A Nationwide Study of Prurigo Nodularis: Disease Burden and Healthcare Utilization in the United States

Wongvibulsin, Shannon; Sutaria, Nishadh; Williams, Kyle; Huang, Amy; Choi, Justin; Roh, Youkyung S.; Hong, Michael; Kelley, Davis; Pahalyants, Vartan; Murphy, William S.; Alphonse, Martin P.; Bakhshi, Pegah R.; Walia, Anant; Semenov, Yevgeniy R.; Kwatra, Shawn G.

doi:10.1016/j.jid.2021.02.756

Cited by 27 publications

(26 citation statements)

References 17 publications

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“…However, the completion rate was approximately 74.4%. Statistical analysis was pre‐planned and utilized two‐sample t ‐tests with unequal variances to compare mean QoL scores to published scores for AD and psoriasis 15,16 . Statistical significance was defined as P < 0.05.…”

Section: Methodsmentioning

confidence: 99%

“…PN may initially present as grouped lesions but can disseminate to become more widespread 3 . Although the precise aetiology of PN remains unknown, it has been associated with comorbid dermatological conditions, such as atopic dermatitis (AD), 2,4–6 and with systemic inflammation and several systemic illnesses, including HIV, chronic renal failure, liver disease, thyroid disease and malignancy 2,6–15 . Compared with other chronic itch conditions, the itch of PN is among the most severe 16 …”

Section: Introductionmentioning

confidence: 99%

“…Although epidemiological studies have described the natural history and demographics of PN, 11,17–19 there are few studies examining patient‐reported experiences of the disease, including its impact on patient quality of life (QoL) 20 . This may be because PN is an under‐recognized condition that is less common than other pruritic, inflammatory skin diseases such as AD and psoriasis, making it difficult to obtain a large sample patient population for investigation 2,15 . To address these issues, we used a digital epidemiological approach to perform a cross‐sectional analysis of PN disease burden using patient‐reported measures.…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics and disease burden in prurigo nodularis

et al. 2021

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Summary Background Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by intense pruritus, but information on patient experience and impact on quality of life (QoL) remains understudied. Aim To characterize disease characteristics and QoL in a global sample of patients with PN. Methods An anonymous survey was distributed via patient support groups for PN. Results In total, 231 members responded to the survey. The majority of respondents reported itch localized both to nodules and to intervening skin (67.0%). Associated symptoms included prickling, pain, stinging and burning. The extensor lower legs (69% right, 67.3% left) and flexor forearms (66.1% right, 62% left) were the most common sites of itch. Participants reported frequent healthcare utilization, with 36.3% visiting a doctor ≥ 10 times in the past year. Physician‐diagnosed anxiety (45.4%), depression (16.4%) and the atopic triad (18.7%) were commonly reported. Patients with PN had mean scores of 16.4, 11.6 and 16.8 on the Dermatology Life Quality Index, Pittsburgh Sleep Quality Index and 5‐Dimensions Itch, respectively. Conclusions Severe pruritus with accompanying pain, stinging and burning is characteristic of PN, with the majority of patients experiencing itch in both nodular and interlesional skin. Patients further report decreased QoL scores and impaired sleep. Patient experiences should guide future management of PN.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics and disease burden in prurigo nodularis

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“… 12 Additionally, PN poses a significant health-care burden due to the increased prevalence of comorbidities and increased utilization of specialty care. 13 …”

Section: Introductionmentioning

confidence: 99%

Immunotargets and Therapy for Prurigo Nodularis

Labib¹,

Ju²,

Does³

et al. 2022

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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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“…We used the Aetna national insurance claims database which provides deidentified information on claims data and defined patients with PN as individuals with two or more PN medical claims using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code L28Á1 between October 2015 and December 2019. 2,5 The study was exempt from institutional review board approval as the information from the database was deidentified.…”

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confidence: 99%

Latent class analysis identification of prurigo nodularis comorbidity phenotypes

et al. 2022

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In contrast, the incidence of dermatological manifestations in adult populations with COVID has been reported to be around 20%, 7 with transient signs and highly variable morphology: morbilliform, pernio-like and urticarial lesions being the most common. 8 Children with COVID-19 who do not have PIMS-TS have been reported to have similar eruptions to adults. 8 The pathological mechanism of MCM in patients with COVID-19 can be classified into those with similar features to other viral exanthems, and those secondary to systemic consequences of COVID-19, particularly vasculopathic and thrombotic tendencies. The predilection of mucocutaneous involvement is poorly understood. In our study, 25Á7% of patients demonstrated MCM after initial presentation of illness, suggesting a reactive phenomenon.The PIMS-TS phenotype is similar to toxic shock syndrome (TSS) and Kawasaki disease (KD); however, there are some significant differences especially with regard to myocardial involvement which is rare in TSS but was commonly encountered especially in the early patients with PIMS-TS. Other differences include the presence of shock in patients with PIMS-TS and TSS, and the relative absence in KD. Coronary abnormalities are relatively common in KD, present in some patients with PIMS-TS with myocardial involvement and variable arrythmias, but rarely encountered in TSS. Gastrointestinal features are often seen in PIMS-TS, relatively frequently seen in TSS but less common in KD. Finally, cutaneous manifestations are seen in all three conditions; however, a fine, diffuse blanching maculopapular rash is typical of TSS, with variable morphology seen in KD and PIMS-TS.To our knowledge this is the largest study to date describing the clinical morphology, time course and sites of MCM in children with PIMS-TS. Importantly, these do not appear to have any prognostic value, and no pathognomonic cutaneous signs were identified. Furthermore, children with PIMS-TS may show MCM more frequently than those with COVID-19 infection. However, due to lack of PCR testing, the true incidence of COVID-19 infection in the early stages of the pandemic are not known.Limitations of our study include retrospective collection of data and reliance on descriptive rash terms by clinicians without specialist training in dermatology. Furthermore, the MCM seen are most likely reactive in nature, disappearing relatively quickly once the patient starts to recover. Future work focusing on the value of using cutaneous signs, such as objective measures of microvascular perfusion as a marker of disease control, would result in less reliance on invasive blood monitoring. There is also need for improved understanding regarding the pathophysiology of MCM in PIMS-TS, in which biopsies from those affected, although seldom performed on children, would be valuable.

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A Nationwide Study of Prurigo Nodularis: Disease Burden and Healthcare Utilization in the United States

Cited by 27 publications

References 17 publications

Clinical characteristics and disease burden in prurigo nodularis

Clinical characteristics and disease burden in prurigo nodularis

Immunotargets and Therapy for Prurigo Nodularis

Latent class analysis identification of prurigo nodularis comorbidity phenotypes

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