influences skin inflammation is largely undefined. We show in a preclinical mouse model that S. aureus epicutaneous exposure induced eosinophil-recruiting chemokines and eosinophil infiltration into the skin. Remarkably, we found that eosinophils had a comparable contribution to the skin inflammation as T cells, in a manner dependent on eosinophil-derived IL-17A and IL-17F production. Importantly, IL-36R signaling induced CCL7-mediated eosinophil recruitment to the inflamed skin. Last, S. aureus proteases induced IL-36α expression in keratinocytes, which promoted infiltration of IL-17-producing eosinophils. Collectively, we uncovered a mechanism for S. aureus proteases to trigger eosinophil-mediated skin inflammation, which has implications in the pathogenesis of inflammatory skin diseases.
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Affiliation(s)
- Sabrina N. Kline
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Nicholas A. Orlando
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Alex J. Lee
- Department of Oncology, Bloomberg Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD21205
| | - Meng-Jen Wu
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Jing Zhang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Christine Youn
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Laine E. Feller
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Cristina Pontaza
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Dustin Dikeman
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Nathachit Limjunyawong
- Center of Research Excellence in Allergy and Immunology, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok10700, Thailand
| | - Kaitlin L. Williams
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Yu Wang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Daniela Cihakova
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Elizabeth A. Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic Arizona, Scottsdale, AZ85259
| | - Scott K. Durum
- Cancer Innovation Laboratory, Center for Cancer Research, National Cancer Institute, NIH, Frederick, MD21702
| | - Luis A. Garza
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
| | - Xinzhong Dong
- HHMI, Johns Hopkins University School of Medicine, Baltimore, MD21205
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD21205
| | - Nathan K. Archer
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD21287
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13
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Ma F, Gharaee-Kermani M, Tsoi LC, Plazyo O, Chaskar P, Harms P, Patrick MT, Xing X, Hile G, Piketty C, Lazzari A, Van Delm W, Maverakis E, Nakamura M, Modlin RL, Kahlenberg JM, Billi AC, Julia V, Krishnaswamy JK, Gudjonsson JE. Single-cell profiling of prurigo nodularis demonstrates immune-stromal crosstalk driving profibrotic responses and reversal with nemolizumab. J Allergy Clin Immunol 2024; 153:146-160. [PMID: 37506977 PMCID: PMC11231883 DOI: 10.1016/j.jaci.2023.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Prurigo nodularis (PN) is a chronic neuroimmune skin disease characterized by bilaterally distributed pruritic hyperkeratotic nodules on extremities and trunk. Neuroimmune dysregulation and chronic scratching are believed to both induce and maintain the characteristic lesions. OBJECTIVES This study sought to provide a comprehensive view of the molecular pathogenesis of PN at the single-cell level to identify and outline key pathologic processes and the cell types involved. Features that distinguish PN skin from the skin of patients with atopic dermatitis were of particular interest. We further aimed to determine the impact of the IL31RA antagonist, nemolizumab, and its specificity at the single-cell level. METHODS Single-cell RNA-sequencing of skin from 15 healthy donors and nonlesional and lesional skin from 6 patients each with PN and atopic dermatitis, combined with spatial-sequencing using the 10x Visium platform. Integration with bulk RNA-sequencing data from patients treated with nemolizumab. RESULTS This study demonstrates that PN is an inflammatory skin disease characterized by both keratinocyte proliferation and activation of profibrotic responses. This study also demonstrates that the COL11A1+ fibroblast subset is a major contributor to fibrosis and is predominantly found in the papillary dermis of PN skin. Activation of fibrotic responses is the main distinguishing feature between PN and atopic dermatitis skin. This study further shows the broad effect of nemolizumab on PN cell types, with a prominent effect driving COL11A1+ fibroblast and keratinocyte responses toward normal. CONCLUSIONS This study provides a high-resolution characterization of the cell types and cellular processes activated in PN skin, establishing PN as a chronic fibrotic inflammatory skin disease. It further demonstrates the broad effect of nemolizumab on pathological processes in PN skin.
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Affiliation(s)
- Feiyang Ma
- Department of Dermatology, University of Michigan, Ann Arbor, Mich
| | | | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, Mich; Department of Biostatistics, University of Michigan, Ann Arbor, Mich; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Mich
| | - Olesya Plazyo
- Department of Dermatology, University of Michigan, Ann Arbor, Mich
| | | | - Paul Harms
- Department of Dermatology, University of Michigan, Ann Arbor, Mich; Department of Pathology, University of Michigan, Ann Arbor, Mich
| | | | - Xianying Xing
- Department of Dermatology, University of Michigan, Ann Arbor, Mich
| | - Grace Hile
- Department of Dermatology, University of Michigan, Ann Arbor, Mich
| | | | | | | | - Emanual Maverakis
- Department of Dermatology, University of California-Davis, Sacramento, Calif
| | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, Mich
| | - Robert L Modlin
- Department of Dermatology, University of California-Los Angeles, Calif
| | - J Michelle Kahlenberg
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Mich; Taubman Medical Research Institute, University of Michigan, Ann Arbor, Mich
| | - Allison C Billi
- Department of Dermatology, University of Michigan, Ann Arbor, Mich
| | | | | | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, Mich; Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Mich; Taubman Medical Research Institute, University of Michigan, Ann Arbor, Mich.
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14
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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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15
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Conrad C, Schlapbach C. Prurigo nodularis forecast: Light type 2 inflammation with high chances of fibrosis. J Allergy Clin Immunol 2024; 153:93-94. [PMID: 37951309 DOI: 10.1016/j.jaci.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Curdin Conrad
- Department of Dermatology, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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16
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Hu M, Scheffel J, Elieh-Ali-Komi D, Maurer M, Hawro T, Metz M. An update on mechanisms of pruritus and their potential treatment in primary cutaneous T-cell lymphoma. Clin Exp Med 2023; 23:4177-4197. [PMID: 37555911 PMCID: PMC10725374 DOI: 10.1007/s10238-023-01141-x] [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: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 08/10/2023]
Abstract
Primary cutaneous T-cell lymphomas (CTCL), which include mycosis fungoides (MF) and Sézary syndrome (SS), are a group of lymphoproliferative disorders characterized by clonal accumulation of neoplastic T-lymphocytes in the skin. Severe pruritus, one of the most common and distressing symptoms in primary CTCL, can significantly impair emotional well-being, physical functioning, and interpersonal relationships, thus greatly reducing quality of life. Unfortunately, effectively managing pruritus remains challenging in CTCL patients as the underlying mechanisms are, as of yet, not fully understood. Previous studies investigating the mechanisms of itch in CTCL have identified several mediators and their corresponding antagonists used for treatment. However, a comprehensive overview of the mediators and receptors contributing to pruritus in primary CTCL is lacking in the current literature. Here, we summarize and review the mediators and receptors that may contribute to pruritus in primary CTCL to explore the mechanisms of CTCL pruritus and identify effective therapeutic targets using the PubMed and Web of Science databases. Studies were included if they described itch mediators and receptors in MF and SS. Overall, the available data suggest that proteases (mainly tryptase), and neuropeptides (particularly Substance P) may be of greatest interest. At the receptor level, cytokine receptors, MRGPRs, and TRP channels are most likely important. Future drug development efforts should concentrate on targeting these mediators and receptors for the treatment of CTCL pruritus.
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Affiliation(s)
- Man Hu
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Jörg Scheffel
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Daniel Elieh-Ali-Komi
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Tomasz Hawro
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany.
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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17
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Calugareanu A, Specque F, Demouche S, Grolleau C, Dobos G, Merandet M, Bergerat D, Peltier S, Jachiet M, Cassius C, Mahevas T, Saussine A, How-Kit A, Onifarasoaniaina R, Serror K, Bohec M, Baulande S, Lepelletier C, Mrad M, Charvet E, Masson AD, Boccara D, Battistella M, Buanec HL, Bouaziz JD. Transcriptomic Landscape of Prurigo Nodularis Lesional Skin CD3+ T Cells Using Single-Cell RNA Sequencing. J Invest Dermatol 2023; 143:2525-2529.e5. [PMID: 37263486 DOI: 10.1016/j.jid.2023.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Andreea Calugareanu
- INSERM U976, Hôpital Saint-Louis, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florian Specque
- Clinical Research and Bioinformatics Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Demouche
- INSERM U976, Hôpital Saint-Louis, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chloe Grolleau
- INSERM U976, Hôpital Saint-Louis, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gabor Dobos
- Skin Tumor Centre Charité (HTCC), Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Marie Jachiet
- Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charles Cassius
- INSERM U976, Hôpital Saint-Louis, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibault Mahevas
- Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Saussine
- Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Kevin Serror
- INSERM U976, Hôpital Saint-Louis, Paris, France; Department of Plastic Surgery and Burn Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mylène Bohec
- Institut Curie Genomics of Excellence (ICGex) Platform, Paris, France
| | - Sylvain Baulande
- Institut Curie Genomics of Excellence (ICGex) Platform, Paris, France
| | - Clemence Lepelletier
- Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Mrad
- Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Estelle Charvet
- Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Adèle de Masson
- INSERM U976, Hôpital Saint-Louis, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - David Boccara
- INSERM U976, Hôpital Saint-Louis, Paris, France; Institut Cochin, INSERM U1016, CNRS UMR8104, Université de Paris, Paris, France; Université de Paris, Paris, France
| | - Maxime Battistella
- INSERM U976, Hôpital Saint-Louis, Paris, France; Université de Paris, Paris, France; Pathology department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Jean-David Bouaziz
- INSERM U976, Hôpital Saint-Louis, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
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18
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Shao Y, Wang D, Zhu Y, Xiao Z, Jin T, Peng L, Shen Y, Tang H. Molecular mechanisms of pruritus in prurigo nodularis. Front Immunol 2023; 14:1301817. [PMID: 38077377 PMCID: PMC10701428 DOI: 10.3389/fimmu.2023.1301817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Pruritus is the most common symptom of dermatological disorders, and prurigo nodularis (PN) is notorious for intractable and severe itching. Conventional treatments often yield disappointing outcomes, significantly affecting patients' quality of life and psychological well-being. The pathogenesis of PN is associated with a self-sustained "itch-scratch" vicious cycle. Recent investigations of PN-related itch have partially revealed the intricate interactions within the cutaneous neuroimmune network; however, the underlying mechanism remains undetermined. Itch mediators play a key role in pruritus amplification in PN and understanding their action mechanism will undoubtedly lead to the development of novel targeted antipruritic agents. In this review, we describe a series of pruritogens and receptors involved in mediating itching in PN, including cytokines, neuropeptides, extracellular matrix proteins, vasculogenic substances, ion channels, and intracellular signaling pathways. Moreover, we provide a prospective outlook on potential therapies based on existing findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Hui Tang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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19
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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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Wang L, Wang B, Kou E, Du L, Zhu Y. New insight into the role of fibroblasts in the epithelial immune microenvironment in the single-cell era. Front Immunol 2023; 14:1259515. [PMID: 37809065 PMCID: PMC10556469 DOI: 10.3389/fimmu.2023.1259515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
The skin is exposed to environmental challenges and contains heterogeneous cell populations such as epithelial cells, stromal cells, and skin-resident immune cells. As the most abundant type of stromal cells, fibroblasts have been historically considered silent observers in the immune responses of the cutaneous epithelial immune microenvironment (EIME), with little research conducted on their heterogeneity and immune-related functions. Single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics (ST) have overcome the limitations of bulk RNA sequencing and help recognize the functional and spatial heterogeneity of fibroblasts, as well as their crosstalk with other types of cells in the cutaneous EIME. Recently, emerging single-cell sequencing data have demonstrated that fibroblasts notably participate in the immune responses of the EIME and impact the initiation and progression of inflammatory skin diseases. Here, we summarize the latest advances in the role of fibroblasts in the cutaneous EIME of inflammatory skin diseases and discuss the distinct functions and molecular mechanisms of activated fibroblasts in fibrotic skin diseases and non-fibrotic inflammatory skin diseases. This review help unveil the multiple roles of fibroblasts in the cutaneous EIME and offer new promising therapeutic strategies for the management of inflammatory skin diseases by targeting fibroblasts or the fibroblast-centered EIME.
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Affiliation(s)
| | | | | | - Lin Du
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Yuanjie Zhu
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai, China
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21
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Andre N, Horev A. The top 100 most cited contributions on prurigo nodularis: A bibliometric analysis. Clin Dermatol 2023; 41:650-654. [PMID: 37797729 DOI: 10.1016/j.clindermatol.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Nicolas Andre
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Horev
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; Pediatric Dermatology Service, Soroka University Medical Center, Beer-Sheva, Israel.
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Deng J, Liao V, Parthasarathy V, Cornman HL, Kambala A, Kwatra MM, Ständer S, Piketty C, Chaskar P, Krishnaswamy JK, Julia V, Kwatra SG. Modulation of Neuroimmune and Epithelial Dysregulation in Patients With Moderate to Severe Prurigo Nodularis Treated With Nemolizumab. JAMA Dermatol 2023; 159:977-985. [PMID: 37556125 PMCID: PMC10413221 DOI: 10.1001/jamadermatol.2023.2609] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/15/2023] [Indexed: 08/10/2023]
Abstract
Importance Prurigo nodularis (PN) is a debilitating skin disease characterized by intense pruritus and hyperkeratotic skin nodules. Nemolizumab, a monoclonal antibody targeting interleukin 31 receptor α, is a promising novel therapy for the treatment of moderate to severe PN. The biological mechanisms by which nemolizumab promotes improvement of itch and skin lesions in PN are unknown. Objective To characterize changes in plasma protein biomarkers associated with clinical response to nemolizumab in patients with PN. Design, Setting, and Participants This multicenter cohort study included patients recruited from Austria, France, Germany, Poland, and the US from a phase 2 clinical trial. Adults diagnosed with moderate to severe PN with severe pruritus for at least 6 months were included in the original trial. Patients in the nemolizumab group were included in the present study if they achieved at least a 4-point decrease in the Peak Pruritus Numerical Rating Scale (PP-NRS) from baseline to week 12 during nemolizumab treatment. Placebo controls did not experience a 4-point decrease in PP-NRS. Mass spectrometry with tandem mass tags to enrich skin-specific protein detection was used to characterize changes in plasma protein expression in nemolizumab and placebo groups. Data were collected from November 2, 2017, to September 26, 2018, and analyzed from December 6, 2019, to April 8, 2022. Intervention As part of the clinical trial, patients were treated with 3 doses of nemolizumab or placebo at 0, 4, and 8 weeks. Main Outcomes and Measures Changes in plasma and epidermal protein expression in nemolizumab-treated patients compared with the placebo group at 0, 4, and 12 weeks. Results Among the 38 patients included in the analysis (22 women and 16 men; mean [SD] age, 55.8 [15.8] years), enrichment analysis of canonical pathways, biological functions, and upstream regulators showed downregulation of terms involving inflammation (IL-6, acute-phase response, signal transducer and activator of transcription 3, and interferon γ), neural processes (synaptogenesis signaling and neuritogenesis), tissue remodeling and fibrosis (transforming growth factor β1 and endothelin-1), and epidermal differentiation (epithelial mesenchymal transition) in the plasma of nemolizumab group. Conclusions and Relevance In this cohort study, differences between nemolizumab and placebo groups included modulation of inflammatory signaling, neural development, and epithelial differentiation, suggesting a promising potential approach for clinical management of PN.
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Affiliation(s)
- Junwen Deng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Viviane Liao
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hannah L. Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | | | | | | | | | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Keller JJ. Cutaneous neuropeptides: the missing link between psychological stress and chronic inflammatory skin disease? Arch Dermatol Res 2023; 315:1875-1881. [PMID: 36700961 DOI: 10.1007/s00403-023-02542-4] [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: 08/16/2022] [Revised: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
A "brain-skin" connection has been long been observed between chronic stress and chronic inflammatory skin disease including urticaria, psoriasis, atopic dermatitis, and prurigo nodularis. The relationship appears to be bidirectional. Chronic psychological stress has been shown to sustain hyperactivity of the sympathetic branch of the autonomic nervous system. Chronic stress is proinflammatory and in the context of several dermatologic disorders may be associated with an increase in dermal nerve fiber density, mast cells, nerve growth factor and calcitonin-gene-related peptide (CGRP). Furthermore, CGRP elicits a TH2-polarized T-cell response that is a hallmark of chronic pruritic conditions such as atopic dermatitis and prurigo nodularis. This TH2 response contributes directly to acute pruritus as well as the sensitization of cutaneous sensory neurons that are critical for chronic pruritus. Prurigo nodularis is a debilitating skin disorder featuring prominent nerve structural, neuropeptide, and TH2 cytokine aberrations that is a model deserving of future study.
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Affiliation(s)
- Jesse Joel Keller
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave CH16D, Portland, OR, 97239, USA.
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24
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Alkon N, Assen FP, Arnoldner T, Bauer WM, Medjimorec MA, Shaw LE, Rindler K, Holzer G, Weber P, Weninger W, Freystätter C, Chennareddy S, Kinaciyan T, Farlik M, Jonak C, Griss J, Bangert C, Brunner PM. Single-cell RNA sequencing defines disease-specific differences between chronic nodular prurigo and atopic dermatitis. J Allergy Clin Immunol 2023; 152:420-435. [PMID: 37210042 DOI: 10.1016/j.jaci.2023.04.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/12/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Chronic nodular prurigo (CNPG) is an inflammatory skin disease that is maintained by a chronic itch-scratch cycle likely rooted in neuroimmunological dysregulation. This condition may be associated with atopy in some patients, and there are now promising therapeutic results from blocking type 2 cytokines such as IL-4, IL-13, and IL-31. OBJECTIVES This study aimed to improve the understanding of pathomechanisms underlying CNPG as well as molecular relationships between CNPG and atopic dermatitis (AD). METHODS We profiled skin lesions from patients with CNPG in comparison with AD and healthy control individuals using single-cell RNA sequencing combined with T-cell receptor sequencing. RESULTS We found type 2 immune skewing in both CNPG and AD, as evidenced by CD4+ helper T cells expressing IL13. However, only AD harbored an additional, oligoclonally expanded CD8A+IL9R+IL13+ cytotoxic T-cell population, and immune activation pathways were highly upregulated in AD, but less so in CNPG. Conversely, CNPG showed signatures of extracellular matrix organization, collagen synthesis, and fibrosis, including a unique population of CXCL14-IL24+ secretory papillary fibroblasts. Besides known itch mediators such as IL31 and oncostatin M, we also detected increased levels of neuromedin B in fibroblasts of CNPG lesions compared with AD and HC, with neuromedin B receptors detectable on some nerve endings. CONCLUSIONS These data show that CNPG does not harbor the strong disease-specific immune activation pathways that are typically found in AD but is rather characterized by upregulated stromal remodeling mechanisms that might have a direct impact on itch fibers.
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Affiliation(s)
- Natalia Alkon
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Frank P Assen
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Tamara Arnoldner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang M Bauer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Marco A Medjimorec
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Lisa E Shaw
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Katharina Rindler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Gregor Holzer
- Department of Dermatology, Klinik Donaustadt, Vienna, Austria
| | - Philipp Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Christian Freystätter
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Sumanth Chennareddy
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Matthias Farlik
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Johannes Griss
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Christine Bangert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Patrick M Brunner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.
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25
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Misery L, Pierre O, Le Gall-Ianotto C, Lebonvallet N, Chernyshov PV, Le Garrec R, Talagas M. Basic mechanisms of itch. J Allergy Clin Immunol 2023; 152:11-23. [PMID: 37201903 DOI: 10.1016/j.jaci.2023.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
Pruritus (or itch) is an unpleasant sensation leading to a desire to scratch. In the epidermis, there are selective C or Aδ epidermal nerve endings that are pruriceptors. At their other ends, peripheral neurons form synapses with spinal neurons and interneurons. Many areas in the central nervous system are involved in itch processing. Although itch does not occur solely because of parasitic, allergic, or immunologic diseases, it is usually the consequence of neuroimmune interactions. Histamine is involved in a minority of itchy conditions, and many other mediators play a role: cytokines (eg, IL-4, IL-13, IL-31, IL-33, and thymic stromal lymphopoietin), neurotransmitters (eg, substance P, calcitonin gene-related peptide, vasoactive intestinal peptide, neuropeptide Y, NBNP, endothelin 1, and gastrin-releasing peptide), and neurotrophins (eg, nerve growth factor and brain-derived neurotrophic factor). Moreover, ion channels such as voltage-gated sodium channels, transient receptor potential vanilloid 1, transient receptor ankyrin, and transient receptor potential cation channel subfamily M (melastatin) member 8 play a crucial role. The main markers of nonhistaminergic pruriceptors are PAR-2 and MrgprX2. A notable phenomenon is the sensitization to pruritus, in which regardless of the initial cause of pruritus, there is an increased responsiveness of peripheral and central pruriceptive neurons to their normal or subthreshold afferent input in the context of chronic itch.
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Affiliation(s)
- Laurent Misery
- Laboratoire Interactions Neurones-Keratinocytes (LINK), University of Brest, Brest, France; Department of Dermatology and Venereology, University Hospital of Brest, Brest, France.
| | - Ophélie Pierre
- Laboratoire Interactions Neurones-Keratinocytes (LINK), University of Brest, Brest, France
| | - Christelle Le Gall-Ianotto
- Laboratoire Interactions Neurones-Keratinocytes (LINK), University of Brest, Brest, France; Department of Dermatology and Venereology, University Hospital of Brest, Brest, France
| | - Nicolas Lebonvallet
- Laboratoire Interactions Neurones-Keratinocytes (LINK), University of Brest, Brest, France
| | - Pavel V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - Raphaële Le Garrec
- Laboratoire Interactions Neurones-Keratinocytes (LINK), University of Brest, Brest, France
| | - Matthieu Talagas
- Laboratoire Interactions Neurones-Keratinocytes (LINK), University of Brest, Brest, France; Department of Dermatology and Venereology, University Hospital of Brest, Brest, France
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26
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Andre N, Horev A. The top 100 most cited contributions on prurigo nodularis: A bibliometric analysis. Clin Dermatol 2023; 41:540-544. [PMID: 37595850 DOI: 10.1016/j.clindermatol.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Affiliation(s)
- Nicolas Andre
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Horev
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; Pediatric Dermatology Service, Soroka University Medical Center, Beer-Sheva, Israel.
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27
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Selvaraj KJ, Stewart T, Frew JW. Maintenance of response to dupilumab in prurigo nodularis: A retrospective cohort study. JAAD Int 2023; 11:143-144. [PMID: 37128264 PMCID: PMC10148145 DOI: 10.1016/j.jdin.2023.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- Katina J. Selvaraj
- Department of Dermatology, Concord Repatriation General Hospital, Sydney, Australia
| | - Thomas Stewart
- Department of Dermatology, Concord Repatriation General Hospital, Sydney, Australia
| | - John W. Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Correspondence to: John W. Frew, MBBS, MMed, MS, PhD, Laboratory of Translational Cutaneous Medicine, Department of Dermatology, Liverpool Hospital, Suite 7, Level 1, 45-47 Goulburn St, Liverpool NSW 2170, Australia
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28
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Parthasarathy V, Cravero K, Xu L, Deng J, Sun Z, Engle SM, Sims JT, Okragly AJ, Kwatra SG. The blood proteomic signature of prurigo nodularis reveals distinct inflammatory and neuropathic endotypes: A cluster analysis. J Am Acad Dermatol 2023; 88:1101-1109. [PMID: 36806647 PMCID: PMC11212685 DOI: 10.1016/j.jaad.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/02/2023] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Prurigo nodularis (PN) is an extremely pruritic, chronic inflammatory skin disease. Little is known about systemic inflammation in PN. OBJECTIVE To characterize plasma inflammatory biomarkers in patients with PN and investigate the presence of disease endotypes. METHODS In this cross-sectional study, Olink proteomic analysis was performed on plasma samples from patients with PN (n = 29) and healthy controls (n = 18). RESULTS Patients with PN had increased levels of 8 circulating biomarkers compared to controls, including tumor necrosis factor, C-X-C Motif Chemokine Ligand 9, interleukin-12B, and tumor necrosis factor receptor superfamily member 9 (P < .05). Two PN clusters were identified in cluster 1 (n = 13) and cluster 2 (n = 16). Cluster 2 had higher levels of 25 inflammatory markers than cluster 1. Cluster 1 had a greater percentage of patients with a history of myelopathy and spinal disc disease compared with cluster 2 (69% vs 25%, P = .03). Patients in cluster 2 were more likely to have a history of atopy (38% in cluster 2 vs 8% in cluster 1, P = .09). LIMITATIONS Small sample size precludes robust subgroup analyses. CONCLUSION This study provides evidence of neuroimmune-biased endotypes in PN and can aid clinicians in managing patients with PN that are nonresponsive to traditional therapies.
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Affiliation(s)
- Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Karen Cravero
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lillian Xu
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Junwen Deng
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Zhe Sun
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | | | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland.
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29
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Liu T, Chu Y, Li S, Wang Y, Zhong X, Fang H, Qiao J. Myeloid dendritic cells are increased in the lesional skin and associated with pruritus in patients with prurigo nodularis. MedComm (Beijing) 2023; 4:e204. [PMID: 36789100 PMCID: PMC9921813 DOI: 10.1002/mco2.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 02/13/2023] Open
Abstract
The number of dermal mDCs (CD11c+ cells) was increased with itch intensity (r = 0.886, p = 0.003) using immunofluorescence (IF). On IF, CD11c+ mDCs expressed IL-31 in lesional PN skin. Fluorescence in situ hybridization combined with IF also confirmed IL-31 mRNA expression by mDCs in PN lesion. Higher population of colocalization of CD11c+ mDCs expressing IL-31 mRNA were more than CD68+ macrophages and CD3+ T cells in consecutive sections of PN skin lesion. HC, healthy control; PN, prurigo nodularis; SPN, PN with severe pruritus (itch NRS score ≥7 points); MPN, PN with mild pruritus (itch NRS score <3 points); NRS, Numeric Rating Scale; AD, atopic dermatitis; mDC, myeloid dendritic cell.
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Affiliation(s)
- Taoming Liu
- Department of Dermatology, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yuqi Chu
- Department of Dermatology, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Sheng Li
- Department of Dermatology, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yuqian Wang
- Department of Dermatology, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xinyue Zhong
- Department of Dermatology, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Hong Fang
- Department of Dermatology, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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30
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Blockage of the IL-31 Pathway as a Potential Target Therapy for Atopic Dermatitis. Pharmaceutics 2023; 15:pharmaceutics15020577. [PMID: 36839897 PMCID: PMC9961325 DOI: 10.3390/pharmaceutics15020577] [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: 01/28/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Atopic dermatitis (AD), a pruritic, inflammatory chronic disease with multifactorial pathogenesis, has been a therapeutic challenge. Novel target treatments aim to reduce not only the immunologic dysfunction and microbiome dysbiosis but also the recovery of the damaged skin barrier. The current review focuses on the interleukin 31 (IL-31) pathway and AD and offers an overview of the current clinical studies with monoclonal antibodies blocking this cascade. Pruritus, the key symptom of AD, has substantial participation of the IL-31 complex and activation of relevant signaling pathways. Epidermal keratinocytes, inflammatory cells, and cutaneous peripheral nerves express the interleukin-31 receptor α-chain (IL-31RA), upregulated by Staphylococcus aureus toxins or Th2 cytokines involved in AD. Nemolizumab is a humanized monoclonal antibody that antagonizes IL-31RA, inhibiting the IL-31 cascade and therefore contributing to reducing the pruritus and inflammation and recovering the damaged skin barrier in AD patients. Phases 2 and 3 clinical trials with nemolizumab in AD show a suitable safety profile, with a fast, efficient, and sustained reduction of pruritus and severity scores, especially when associated with topical treatment. Deciphering the full interplay of the IL-31 pathway and AD may expand the potential of nemolizumab as a targeted therapy for AD and other pruritic conditions.
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31
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Ju T, Labib A, Nattkemper L, Engle S, Auxier A, Hahn N, Sissons S, Sims JT, Sun Z, Okragly AJ, Yosipovitch G. Serum Interleukin-13 and Caspase 8 are Elevated in Prurigo Nodularis. Acta Derm Venereol 2023; 103:adv00861. [PMID: 36748331 PMCID: PMC10391783 DOI: 10.2340/actadv.v103.4804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/07/2022] [Indexed: 02/08/2023] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Teresa Ju
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Angelina Labib
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Leigh Nattkemper
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, the University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sarah Engle
- Immunology Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Autum Auxier
- Immunology Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Nathan Hahn
- Immunology Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Sean Sissons
- Immunology Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Jonathan T Sims
- Immunology Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Zhe Sun
- Discovery/Development Statistics, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN USA
| | - Angela J Okragly
- Immunology Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, the University of Miami Miller School of Medicine, Miami, FL, USA.
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32
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Patel JR, Joel MZ, Lee KK, Kambala A, Cornman H, Oladipo O, Taylor M, Deng J, Parthasarathy V, Cravero K, Marani M, Zhao R, Sankararam S, Li R, Pritchard T, Rebecca V, Kwatra MM, Ho WJ, Dong X, Kang S, Kwatra SG. Single-cell RNA sequencing reveals dysregulated fibroblast subclusters in prurigo nodularis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.29.526050. [PMID: 36778229 PMCID: PMC9915465 DOI: 10.1101/2023.01.29.526050] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Prurigo nodularis (PN) is an intensely pruritic, chronic inflammatory skin disease that disproportionately affects black patients. However, the pathogenesis of PN is poorly understood. We performed single-cell transcriptomic profiling, ligand receptor analysis and cell trajectory analysis of 28,695 lesional and non-lesional PN skin cells to uncover disease-identifying cell compositions and genetic characteristics. We uncovered a dysregulated role for fibroblasts (FBs) and myofibroblasts as a key pathogenic element in PN, which were significantly increased in PN lesional skin. We defined seven unique subclusters of FBs in PN skin and observed a shift of PN lesional FBs towards a cancer-associated fibroblast (CAF)-like phenotype, with WNT5A+ CAFs increased in the skin of PN patients and similarly so in squamous cell carcinoma (SCC). A multicenter PN cohort study subsequently revealed an increased risk of SCC as well as additional CAF-associated malignancies in PN patients, including breast and colorectal cancers. Systemic fibroproliferative diseases were also upregulated in PN patients, including renal sclerosis and idiopathic pulmonary fibrosis. Ligand receptor analyses demonstrated increased FB1-derived WNT5A and periostin interactions with neuronal receptors MCAM and ITGAV, suggesting a fibroblast-neuronal axis in PN. Type I IFN responses in immune cells and increased angiogenesis/permeability in endothelial cells were also observed. As compared to atopic dermatitis (AD) and psoriasis (PSO) patients, increased mesenchymal dysregulation is unique to PN with an intermediate Th2/Th17 phenotype between atopic dermatitis and psoriasis. These findings identify a pathogenic role for CAFs in PN, including a novel targetable WNT5A+ fibroblast subpopulation and CAF-associated malignancies in PN patients.
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Affiliation(s)
- Jay R. Patel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marina Z. Joel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin K. Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hannah Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olusola Oladipo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Taylor
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - June Deng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Cravero
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melika Marani
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan Zhao
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sreenidhi Sankararam
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruixiang Li
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vito Rebecca
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Won Jin Ho
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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33
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Shao Y, Zhu Y, Xiao Z, Shen Y, Dai B, Tang H, Wang D. RNA sequencing reveals the transcriptome profile of the atopic prurigo nodularis with severe itching. Exp Dermatol 2023; 32:30-40. [PMID: 36134503 DOI: 10.1111/exd.14678] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 01/06/2023]
Abstract
Prurigo nodularis (PN), characterized by inevitable chronicity and severe pruritus, is most frequently associated with atopy compared with other origins. However, the skin transcriptomic profiling of PN arising from atopic dermatitis (AD), so-called atopic PN (APN), remains unclear. We sought to explore the cutaneous transcriptome of APN with severe pruritus and compare it with classic AD. RNA sequencing was performed on the lesional skin from 13 APN to 11 AD patients with severe pruritus (itch numerical rating scale score ≥ 7) and normal skin from 11 healthy subjects. Quantitative real-time polymerase chain reaction and immunochemistry were used for validation. We detected 1085 and 1984 differentially expressed genes (DEGs) in lesional APN skin and lesional AD skin versus normal skin, respectively. In total, 142 itch/inflammation-related DEGs were identified. Itch/inflammation-related DEGs, such as IL-6, IL-10, IL-13, oncostatin M, and IL-4 receptor, had elevated gene transcript levels in both diseases. The itch/inflammation-related DEGs that increased only in APN were mainly neuroactive molecules, while many inflammatory mediators such as T helper 22-related genes were found to be increased only in AD. Both disorders showed mixed Th1/Th2/Th17 polarisation and impaired skin barrier. In contrast to AD, M1/M2 macrophage activation, tumor necrosis factor production, fibrosis, revascularization and neural dysregulation are unique features of APN. The study findings broaden our understanding of the pathogenesis underlying APN, which provides insights into novel pathogenesis with potential therapeutic implications.
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Affiliation(s)
- Yixin Shao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiqi Zhu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zijing Xiao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanyun Shen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Beiying Dai
- Center for New Drug Safety Evaluation and Research, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Hui Tang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Duoqin Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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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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35
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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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36
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Zeidler C, Pereira MP, Ständer S. [Update on the treatment of chronic prurigo]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:614-619. [PMID: 35925236 DOI: 10.1007/s00105-022-05020-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Chronic prurigo is an inflammatory dermatosis defined by the presence of chronic pruritus and single to multiple symmetrically distributed pruriginous lesions such as nodules, papules, and plaques. Various dermatological, systemic, neurological, and/or psychiatric diseases are associated with chronic prurigo. The care of these patients is very complex due to the multifactorial character and also because of the sometimes very pronounced consequences such as an impairment of quality of life with sleep disorders. Furthermore, there are no approved therapies. The current guideline-based treatment recommendations include topical application of steroids, capsaicin, calcineurin inhibitors, phototherapy, and systemic use of gabapentinoids, μ‑opioid receptor antagonists, immunosuppressants, or dupilumab. Results from randomized controlled trials and case series on new therapies including biologics (e.g., nemolizumab) and Janus kinase inhibitors are promising. This article provides an overview of currently available treatment options and discusses the latest data on the efficacy of future therapies.
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Affiliation(s)
- Claudia Zeidler
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - Manuel Pedro Pereira
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - Sonja Ständer
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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Abstract
Nemolizumab is a subcutaneously administered humanized anti-interleukin-31 (IL-31) receptor A (IL-31RA) monoclonal antibody that is being developed by Chugai Pharmaceutical Co. Ltd, Maruho Co. Ltd and Galderma Pharma S.A. for the treatment of skin diseases, including atopic dermatitis (AD), AD associated pruritus (ADaP), prurigo nodularis (PN), chronic kidney disease associated pruritus (CKDaP) and systemic sclerosis (SSc). IL-31 is a neuroimmune cytokine that induces itch, inflammation, keratinocyte differentiation and fibroblast activation in chronic pruritic skin diseases. Nemolizumab (Mitchga® Syringes) was approved in Japan on 28 March 2022 for use in adults and children over the age of 13 years for the treatment of itch associated with AD (only when existing treatment is insufficiently effective). This article summarizes the milestones in the development of nemolizumab leading to this first approval.
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Affiliation(s)
- Susan J Keam
- Springer Nature, Mairangi Bay, Private Bag 65901, Auckland, 0754, New Zealand.
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38
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Misery L. Chronic prurigo. Br J Dermatol 2022; 187:464-471. [DOI: 10.1111/bjd.21698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Laurent Misery
- Univ Brest, LIEN Brest France
- University Hospital of Brest Department of Dermatology, Venerology and Allergology and French Expert Centre on Pruritus Brest France
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Labib A, Ju T, Vander Does A, Yosipovitch G. Immunotargets and Therapy for Prurigo Nodularis. Immunotargets Ther 2022; 11:11-21. [PMID: 35502157 PMCID: PMC9056055 DOI: 10.2147/itt.s316602] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/08/2022] [Indexed: 12/18/2022] Open
Abstract
Prurigo nodularis is a chronic inflammatory skin disease consisting of severely pruritic nodules that can be very debilitating for patients. The basis of this skin condition is immunological dysregulation and neural amplification, driven by T-lymphocytes, mast cells, eosinophilic granulocytes, macrophages, and cytokines mediating itchy processes. Further complicating this already taxing diagnosis is the lack of approved treatment and consensus on management; although there are off-label treatments utilized as therapy. Immunomodulators are the cornerstone of treatment for PN, and additional novel therapies targeting key players in the immunological cascade are currently undergoing investigation. In this review, we will highlight targets of the immune cascade and explore current immunomodulating treatments as well as immunotherapies on the horizon for the management of prurigo nodularis.
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Affiliation(s)
- Angelina Labib
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa Ju
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashley Vander Does
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Gil Yosipovitch, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, 1600 NW 10th Ave RMSB Building 2067B, Miami, FL, USA, Tel +1 305 213-5824, Email
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Steinhoff M, Ahmad F, Pandey A, Datsi A, AlHammadi A, Al-Khawaga S, Al-Malki A, Meng J, Alam M, Buddenkotte J. Neuro-immune communication regulating pruritus in atopic dermatitis. J Allergy Clin Immunol 2022; 149:1875-1898. [PMID: 35337846 DOI: 10.1016/j.jaci.2022.03.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/13/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
Atopic dermatitis (AD) is a common, chronic-relapsing inflammatory skin disease with significant disease burden. Genetic and environmental trigger factors contribute to AD, activating two of our largest organs, the nervous and immune system. Dysregulation of neuro-immune circuits plays a key role in the pathophysiology of AD causing inflammation, pruritus, pain, and barrier dysfunction. Sensory nerves can be activated by environmental or endogenous trigger factors transmitting itch stimuli to the brain. Upon stimulation, sensory nerve endings also release neuromediators into the skin contributing again to inflammation, barrier dysfunction and itch. Additionally, dysfunctional peripheral and central neuronal structures contribute to neuroinflammation, sensitization, nerve elongation, neuropathic itch, thus chronification and therapy-resistance. Consequently, neuro-immune circuits in skin and central nervous system may be targets to treat pruritus in AD. Cytokines, chemokines, proteases, lipids, opioids, ions excite/sensitize sensory nerve endings not only induce itch but further aggravate/perpetuate inflammation, skin barrier disruption, and pruritus. Thus, targeted therapies for neuro-immune circuits as well as pathway inhibitors (e.g., kinase inhibitors) may be beneficial to control pruritus in AD either in systemic and/or topical form. Understanding neuro-immune circuits and neuronal signaling will optimize our approach to control all pathological mechanisms in AD, inflammation, barrier dysfunction and pruritus.
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Affiliation(s)
- Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Department of Dermatology, Weill Cornell Medicine-Qatar, Doha, Qatar; Qatar University, College of Medicine, Doha, Qatar; Department of Dermatology, Weill Cornell Medicine, New York, USA.
| | - Fareed Ahmad
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Atul Pandey
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Angeliki Datsi
- Institute for Transplantational Diagnostics and Cell Therapeutics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ayda AlHammadi
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Sara Al-Khawaga
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Aysha Al-Malki
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Jianghui Meng
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Majid Alam
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Joerg Buddenkotte
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar; Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
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Sonkoly E. Reversal of the disease signature in prurigo nodularis by blocking the itch cytokine. J Allergy Clin Immunol 2022; 149:1213-1215. [PMID: 35189125 DOI: 10.1016/j.jaci.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Enikö Sonkoly
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Dermatology and Venereology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.
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Nguyen HH, Shinkuma S, Hayashi R, Katsumi T, Nishiguchi T, Natsuga K, Fujita Y, Abe R. New insight of itch mediators and proinflammatory cytokines in epidermolysis bullosa. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2022. [DOI: 10.1002/cia2.12230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hong Ha Nguyen
- Division of Dermatology Niigata University Graduate School of Medical and Dental Science Niigata Japan
| | - Satoru Shinkuma
- Division of Dermatology Niigata University Graduate School of Medical and Dental Science Niigata Japan
- Department of Dermatology Nara Medical University Kashihara Japan
| | - Ryota Hayashi
- Division of Dermatology Niigata University Graduate School of Medical and Dental Science Niigata Japan
| | - Tatsuya Katsumi
- Division of Dermatology Niigata University Graduate School of Medical and Dental Science Niigata Japan
| | - Tomoki Nishiguchi
- Division of Dermatology Niigata University Graduate School of Medical and Dental Science Niigata Japan
| | - Ken Natsuga
- Department of Dermatology Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Yasuyuki Fujita
- Department of Dermatology Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan
- Department of Dermatology Sapporo City General Hospital Sapporo Japan
| | - Riichiro Abe
- Division of Dermatology Niigata University Graduate School of Medical and Dental Science Niigata Japan
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