Chronic prurigo: A retrospective study of 168 cases

Abstract

Chronic prurigo is classified into two clinical subtypes: prurigo nodularis (PN) and prurigo chronica multiformis (PCM) in Japan. In this study, we retrospectively investigated the clinical features of 168 patients with chronic prurigo (103 with PN and 65 with PCM) diagnosed at the Tokyo Medical and Dental University, and compared age, sex, prevalence of comorbidities, blood test results, histology and treatment efficacy in both groups. We found that patients with PCM were significantly older than those with PN. Males were more frequently diagnosed with PCM than females; however, both sexes were similarly affected by PN. Chronic infection was more prevalent in PN, whereas diabetes was more common in PCM. For both subtypes, serum immunoglobulin E levels were elevated above the normal range. However, serum thymus and activation‐regulated chemokine/CCL17 levels and the number of blood eosinophils were significantly higher in patients with PCM than in those with PN. Histologically, much higher numbers of CD4+ cells than CD8+ cells were distributed in the lesions of both subtypes. Eosinophils were distributed predominantly in intracollagenous lesions in PCM but were observed mainly in perivascular lesions in PN. There were no differences in basophil and mast cell distributions in the lesions of the two groups. Treatment efficacy was also similar in both subtypes. Together, both subtypes exhibit inflammation patterns predominantly driven by T‐helper 2 cells. With respect to PCM, elevated numbers of blood eosinophils and the recruitment of these cells into intracollagenous areas may be important for pathogenesis.

Successful Treatment of Prurigo Nodularis by Dupilumab: Report of 24 Patients

“…Considering that Williams’ criteria place more emphasis on flexural dermatitis, we tend to use Chinese criteria to assess atopic diathesis of PN patients for better sensitivity. Besides, in our study, most patients (16/24, 66.6%) are found with an elevated level of serum IgE but a normal level of the total number of blood eosinophils, and this result is similar to another research [15]. Pathological mechanisms of AD still remain unclear, but immune dysregulation, barrier defects, and cutaneous dysbiosis are demonstrated to be involved and the importance of Th2 cells has been focused [16–18].…”

Comorbidities of Chronic Prurigo: A Systematic Review and Meta-Analysis

“…Nearly 57.5% ( n = 13,274) of CPG patients were female in 16 studies that developed gender proportions [16–19, 21–32]. These studies were conducted in different regions, including Europe [16, 18, 21, 24–26, 28–31], Asia [17, 19, 23, 32], and America [20, 22, 27], of which females compose 64.26%, 44.54%, and 54.04%, respectively. The diagnosis of CPG was made using different methods.…”

“…The diagnosis criterion was not provided in one study [27]. Data were compiled from insurance databases [22, 25, 29], hospital records [16–21, 23, 24, 26–28, 30–32], and online surveys such as online questionnaires [27]. A detailed description of each study’s demographic characteristics, data resources, and diagnostic criteria for CPG/comorbidities is listed in Table 1.…”

“…Of the eight studies that refer to DM as a whole [16, 17, 19–21, 23, 24, 28], 791 of the 3,547 CPG patients had DM in their lifetime. The crude prevalence ranged from 8.33% to 26.25%.…”

Dupilumab for Recurrent Prurigo Nodularis: A Case Report and Review of the Literature

“…PN is one of the most pruritic diseases associated with pruritus in dermatology [2,18] . Clinical statistics found that the pruritus VAS score of PN can reach to maximum 10 points [7,19,20] . Therefore, it is very important to effectively control and treat the pruritus caused by PN.…”