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Copyright of Dermatologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Patients with chronic prurigo (CPG) experience intense itching leading to constant scratching, resultant lesions and, often, poor sleep and life quality. First-line therapies include emollients, topical corticosteroids and calcineurin inhibitors and ultraviolet therapies, with systemic agents including immunomodulators and neurological agents also suggested. In randomized controlled trials, dupilumab and nemolizumab both improved CPG itch and lesions and have subsequently become the first treatments to receive approval for prurigo nodularis (the most common subtype of CPG). Other emerging treatments, including vixarelimab, and Janus kinase inhibitors (abrocitinib and povorcitinib), show early promise in CPG. [ABSTRACT FROM AUTHOR]

Background: Itch terminology is ambiguous. How itch was described in online materials and how terminology influenced the readability of these materials was previously unknown. Materials and methods: Two groups of search terms, itch and prurigo, were translated into five of the most prevalent European Union (EU) languages. The itch group consisted of "itch" and "pruritus." The prurigo group consisted of "prurigo," "prurigo nodularis," and "chronic prurigo". Then, a search of the terms in each language was queried in the Google search engine in the private mode of the Internet browser. The first 50 results generated were assessed for suitability. Patient education was the primary objective of the materials provided, with no barriers or advertisements included. In cases where the terms yielded identical outcomes, any duplicated materials were omitted from the analysis. When translating search terms within a group led to just one shared transcription, the results were attributed to the search term with the most similar syntax. The Lix score was utilized to assess readability. Results: 314 articles in English, German, Italian, French, and Spanish were evaluated. The term "pruritus" was the most commonly used description for the sensation of itching, with 142 (45%) articles included. Overall, the mean Lix score was 54 ± 9, classifying all articles as hard to comprehend. Articles in the itch group had significantly (P < 0.001) lower mean Lix score (52 ± 9) than materials in the prurigo group (56 ± 10). Conclusions: Despite being more accessible to conceptualize, skin conditions such as prurigo had lower readability compared to information about the itch itself. The distinction between "itch" and "pruritus" was unclear. [ABSTRACT FROM AUTHOR]

Background: Prurigo nodularis (PN) is an intensely pruritic disease characterized by itchy nodules on the trunk/extremities; it is often accompanied by skin pain and sleep disruption with negative impacts on the quality of life (QoL). The patient‐reported outcome (PRO) instruments, Worst Itch‐Numeric Rating Scale (WI‐NRS), Skin Pain‐NRS, Sleep‐NRS and Dermatology Life Quality Index (DLQI) have been psychometrically validated and the clinically meaningful within‐patient improvement thresholds (responder definition) have been established through data pooled from the two Phase‐3 trials (PRIME, NCT04183335 and PRIME2, NCT04202679) of dupilumab in adults with PN uncontrolled on topical therapies. Objectives: To estimate the proportion of dupilumab‐treated patients (vs. placebo) achieving clinically meaningful improvement in itch, skin pain, sleep and QoL, either alone or in combination, from the data pooled from PRIME and PRIME2 trials. Methods: The patient‐level data pooled from the two Phase‐3 trials (N = 311) were used for this post hoc analysis. Thresholds of clinically meaningful within‐patient improvement in PRO instrument scores from baseline at Week 24 used for defining responders were 4 (WI‐NRS and Skin Pain‐NRS), 2 (Sleep‐NRS) and 9 points (DLQI). The proportion of dupilumab‐treated patients, versus placebo, achieving the thresholds, and the time taken to achieve the thresholds were evaluated for the individual and combination of PROs. Results: Responder rates were significantly higher with dupilumab, versus placebo at Week 24 for WI‐NRS (58.8% vs. 19.0%, p < 0.0001), Skin Pain‐NRS (49.7% vs. 20.9%, p < 0.0001), Sleep‐NRS (42.5% vs. 23.4%, p < 0.0001) and DLQI (64.7% vs. 22.8%, p < 0.0001). Proportion of patients achieving simultaneous improvement in symptoms and QoL (24.8% vs. 6.3%, p < 0.0001) were significantly higher in dupilumab‐treated patients versus placebo. The time needed for achieving clinically meaningful improvement in symptoms were significantly lower in dupilumab‐treated patients, versus placebo. Conclusions: Significantly greater proportion of dupilumab‐treated patients with PN, versus placebo, demonstrated clinically meaningful improvements in PRO measures of symptoms and QoL. [ABSTRACT FROM AUTHOR]

Background: Prurigo nodularis (PN) also known as chronic prurigo, is a chronic inflammatory skin disease characterized by intensely itchy nodules/lesions which occur due to intensive scratching. PN management is, in part, based on clinician evaluations of PN lesions, which can be supported by clinician‐reported outcomes (ClinRO) such as the Prurigo Activity and Severity (PAS) instrument. A 5‐item version of PAS was included in recent phase‐3 dupilumab PN trials (PRIME [NCT04183335]/PRIME2 [NCT04202679]). The PAS score was derived using the unweighted sum of 3‐items of the 5‐item PAS (range, 0–11; higher score indicates worse activity and severity): Item 2 (number of lesions), Item 5a (percentage of lesions with excoriations/crusts) and Item 5b (percentage of healed lesions) for use in clinical practice and for communication of treatment benefit to physicians. Objectives: To evaluate the measurement properties of PAS score and derive within‐patient (responder definition) and between‐group improvement thresholds for interpreting changes in PAS score in patients with PN. Methods: The data source was the pooled treatment group, intention‐to‐treat (ITT) data from the phase‐3 PRIME (NCT04183335) and PRIME2 (NCT04202679) studies evaluating the efficacy of dupilumab in adult patients with PN with ≥20 nodules and severe itch uncontrolled with topical therapies. PAS score reliability, validity and sensitivity to change were evaluated, and anchor‐ and distribution‐based methods were applied to derive meaningful change thresholds. Results: The pooled ITT population included 311 patients (mean age 49.5 years, 65.3% female). Adequate to good psychometric properties were demonstrated for PAS score. The within‐patient meaningful improvement threshold was estimated as 3.0 points (absolute change) and 37% (per cent change). A 1.7‐point (absolute change) and 20% (per cent change) improvement were estimated to reflect a between‐group meaningful change in PAS score. Conclusions: PAS score is a simple, clinically relevant indicator of PN lesion activity and severity supported by suitable psychometric performance. [ABSTRACT FROM AUTHOR]

Abrocitinib, an oral small-molecule Janus Kinase 1 (JAK1) inhibitor, is primarily approved for treating moderate-to-severe atopic dermatitis (AD) in adults and adolescents aged 12 and older. This review examines the emerging off-label uses of Abrocitinib. We identified 37 papers reporting on the use of Abrocitinib in various conditions other than AD. The most commonly reported uses were for vitiligo, prurigo nodularis, and hand eczema, with 12 cases each. There were also 10 cases of lichen sclerosus and chronic pruritus of unknown origin and 5 cases each of pityriasis rubra pilaris alopecia areata. Additionally, erythematotelangiectatic rosacea and steroid-induced rosacea were reported in four cases each. Other conditions treated with Abrocitinib were noted, but these mostly had only one or two reported cases. Interestingly, out of the 103 patients reviewed, all studies reported favorable clinical outcomes and satisfactory results, with the exception of one isolated case where Abrocitinib was used to treat erythematotelangiectatic rosacea. [ABSTRACT FROM AUTHOR]

Prurigo nodularis (PN) manifests with highly pruritic lesions that negatively impact patient quality of life. Due to the variability in manifestation, hypertrophic lichen planus, pemphigoid nodularis, and neurotic excoriations tend to mimic PN. The pathophysiology of PN is believed to be due to interactions in the neural and immune pathways causing the release of proinflammatory and pruritogenic cytokines. Dermatologic and systemic conditions, including atopic dermatitis and chronic kidney disease, accompany PN diagnoses. Patients with moderate to severe or recalcitrant PN may benefit from dupilumab, the first medication approved by the US Food and Drug Administration (FDA) to treat PN. Here, we provide an updated review of PN with a focus on its pathophysiology, histologic findings, and current treatment options. [ABSTRACT FROM AUTHOR]

The complex hormonal and immunological changes that occur during pregnancy can lead to the development of specific skin conditions, of which atopic dermatitis, now referred to as atopic eruption of pregnancy (AEP), is the most common. AEP typically presents before the third trimester and is characterized by eczematous or prurigo skin lesions that predominantly involve the flexures, extremities and/or trunk. Management options for AEP include topical treatments, phototherapy and systemic therapies. Novel therapies have been developed for the treatment of atopic dermatitis and further studies of their use in pregnant people will be useful. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Prurigo nodularis (PN) is a debilitating chronic neuroimmunologic skin condition due to the intense pruritus and difficult to treat. The pruritogenic cytokines, particularly IL-4, IL-13, IL-22, IL-31, and oncostatin M (OSM), play a crucial role in the pathogenesis of PN, potentially involving the JAK1-STAT pathway. An oral JAK1 inhibitor, abrocitinib, is presently undergoing Phase 2 trials for the treatment of PN. We evaluated the efficacy of abrocitinib at a daily dosage of 100 mg in treating two patients with PN affecting both lower limbs: a 50-year-old male with a 16-year disease history and a 38-year-old female with over three years of disease history, both of whom had failed to respond to multiple conventional treatments. Both patients responded rapidly after one week of treatment and exhibited a marked improvement. Following eight weeks of therapy, near-complete resolution of both pruritus and lesions was achieved, and no adverse effects were reported. Additionally, there were no reported side effects during the initial four months of continued treatment. Abrocitinib is an effective targeted therapy for PN, offering a promising new option for refractory patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Prurigo nodularis (PN) is characterized by intensely itchy nodules/lesions and skin pain, which can have a substantial impact on health‐related quality of life (HRQoL). Treatment benefits on such symptoms and impacts are best assessed in trials using patient‐reported outcome (PROs) instruments such as Skin Pain Numerical Rating Scale (NRS), Sleep‐NRS and Dermatology Life Quality Index (DLQI). However, no guidance exists for interpreting meaningful changes in scores using these PROs in patients with PN. Objectives: The main objective was to derive within‐patient (responder definition) and between‐group improvement thresholds for interpreting Skin Pain‐NRS, Sleep‐NRS and DLQI total scores in patients with PN. The measurement properties of the three PROs were also evaluated. Methods: Intention‐to‐treat (ITT), blinded and pooled data were used from the Phase 3 PRIME (NCT04183335) and PRIME2 (NCT04202679) studies evaluating the efficacy of dupilumab in adult patients with PN. Anchor‐ and distribution‐based methods were applied to derive responder definition and between‐group thresholds for Skin Pain‐NRS, Sleep‐NRS and DLQI. Data were additionally used to examine the instrument measurement properties, including reliability, validity and responsiveness. Results: A total of 311 patients (mean age 49.5 years, 65.3% female) were included in the pooled ITT population. The within‐patient improvement threshold for Skin Pain‐NRS was estimated as 4.0 points, 2.0 points for Sleep‐NRS and 9.0 points for DLQI total score. A 1.5‐point improvement in Skin Pain‐NRS scores, 1.0‐point in Sleep‐NRS and 4.0‐point in DLQI indicated a between‐group meaningful change. Adequate to good psychometric properties were demonstrated for all three instruments. Conclusions: The results of this study can aid interpretation of Skin Pain‐NRS, Sleep‐NRS and DLQI scores in patients with PN in both clinical trials and clinical practice to better understand and treat PN‐related skin pain and the impact of PN on sleep quality and HRQoL. [ABSTRACT FROM AUTHOR]

Actinic prurigo is a rare photodermatosis characterized by pruritic papulonodular lesions. Treatment is challenging, especially in children, as sun protection strategies need to be rigorously implemented and symptoms often persist throughout the year. Herein, we present a case of actinic prurigo in an 8‐year‐old patient with rapid and successful relief with baricitinib. [ABSTRACT FROM AUTHOR]

The article explores racial and geographic disparities in global clinical trials for prurigo nodularis (PN), a chronic skin condition. Studies indicate that PN is more prevalent among skin of color (SOC) and atopic dermatitis (AD) patients, with Black patients in the United States being disproportionately affected. The analysis of phase II/III PN clinical trials reveals a lack of diversity in participant representation, with the majority being White. The study emphasizes the need to diversify clinical trials to better reflect the affected patient population and improve outcomes for those disproportionately affected by PN. [Extracted from the article]

Itchy skin or pruritus is a common cutaneous symptom that causes an urge to scratch, and the role of interleukins (IL) in itchy skin has been widely studied. IL‐4 and IL‐13 are known to induce chronic itch. Similarly, the direct role of IL‐31 in inducing itch has been demonstrated in clinical situations such as atopic dermatitis and prurigo nodularis. Moreover, IL‐4 receptor α antibodies (dupilumab) and IL‐31 receptor A antibodies (nemolizumab) inhibit pruritus. However, the interplay between these ILs in pruritus remains unclear. Therefore, we investigated the reciprocal effects of these cytokines on pruritus in mice. The intradermal administration of IL‐31 induced itch‐associated scratching behaviour in a dose‐dependent manner. Interestingly, the amount of IL‐31 and IL‐4/IL‐13, co‐administration or 30 min pre‐administration of IL‐4/IL‐13 and intradermal or intravenous pre‐administration of IL‐4 did not affect IL‐31‐induced itch‐associated scratching behaviour when it was observed for 30 min, 2 h, 24 h or 48 h. Pre‐administration of neutralising antibodies against IL‐4 and IL‐13 also did not affect IL‐31‐induced itch‐associated scratching behaviour. These results suggest that IL‐31 can induce itching independently of IL‐4 and IL‐13 in vivo. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. 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. 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background. Breaking the itch-scratch cycle and facilitating lesion healing are pivotal in managing prurigo nodularis (PN). This study seeks to assess the efficacy of baricitinib, an oral JAK1/2 inhibitor, for treating PN. Methods. In this prospective pilot study, 12 patients with moderate to severe PN were administered oral baricitinib at a dosage of 4 mg/day for 12 weeks. The primary objective was to assess the efficacy of baricitinib in PN patients using the numeric rating scale (NRS) for pruritus, NRS sleep score, a 5-point investigator's global assessment (IGA) scale, dermatology life quality index (DLQI), and nodular lesion count at weeks 0, 1, 2, 4, 8 and 12. In addition, the NRS pruritus and sleep scores were assessed via phone on days 2 and 4 after baricitinib treatment. Results. Baricitinib treatment led to a statistically significant improvement in the mean NRS pruritus and sleep scores, evident as early as day 2 (57.7% change from baseline; P < 0.001 , and 34.7% change from baseline, P = 0.029 , respectively) and consistently declining thereafter. Evaluation of nodular lesions revealed a significant reduction starting from week 2 (mean difference of 37.08 from baseline; P < 0.001). Analysis of other endpoints, including mean DLQI and IGA scores, also demonstrated substantial improvement at all time points (week 1, 2, 4, 8, and 12) compared to baseline. However, it is important to acknowledge the limitation of a small sample size. This constraint warrants consideration when interpreting the results and generalizing the findings. Conclusion. This preliminary study underscores baricitinib's potential for PN treatment by providing a rapid clinical response. The larger and longer randomized controlled trials are essential to determine the effectiveness, longevity, and safety of baricitinib in managing PN. This trial is registered with TCTR20230227002. [ABSTRACT FROM AUTHOR]

Epidermolysis bullosa pruriginosa is an extremely rare form of dystrophic epidermolysis bullosa. Its cause is the underlying mutation, most often in the COL7A1 gene. Based upon a specific type of mutation in a patient (missense, non-sense, frameshift, splice-site mutations), a distinct, specific phenotype can be observed. This study presents a case series of three family members from the Pomerania region in Poland, with a novel missense mutation of p.Val2402Gly/-c.7205T>G in exon 94 of the COL7A1 gene. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigated a new imaging technique called ex vivo confocal microscopy to examine rare skin conditions. By analyzing tissue samples from different skin disorders, we found that this technique could accurately identify unique microscopic features of both common and rare skin diseases. Importantly, examiners with more experience in interpreting these images achieved higher accuracy in diagnosis. This suggests that ex vivo confocal microscopy has the potential to be a valuable tool alongside traditional methods for diagnosing rare skin conditions early and accurately, leading to better treatment outcomes for patients. While ex vivo confocal laser scanning microscopy has previously demonstrated its utility in most common skin diseases, its use in the assessment of dermatological entities with lower incidence remains unexplored in most cases. We therefore aimed to evaluate the diagnostic efficacy of some rare skin tumors as well as a few inflammatory skin diseases, that have not yet been studied in ex vivo confocal laser scanning microscopy. A total of 50 tissue samples comprising 10 healthy controls, 10 basal cell carcinoma, 10 squamous cell carcinoma, and 20 rare skin conditions were imaged using the newest generation ex vivo confocal microscopy (Vivascope 2500 M-G4, Vivascope GmbH, Munich, Germany). Three blinded investigators were asked to identify characteristic features of rare skin disorders and distinguish them from more common skin diseases in the ex vivo confocal microscopy images. Our findings present the capability of ex vivo confocal microscopy to display distinctive morphologic patterns in common and rare skin diseases. As might be expected, we found a strong correlation between imaging experience and diagnostic accuracy. While the imaging inexperienced dermatohistopathologist reached 60% concordance, the imaging-trained dermatologist obtained 88% agreement with dermatohistopathology. The imaging-trained dermatohistopathologist achieved concordance up to 92% with gold-standard dermatohistopathology. This study highlights the potential of ex vivo confocal laser scanning microscopy as a promising adjunct to conventional dermatohistopathology for the early and precise identification of rare dermatological disorders. [ABSTRACT FROM AUTHOR]

Background: Prurigo nodularis (PN) is a rare chronic inflammatory skin disease with a high disease burden, but data on clinical and economic burden are still scarce. Objective: To describe the real-world epidemiologic, clinical and therapeutic characteristics and related economic burden of patients with PN compared to a benchmark population in Germany. Methods: This retrospective study was based on an excerpt of German Statutory Health Insurance data of patients with an initial PN diagnosis between 2012 and 2016. PN cohort contained no record of PN in eight quarters before the index quarter and was followed up for eight quarters (unless deceased). Benchmark cohort without PN was calculated using direct standardization and 1:1 matching to PN cohort. Results: Out of 4,536,002 insured patients, 2309 incident patients with PN were identified and matched to the benchmark cohort out of 3,018,382 patients without PN. Patients were mostly between 45 and 80 years when diagnosed with PN. Higher comorbidity rates were reported for PN than benchmark, with a rising disease burden at follow-up. Most patients with PN (91.3%) were diagnosed outpatient and had >50% more outpatient visits than the benchmark cohort. Hospitalization rates were higher in PN (53.9%) versus benchmark (35.1%), yielding twice longer mean hospital stays for PN (12 days) compared to benchmark (6 days) (p < 0.001). The most common initial therapy for patients with PN was topical corticosteroids (47.6%); ≥10% of patients were treated with antidepressants, antihistamines or systemic corticosteroids. Therapy rates were higher for PN compared to benchmark (p < 0.001). Mean initial costs were twofold higher in PN versus benchmark for outpatient, inpatient and drugs. During follow-up, an increase of >70% in mean PN costs compared to benchmark was identified for outpatient, inpatient and concomitant treatments (p < 0.001). Conclusion: This study highlights the significantly higher clinical and economic burden incurred by PN compared to benchmark patients in Germany, reflecting the unmet medical need for PN. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that cortisol levels are abnormal in chronic urticaria and atopic dermatitis, but other steroids, such as dehydroepiandrosterone (DHEA) and testosterone, are still unknown, and whether these hormones affect the maintenance of skin homeostasis or the pathogenesis of skin diseases is not fully understood. Limited data are available on steroid levels in prurigo nodularis (PN)-related research, and no study has examined the association between pruritus severity and steroid levels in PN patients. Aims: This pilot study aimed to investigate the differences in the levels of five steroids combined with their ratios in plasma between PN patients and controls and to examine the associations between the biomarkers and pruritus severity. Methods: Plasma concentrations of five steroids, including cortisol, cortisone, testosterone, progesterone, and dehydroepiandrosterone (DHEA), in 36 patients with PN were compared with concentrations in thirty-six and matched healthy controls. The concentrations of steroids were quantitated using liquid chromatography-tandem mass spectrometry. The PN symptoms, including pruritus severity, pain, and life quality, were assessed with the use of the visual analog scale, prurigo score index, numerical rating scale, and verbal rating scale and dermatology life quality index scores. Results: In comparison with controls, PN patients had lower levels of plasma cortisol and cortisone, which negatively correlated with PN symptoms. PN patients had higher levels of cortisone and testosterone to cortisol, which positively correlated with pruritus severity. Additionally, there were no significant differences in plasma concentrations of DHEA and testosterone between the two groups. We found no correlation between plasma concentrations of DHEA and testosterone and pruritus severity. Conclusion: This pilot study suggests that there may be abnormalities in peripheral blood levels of cortisol, and cortisone and the ratios of cortisone and testosterone to cortisol in patients with PN, and they are related to pruritus severity. The plasma concentrations of testosterone and DHEA may be not abnormal in PN patients and may not be associated with pruritus severity. [ABSTRACT FROM AUTHOR]

Prurigo nodularis (PN) is a chronic inflammatory skin disease that is associated with variability in peripheral blood eosinophil levels and response to T-helper 2 targeted therapies (Th2). Our objective was to determine whether circulating immune profiles with respect to type 2 inflammation differ by race and peripheral blood eosinophil count. Plasma from 56 PN patients and 13 matched healthy controls was assayed for 54 inflammatory biomarkers. We compared biomarker levels between PN and HCs, among PN patients based on absolute eosinophil count, and across racial groups in PN. Eleven biomarkers were elevated in PN versus HCs including interleukin (IL)-12/IL-23p40, tumor necrosis factor-alpha (TNF-α), Thymic stromal lymphopoietin (TSLP), and macrophage-derived chemokine (MDC/CCL22). Additionally, PN patients with AEC > 0.3 K cells/μL had higher Th2 markers (eotaxin, eotaxin-3, TSLP, MCP-4/CCL13), and African American PN patients had lower eosinophils, eotaxin, and eotaxin-3 versus Caucasian and Asian PN patients (p < 0.05 for all). Dupilumab responders had higher AEC (p < 0.01), were more likely to be Caucasian (p = 0.02) or Asian (p = 0.05) compared to African Americans, and more often had a history of atopy (p = 0.08). This study suggests that blood AEC > 0.3 K and Asian and Caucasian races are associated with Th2 skewed circulating immune profiles and response to Th2 targeted therapies. [ABSTRACT FROM AUTHOR]

(1) Background: Although the association between psoriasis and atopic dermatitis (AD) is reported in the literature, scarce data are known about the efficacy of biologic therapy (including TNF and IL-17 inhibitors) in patients with psoriatic arthritis (PsA) and concomitant AD. (2) Objective: We aimed to explore AD in patients with PsA undergoing biologics for their active disease, focusing on prevalence and clinical and potential therapeutic implications. (3) Material and methods: We performed a retrospective analysis of 64 patients with PsA receiving various biological agents, followed-up in an academic outpatient rheumatology department up to 10 years. (4) Results: Atopic diseases were reported in about one third of cases, with a higher incidence of AD (10 cases; 52.6%) vs. atopic rhinitis (6 cases; 31.6%) and allergic asthma (3 cases; 15.8%). Three morphological patterns of AD were recognized including chronic prurigo (3 cases), a chronic lichen simplex (1 case), and eczemas (6 cases). All PsA with concomitant AD displayed a late onset of skin atopy (in their adult life) and demonstrated a specific profile (younger), from urban settings, equally distributed among genders, and requiring switching to a higher number of biologics to achieve disease control. (5) Conclusion: PsA and AD may coexist, requiring special attention when selecting the optimal biologic agent. [ABSTRACT FROM AUTHOR]

Copyright of Our Dermatology Online / Nasza Dermatologia Online is the property of Our Dermatology Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A study published in the British Journal of Dermatology examined the long-term consequences of stigmatization in patients with childhood or adolescence-onset atopic dermatitis (AD). The study found that stigmatization in childhood or adolescence was associated with increased feelings of stigmatization, disease burden, stress, and the need for psychological support in adulthood. However, the study did not establish a causal relationship between childhood stigmatization and these outcomes. The researchers emphasized the importance of healthcare teams being aware of the vulnerability of children and adolescents with AD who experience stigmatization and the need for evidence-based interventions to improve their quality of life. The study was funded by Almirall SAS and the data is available upon request. [Extracted from the article]

Background: Prurigo nodularis (PN) is an intensively pruritic skin disease that negatively influences quality of life. Cryosim‐1 (Intrinsic IB Spot) is a synthetic, selective transient receptor potential melastatin 8 agonist. Aims: To investigate the efficacy and safety of cryosim‐1 in PN patients. Patients/Methods: A randomized, double‐blinded, placebo‐controlled clinical trial including 30 patients was conducted. The numerical rating scale (NRS) of pruritus was evaluated before and 2 h after cryosim‐1 application at every visit. Results: At week 8, the mean pruritus NRS before serum application (4.7 ± 0.4 treatment, 6.1 ± 0.5 placebo; p = 0.045) and 2 h after serum application (2.8 ± 0.4 treatment, 4.3 ± 0.5 placebo; p = 0.031) were significantly lower in the treatment group, and the mean NRS for sleep disorder was significantly lower in the treatment group (2.2 ± 0.5 treatment, 4.2 ± 0.8 placebo; p = 0.031). The mean satisfaction scales for pruritus improvement were significantly higher in the treatment group (7.2 ± 0.6) than in the placebo group (4.0 ± 0.9; p = 0.005). There was no difference in TEWL between the two groups, and no adverse reactions were reported. Conclusions: Cryosim‐1 is a safe and effective topical treatment for PN patients. [ABSTRACT FROM AUTHOR]

Introduction: Prurigo nodularis is a chronic and debilitating condition of not fully elucidated etiopathogenesis. There are scarce data in the literature on the presence of microorganisms in the lesional skin of prurigo nodularis. Objective: To explore the microbiome composition in patients with prurigo nodularis using amplicon-based next-generation sequencing. Material and methods: Adult patients with prurigo nodularis were recruited for the study. Controls were healthy volunteers who presented for a routine nevi check-up. Skin swabs for microbiome analysis were collected, without prior cleaning, from active nodules in patients with prurigo nodularis and corresponding skin areas in healthy volunteers. The V3-V4 region of the 16S rRNA gene was amplified from the extracted DNA. Illumina platform on the MiSeq instrument was used for sequencing. The Silva v.138 database was utilized for identification of taxa. Results: In total, the microbiome profile of 60 active nodules from 24 patients with prurigo nodularis and corresponding skin areas (n = 14) from 9 healthy volunteers was analyzed. Skin microbiome of prurigo nodularis lesions showed decreased alpha and beta diversity when compared with healthy volunteers. Staphylococcus aureus was significantly more abundant in samples from prurigo nodularis patients than in the control samples, while Pseudomonas stutzeri had a greater share in the microbiome from healthy volunteers than from prurigo nodularis patients. Conclusions: Our results highlight several alterations in the diversity and composition of cutaneous microbiome in prurigo nodularis. However, further research on the role of microorganisms in this debilitating condition is necessary. [ABSTRACT FROM AUTHOR]

Pruritic papular eruption is a dermatosis characterized by pruritic symptoms in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Similarly, nodular prurigo is an itchy dermatosis with lesions and histopathological features that resemble those of pruritic papular eruption. Both conditions share a common etiopathogenesis, which involves the cytokines produced by T helper 2 (Th2) cells. Nodular prurigo and pruritic papular eruption are chronic and frequently recalcitrant, thus posing challenges in treatment. The use of biological agents represents a treatment development for chronic and recalcitrant dermatoses. This study aimed to determine the difference in the mean percentage of interleukin-4 (IL-4) and interleukin-5 (IL-5) expressions between nodular prurigo and pruritic papular eruption lesions, which may establish a basis for further biological agent therapy. A cross-sectional study was conducted using paraffin block preparations of the skin lesions of patients diagnosed with nodular prurigo (n=16) and pruritic papular eruption (n=16). Each paraffin block preparation involved immunohistochemical staining using IL-4 and IL-5 monoclonal antibodies. The expressions of IL-4 and IL-5 were assessed through ImageJ for Windows, version 1.53 (National Institutes of Health and the Laboratory for Optical and Computational Instrumentation, University of Wisconsin, USA) by pathologists. The data were analyzed using an unpaired t-test with a significance level of p<0.05. The analytical results indicated that data on the average age of the two groups, disease duration, and storage sample duration followed a normal distribution (p>0.05). The mean percentage of IL-4 expression was significantly different between the nodular prurigo and pruritic papular eruption groups (p=0.000). However, the mean percentage of IL-5 expression was not significantly different between the two groups (p=0.060). In conclusion, the expression of IL-4 was higher in the nodular prurigo group in comparison to the pruritic papular eruption group. Nonetheless, the expression of IL-5 was comparably high in both the nodular prurigo and pruritic papular eruption groups. [ABSTRACT FROM AUTHOR]

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. 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. 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. [ABSTRACT FROM AUTHOR]

(1) Background: Prurigo nodularis (PN) is a persistent and inflammatory dermatological condition characterized by chronic itching and the formation of hardened nodules, significantly impacting the affected individuals' quality of life and psychological well-being. The management of PN poses challenges due to the limited efficacy and undesirable side effects associated with current interventions. (2) Methods: This article examines sixteen patients affected by PN treated with dupilumab, a fully human monoclonal antibody targeting interleukin IL-4 and IL-13 signaling. This involves a retrospective descriptive statistical analysis. (3) Results and (4) Conclusions: In all patients, dupilumab proves to be an effective drug in achieving disease clearance, as indicated by all the parameters considered as assessed by both physicians and patients at each evaluation point (Week 6, Week 16, Week 32, Week 52, Week 68, and Week 84), in comparison to the initial baseline. [ABSTRACT FROM AUTHOR]

Background: Prurigo nodularis (PN) is a chronic inflammatory skin disorder that is characterized by extremely itchy nodules. Proadrenomedullin N‐terminal 20 (PAMP) activates mast cell degranulation via Mas‐related G protein‐coupled receptor X2 (MRGPRX2), which is associated with pruritus in allergic contact dermatitis. However, the mechanisms underlying the action of PAMP and MRGPRX2 in PN remain unclear. Objective: To determine the role of PAMP‐induced mast cell activation via MRGPRX2 (mouse homologous Mrgprb2) in PN. Methods: The expression of PAMP and the number of MRGPRX2‐expressing mast cells in the skin biopsies of patients with PN, atopic dermatitis (AD), and healthy participants were analyzed using immunohistochemistry and immunofluorescence, respectively. The biphasic response of PAMP9‐20 mediated by Mrgprb2 in mouse peritoneal mast cells (PMC) was validated in vitro using qRT‐PCR, ELISA, flow cytometry, and siRNA techniques. Results: PAMP expression and the number of MRGPRX2+ mast cells in lesional PN skin, but not in AD, were elevated compared to healthy skin. PAMP9‐20 mediates the immediate and delayed phase responses of PMC, such as degranulation, histamine and β‐hexosaminidase release, and secretion of inflammatory factors such as CCL2, TNF‐α, and GM‐CSF. These effects were inhibited when Mrgprb2 expression was silenced. Silencing Mrgprb2 did not affect the biphasic response of PMC that was induced by IgE‐FcεRI activation. Conclusions: The results show that PAMP mediates mouse mast cell activation via Mrgprb2, which may be involved in the pathogenesis of PN. The PAMP/ Mrgprb2 pathway, independent of classical IgE signaling, could be developed as a candidate drug target for treating PN. [ABSTRACT FROM AUTHOR]

Pruritus has long been linked to hepatic dysfunction; however, there are limited data characterizing the association between liver disease and prurigo nodularis (PN), a chronic inflammatory skin disease featuring severe pruritis. We thus conducted a cross-sectional analysis of hepatic comorbidities in PN patients using TriNetX, a large global health research network. This analysis revealed that PN patients had a higher risk (p < 0.001) of developing liver cirrhosis, acute and subacute hepatic failure, inflammatory liver disease, chronic hepatitis, nonalcoholic steatohepatitis, portal hypertension, fatty liver, chronic passive congestion of the liver, and hepatocellular carcinoma compared with healthy controls. The cumulative incidence of liver disease was about three times higher in PN patients compared with healthy controls. These findings provided the basis for translational studies to investigate a genetic mechanism for this association. Cutaneous transcriptomic analysis performed on PN patients revealed the dysregulation of genes related to hepatic failure in lesional PN compared with both nonlesional PN and control skin. Similarly, gene set variation analysis (GSVA) revealed a significantly increased (p < 0.05) activation of liver metabolism, chronic hepatic failure, acute hepatic failure, cholestatic liver disease, polycystic liver disease, and hepatocellular carcinoma pathways in lesional PN compared with control skin. A subsequent genome-wide association study (GWAS) identified shared single-nucleotide polymorphisms (SNPs) in the genes AR, EDIL3, MACROD2, PCSK5, RUNX1T1, TENM4, and ZEB2 between PN and liver disease from the FinnGen cohort. Significant dysregulation of the skin–liver axis in PN patients may explain the increased incidence and severity of hepatic comorbidities and help identify future therapeutic targets for PN. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Chronic prurigo (CPG) is an inflammatory skin disease. Comorbidities including dermatological, cardiovascular, and psychiatric diseases have been reported in patients with CPG; however, the evidence has not been systematically evaluated. We aim to summarize the comorbidities, discuss underlying pathogenesis, and highlight the evaluation of CPG patients. Methods: We performed a systematic search using PubMed, Embase, and Web of Science databases for all articles reporting possible associated diseases with CPG. Pooled random-effects odds ratios (ORs) with 95% CI were calculated. Results: A total of 17 studies were included in this systematic review. Statistically significant association (p <0.05) with CPG has been demonstrated with atopic diseases: atopic dermatitis (pooled OR, 10.91; 95% CI, 3.65–32.67), allergic rhinitis (2.66; 1.12–6.27), asthma (3.23; 1.55–6.74); infectious diseases: hepatitis B (pooled OR, 2.15; 95% CI, 1.11–4.14); endocrine diseases: diabetes (pooled OR, 4.93; 95% CI, 1.13–21.56), type 1 diabetes (2.46; 2.16–2.81), type 2 diabetes (1.89; 1.34–2.68), hyperlipoproteinemia (2.90; 1.61–5.22); cardiovascular diseases: heart failure (pooled OR, 4.13; 95% CI, 1.15–14.91), hypertension (3.17; 1.56–6.45); respiratory system diseases: chronic obstructive pulmonary disease (pooled OR, 3.19; 95% CI, 1.42–7.16); urinary system diseases: chronic kidney disease (pooled OR, 4.16; 95% CI, 1.79–9.66); digestive system disease: inflammatory bowel disease (pooled OR, 2.06; 95% CI, 1.26–3.36); and others: osteoporosis (pooled OR, 3.08; 95% CI, 1.70–5.59), thyroid disease (1.70; 1.17–2.47). Conclusion: CPG is associated with various systemic disorders. Recognition of comorbidities is critical to the appropriate management of affected patients. [ABSTRACT FROM AUTHOR]

This article discusses the treatment of chronic prurigo (CPG) with upadacitinib, a selective Janus Kinase (JAK)-1 inhibitor. CPG is a neuroinflammatory dermatosis characterized by persistent itching and scratching. The study presents three cases of refractory CPG that were treated with upadacitinib, resulting in rapid itch improvement, resolution of pruritus, and improvement in quality of life. Upadacitinib could be a promising alternative treatment for CPG, although further research is needed. [Extracted from the article]

Prurigo pigmentosa is an inflammatory skin condition that is characterized by the presence of pruritic reticulated hyperpigmented papules or vesicles of the upper trunk. Previously, this condition was rarely encountered until the rise in popularity of weight reduction methods. Even with the increased prevalence, most affected patients are still adults. We present the case of an adolescent who was successfully treated with doxycycline and encouraged to resume eating. [ABSTRACT FROM AUTHOR]

This article discusses a case of erythema elevatum diutinum (EED) associated with peripheral ulcerative keratitis (PUK) in a 61-year-old Chinese man. The patient presented with painful skin lesions on various parts of his body, which worsened in cold weather. He also experienced recurrent ocular symptoms, including hyperemia and blurred vision. The diagnosis of EED with PUK was established based on clinical and histopathological features. Erythema elevatum diutinum is a rare condition characterized by neutrophilic infiltration in the skin and other organs. [Extracted from the article]

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 PNrelated 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. [ABSTRACT FROM AUTHOR]

Background: The pathogenesis of prurigo nodularis (PN) is considered to be multifactorial, with numerous cells and cytokines confabulating to produce an aberrant immune response. Methods: A cross‐sectional observational study was done in cases of untreated primary prurigo nodularis cases with histopathological assessment in 49 cases from lesional and nonlesional skin with assessment of epidermal and dermal changes, dermal infiltrate, S‐100 and toluidine blue staining to assess the expression of nerve and mast cells. Results: The most common histological changes seen in lesional skin were hyperkeratosis (98%), irregular hyperplasia (69.4%), hypergranulosis (69.4%), subepidermal clefting (6%), vertical collagen bundles (51.0%), and dermal fibrosis (48.9%). Chronic inflammatory infiltrate was seen in all cases (100%) predominantly of lymphocytes (100%) followed by eosinophils (18.4%), plasma cells (8.2%), and neutrophils (2.0%). There was a marked increase in the expression of S‐100 (6.92 ± 3.40 vs. 3.94 ± 2.15, P < 0.001) and toluidine blue (4.99 ± 4.47 vs. 1.22 ± 1.28, P < 0.001) in the lesional skin as compared to the nonlesional skin. Conclusion: We can infer that the epidermal and dermal pathology in PN is related to the infiltrate of lymphocytes, mast cells, and neural hyperplasia which perpetuate the pathogenesis by triggering the itch‐inflammation cycle. Thus, apart from immunosuppressive agents that target lymphocytes and their cytokines, therapy targeted at mast cells and neural proliferation may be needed to treat prurigo nodularis. [ABSTRACT FROM AUTHOR]

Background: Chronic prurigo (CPG) presents with pruriginous lesions and reduced quality of life (QoL). Established treatment options are often unsatisfying. Little is known about the efficacy of topical occlusive treatments. Patients often report rapid relief of symptoms when using topical occlusive zinc oxide patches (ZOP). We, therefore, aimed to assess the efficacy of ZOP. Methods: In this randomized controlled split-body crossover study, 22 participants were analyzed, receiving three treatments sequentially: ZOP, topical betamethasone 17-valerate (topical glucocorticosteroids [TGCs]), and both ZOP and TGC combined (ZOP + TGC). Each intervention was applied to either the right or left side of the body for seven consecutive days. Outcomes were a count of active excoriated pruriginous lesions (APLs), itch, recurrence of APL, QoL, and treatment comfort. They were assessed through photographs and questionnaires: modified Prurigo Activity and Severity Score, modified Itchy Quality of Life Questionnaire, and Therapy Comfort Score. Results: We observed a significant reduction of 46% in APL count for ZOP (95% CI from 30% to 58%, p value: <0.0001). Similar reduction was seen for ZOP + TGC, and a lower reduction was seen for TGC alone (48% [95% CI from 33% to 60%, p value: <0.0001] vs. 26% [95% CI from 4% to 43%, p value: 0.02]). APL counts on the non-treated side remained stable. Significant reduction in itch was observed after all treatments, with the largest improvement for ZOP + TGC, followed by TGC and, lastly, ZOP alone (−2.3 units [95% CI from −3.5 to −1.1, p value: 0.00015] vs. −1.5 units [95% CI from −2.8 to −0.3, p value: 0.01 vs. −1.4 units [95% CI from −2.6 to −0.2, p value: 0.02]). QoL increased significantly after ZOP + TGC as well as after TGC (−8.3 units [95% CI from −13.6 to −3.1, p value: 0.0018] vs. −5.7 units [95% CI from −10.9 to −0.5, p value: 0.03]). A good subjective response concerning treatment comfort was observed. Conclusion: ZOP are effective in reducing APL after 1 week of treatment. Adding TGC to ZOP did not add considerable benefit in reducing APL. All three treatments reduced itch and improved QoL, with the largest improvement shown by ZOP combined with TGC. Patients tolerated ZOP well and reported no adverse events. We therefore suggest ZOP combined with TGC as an effective, fast-acting, low-cost treatment for reducing APL and itch in patients with CPG. [ABSTRACT FROM AUTHOR]

Introduction: Validated patient report tools for quantifying patient experiences of itch in prurigo nodularis (PN) are limited. This study aimed to evaluate the validity of the 11-point peak pruritus numerical rating scale (PP NRS) as a single-item patient-reported outcome (PRO) measure for assessing itch severity in PN. Methods: Content validity of the PP NRS was evaluated through qualitative interviews with adults with PN. The PP NRS was then psychometrically evaluated using data from a placebo-controlled trial of nemolizumab in adults with PN, during which patients completed the PP NRS daily. Meaningful within-patient change was estimated from the qualitative interviews and by anchor- and distribution-based analyses of trial data. Results: The interview participants (N = 21) all understood the PP NRS and reported itch as their worst symptom overall. The PP NRS showed good test–retest reliability and demonstrated convergent validity and known-groups validity. PP NRS scores improved more in patients classified as "improved" on other clinical outcome measures than in those classified as "worsened/unchanged". Triangulation of the different estimates identified a 2- to 5-point decrease in PP NRS score as a meaningful within-patient change threshold. Conclusion: The PP NRS is a content-valid and reliable PRO measure for quantifying itch severity in adults with PN in clinical trials. Trial Registration Number: NCT03181503. Plain Language Summary: Prurigo nodularis is a skin disease where the skin becomes inflamed and very itchy. Itching and scratching can ruin the lives of people with prurigo nodularis. For doctors to know how well treatments for prurigo nodularis are working, they need to be able measure how bad their patients' itching is. Here we tested whether a tool called the peak pruritus numeric rating scale (PP NRS) can be used to reliably measure itching in patients with prurigo nodularis. The PP NRS asks patients to rate their itch "at the worst moment during the previous 24 h" on a scale from 0 ("no itch") to 10 ("worst itch imaginable"). We interviewed 21 patients with prurigo nodularis. Overall, itch was their worst symptom. They were able to use the PP NRS with few or no problems. To further explore whether the PP NRS can be used by patients with prurigo nodularis, we also obtained data from a clinical study. In this clinical study, patients with prurigo nodularis received a drug that might one day be used to treat their disease. They completed the PP NRS daily during the time they received the drug. When we analyzed the data from the clinical study, we found that the PP NRS has the properties a tool like this needs to be useful. We also concluded that a decrease of 2–5 points on the PP NRS scale would be a meaningful improvement in itching for patients with prurigo nodularis. [ABSTRACT FROM AUTHOR]

Background: Treatment of chronic prurigo (CPG) is challenging. As an antagonist of IL-4R, dupilumab has shown effectiveness in treating CPG in several clinical studies. Recently, the US Food and Drug Administration (FDA) approved dupilumab for the treatment of prurigo nodularis (PN). Objectives: The purpose of this study was to examine the efficacy of dupilumab in Chinese patients with CPG, and to analyze the difference in response between subtypes of CPG. Methods: This retrospective study included 18 patients with CPG who were treated with dupilumab for at least 16 weeks from March 2022 to October 2022. Disease severity and patient self-assessment questionnaires were assessed at baseline and each visit, including the peak Pruritus Visual Analogue Scale (PP-VAS), Prurigo Activity and Severity Score (PAS), Investigator Global Assessment (IGA), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS) and Itchy-specific Quality of Life questionnaire (ItchyQoL). Results: After 2 weeks of dupilumab treatment, pruritus scores were significantly reduced as measured by PP-VAS scores. Prurigo Activity and Severity scores decreased significantly at Week 2, whereas IGA improved significantly at Week 8. The DLQI, HADS, and ItchyQoL scores at Week 16 also showed significant improvement from baseline. Patients in all subtypes showed improvement in pruritus and lesion severity. Conclusions: Dupilumab was effective in improving pruritus and lesions in patients with various subtypes of CPG. [ABSTRACT FROM AUTHOR]

This correction to the British Journal of Dermatology article addresses an error in the ORCiD ID for one of the authors and clarifies certain details in the 'Lay summary' and 'Patients and methods' sections. The correction also presents revised data in Table 2 related to the efficacy endpoints of the study on the use of nemolizumab and topical corticosteroids for prurigo nodularis in patients aged 13 years and older. The study showed significant improvements in various endpoints, including pruritus scores and quality of life measures, with nemolizumab compared to a placebo. [Extracted from the article]

The Journal of the European Academy of Dermatology & Venereology's Editor's Picks for November 2024 highlights the urgent need for updated treatments and research on acute urticaria (AU) due to limited evidence and recommendations. Chronic Nodular Prurigo (CNPG) is a pruritic skin condition with frequent comorbidities that worsen itch intensity and quality of life. The Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations emphasize patient-centered targets for elevating eczema care, while a study on hand eczema (HE) explores the relationship between the microbiome, hand hygiene practices, and moisturizer use. [Extracted from the article]

This article discusses the treatment of recalcitrant pediatric prurigo nodularis, a condition characterized by itchy nodules on the skin, with tofacitinib, a non-selective Janus kinase (JAK) inhibitor. The article presents a case study of a 13-year-old boy who experienced significant improvement in his symptoms after starting tofacitinib treatment. The authors suggest that tofacitinib may be a cost-effective and justifiable treatment option for prurigo nodularis due to its ability to inhibit multiple cytokines involved in the condition. However, more research is needed in the pediatric age group. The article also provides a stepwise approach for the management of prurigo nodularis, including various topical and systemic treatments. [Extracted from the article]

Introduction Patients with prurigo nodularis (PN) often report high disease burden with substantial impact on quality of life. Patient Global Impression of Change (PGIC) and Severity (PGIS) are patient self-assessment measures that quantify their experience of disease during treatment. Dupilumab has recently been approved as the first systemic treatment for PN in the US and Europe. Objectives: To evaluate patient-reported global impression of disease severity improvement in dupilumab-treated patients with PN during the LIBERTY-PN PRIME and PRIME 2 trials. Materials & Methods: PRIME and PRIME2 were randomized, double-blind, multicenter, parallel-group, 24-week, phase 3 trials in adults with PN with ≥20 nodules and severe itch, inadequately controlled with topical prescription therapies or for whom these are inadvisable. Patients received 300 mg dupilumab subcutaneously (600 mg loading dose; n = 153) or matched placebo (n = 158) every 2 weeks. In this analysis, data from the two studies were pooled. Patient satisfaction was assessed in the overall placebo group, overall dupilumab-treated group, and those treated with dupilumab who did not achieve the stringent multicomponent endpoint (n = 99) of ≥4-point improvement from baseline in Worst Itch Numerical Rating Scale (WI-NRS, range: 0-10) and an Investigator's Global Assessment PN Stage (IGA PN-S, score range: 0-4) score 0 or 1 (clear or almost clear; ≤5 nodules) at Week (W) 24. Endpoints include proportion of patients achieving: PGIC (range: 0-6) scores of 0 or 1 (very much better or moderately better) at W12, and W24; and PGIS (range: 1-4) score of 1 or 2 (none or mild) at baseline, W12, and W24. Safety was also assessed. Results: Baseline demographic and clinical characteristics were generally similar between groups. In the overall dupilumab and placebo groups, baseline mean (SD) WI-NRS scores were 8.6 (0.9) and 8.4 (1.1), respectively; 32.7% and 34.2% had an IGA PN-S score of 4 (remaining patients had IGA PN-S 3); and mean (SD) PGIS scores were 3.7 (0.5) and 3.7 (0.5) respectively. In dupilumab multicomponent endpoint non-responders, mean (SD) WI-NRS score was 8.6 (0.9). 35.4% and 64.6% had an IGA PN-S score of 4 and 3 respectively; and mean (SD) PGIS score was 3.7 (0.5). At W12, 68.0% vs 38.0% (P < 0.0001 vs placebo) of dupilumab-treated vs placebo-receiving patients achieved PGIC 0 or 1, while 55.6% of dupilumab multicomponent non-responders achieved this endpoint (P = 0.0099 vs placebo). At W24, this increased to 74.5% vs 32.9% (P < 0.0001 vs placebo) of dupilumab-treated vs placebo-receiving patients achieving PGIC 0 or 1, and 61.6% of multicomponent non-achievers (P < 0.0001 vs placebo). At W12, 51.6% vs 22.2% (P < 0.0001 vs placebo) of dupilumab-treated vs placebo-receiving patients achieved PGIS 1 or 2, while 40.4% of multicomponent non-responders achieved the endpoint (P = 0.0027 vs placebo). At W24, 61.4% vs 24.1% (P < 0.0001 vs placebo) of dupilumab-treated vs placebo-receiving patients achieved PGIS 1 or 2, while 44.4% of multicomponent non-responders achieved the endpoint (P = 0.0025 vs placebo). Safety findings were consistent with the known dupilumab safety profile. Conclusions: While not all patients achieved the stringent multicomponent endpoint within the 24-week treatment period during PRIME and PRIME 2 trials, around half of the dupilumab-treated patients still reported significantly more improvement in disease severity and satisfaction with therapy. Overall safety was consistent with the known dupilumab safety profile. [ABSTRACT FROM AUTHOR]

Background: Chronic prurigo (CPG) is a pruritic skin disease, characterized by an itch-scratch cycle and scarring. It reduces patients' quality of life (QoL). Dupilumab is a monoclonal human IgG antibody that inhibits signaling of the interleukin 4 (IL-4) and interleukin 13 (IL-13) pathways through blockade of the IL-4 receptor. Patients with CPG who receive dupilumab often report great improvement in itch and overall QoL. We therefore reviewed our experience in order to follow up on QoL, safety, and treatment response in patients with CPG who received dupilumab. Methods: We conducted a real-world retrospective single-center case series. Outcomes were assessed by phone interviews and photographs using validated questionnaires and scores. Demographic data were obtained from the hospital files. Follow-up was up to 2 years. We assessed QoL with the Dermatology Life Quality Index (DLQI) and the Itchy quality of life questionnaire (ItchyQoL). Numerical Rating Scale (NRS) was used to assess itch. Prurigo lesions were documented with the Prurigo activity and severity score (PAS). Results: Ten patients were included in this study. Results were reported up to 2 years after treatment with dupilumab. The response variables for DLQI, ItchyQoL, NRS, and PAS analyses showed a statistically significant decrease over time (DLQI: p ≤ 0.0001 [−0.84; −1.27], ItchyQoL: p ≤ 0.0001 [−9.89; −18.69], NRS maximum and average: p ≤ 0.0001 [−0.52; −0.86] and p ≤ 0.0001 [−0.55; −0.94], and PAS number of lesions: p = 0.0005 [−1.70; −5.28]). The percent decrease after 1 year of treatment (this estimate is based on model estimates) ranges from −42% to −82%. Four (40%) patients reported mild side effects. No serious side effects were reported. Conclusion: Dupilumab treatment of CGP for up to 2 years is associated with improved QoL and less itching. [ABSTRACT FROM AUTHOR]

Background: Prurigo nodularis (PN) is a chronic pruritic skin disease which is difficult to treat. Current treatment options often lead to limited clinical benefit or severe side effects. Objective: The objective of this study was to evaluate the efficacy and safety of dupilumab in the treatment of PN in adults. Method: This study is a retrospective cohort study. Twenty-four adult patients with PN were included and treated with dupilumab. The primary outcomes were the mean reduction in the Investigator's Global Assessment (IGA) score and pruritus numeric rating scale (p-NRS) score. Outcomes were assessed at baseline, week 4, week 16, and week 36. Results: The study included 24 patients, of whom 9 (37.5%) were male, and the mean (SD) age of the enrolled patients was 49.88 ± 16.71 years. At the end of the 16-week treatment, the mean p-NRS score decreased from 7.50 ± 2.21 to 1.41 ± 0.91 (p < 0.001), sleeplessness numeric rating scale (s-NRS) score declined from 5.33 ± 3.29 to 0.18 ± 0.59 (p < 0.001), and Dermatology Life Quality Index (DLQI) score decreased from 13.32 ± 4.88 to 0.91 ± 0.81 (p < 0.001). Fourteen (63.6%) of 22 patients achieved IGA 0/1 and 21 (95.5%) patients achieved IGA activity 0/1. Among 14 patients who achieved IGA 0/1, 10 had an elevated serum IgE level, and patients with a high serum IgE level showed a more remarkable reduction in IGA (r = 0.52, p = 0.03). Patients with AD responded faster than those without AD (3.76 ± 1.71 weeks vs. 6.40 ± 1.67 weeks, p = 0.01). Adverse events were recorded in 4/24 (16.6%) patients, with conjunctivitis being the most frequent. Conclusion: This study demonstrated that dupilumab is effective and safe for PN and could be a potential therapeutic option. [ABSTRACT FROM AUTHOR]