Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis

Williams, Kyle; Roh, Youkyung S.; Brown, Isabelle; Sutaria, Nishadh; Bakhshi, Pegah R.; Choi, Justin; Gabriel, Sylvie; Chavda, Rajeev; Kwatra, Shawn G.

doi:10.1080/17512433.2021.1852080

Cited by 50 publications

(56 citation statements)

References 93 publications

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“…14 Currently, there are no approved treatments for PN by the Food and Drug Administration (FDA). 2 However, the use of immunotargeting therapies may provide benefit for patients with PN given the current understanding of its inflammatory mechanism. Previously, the mainstay treatment for PN was immunosuppressants such as steroids; however, there are numerous other immunomodulating treatments that have been utilized to treat PN as of late.…”

Section: Introductionmentioning

confidence: 99%

Immunotargets and Therapy for Prurigo Nodularis

Labib¹,

Ju²,

Does³

et al. 2022

ITT

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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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Section: Introductionmentioning

confidence: 99%

Immunotargets and Therapy for Prurigo Nodularis

Labib¹,

Ju²,

Does³

et al. 2022

ITT

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“…According to recent studies, the pathogenesis of PN is associated with decreased intraepidermal nerve fiber density and abnormal secretion of cytokines such as IL-4, IL-17, IL-22, and IL-31. 1 , 2 As a non-selective JAK inhibitor, tofacitinib can inhibit the JAK-STAT pathway, block the transcription of IL-4 and IL-31, 9 , 10 increase the density of epidermal nerve fibers, and reduce pruritus. The first reported case of tofacitinib for PN, 2 the success of baricitinib for prurigo-type atopic dermatitis, 3 both demonstrate the effectiveness of the JAK inhibitor for the treatment of PN.…”

Section: Discussionmentioning

confidence: 99%

“…Prurigo nodularis (PN) is an intensely pruritic disease characterized by highly keratinized, itchy papules and nodules symmetrically distributed on the extremities of the limbs. 1 Treatment is often challenging and unsatisfying. Recently, Janus kinase (JAK) inhibitors has been successfully used for the treatment of PN.…”

Section: Introductionmentioning

confidence: 99%

Tofacitinib for Prurigo Nodularis: A Case Report

Peng¹,

Li²,

Zhou³

et al. 2022

CCID

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Purpose Despite recent advances in the treatment of prurigo nodularis, conventional treatment suffers from a dilemma of poor efficacy. The clinical use of Janus kinase (JAK) inhibitors in the treatment of Prurigo nodularis has rarely been explored. Patients and Methods We present a case of prurigo nodularis successfully treated with, JAK inhibitor tofacitinib with no adverse effects. Results This case report of successful treatment shows a good clinical efficacy of using JAK inhibitor tofacitinib in the treatment of prurigo nodularis. Cytokines may be an important cause of prurigo nodularis. Conclusion JAK inhibitor tofacitinib may be a new option for the treatment of prurigo nodularis, especially for patients who have failed conventional treatment.

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“…This indicates that patients with PN have higher healthcare utilization, even after controlling for health status. This may be due to increased difficulty in treating patients with PN, possibly due to immune dysregulation of the PN pathogenesis 24 . Nevertheless, there appears to be a substantial healthcare burden associated with PN and a large unmet need for effective treatments.…”

Section: Discussionmentioning

confidence: 99%

Association of prurigo nodularis and infectious disease hospitalizations: a national cross‐sectional study

et al. 2021

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Summary Background Prurigo nodularis (PN) is associated with a variety of systemic comorbidities, including infectious diseases such as HIV and viral hepatitis. There are limited data on other infectious disease comorbidities in patients with PN. Aim To characterize infectious disease hospitalizations among patients with PN and the associated cost burden. Methods We searched the 2016–2017 National Inpatient Sample, a cross‐sectional sample of 20% of all US hospitalizations, for infectious disease hospitalizations among patients with PN. Associations of PN with infections and related costs were determined using multivariable logistic and linear regression, adjusting for age, race, sex and insurance type. Results PN was associated with any infection overall (OR = 2.98, 95% CI 2.49–3.56), and with HIV, cutaneous, hepatobiliary, central nervous system, bacterial, viral and fungal/parasitic infections and for sepsis. Patients with PN had a higher mean cost of care (US$11 667 vs. US$8893, P < 0.001) and length of stay (5.5 vs. 4.2 days, P < 0.001) for any infection overall and for 7 of 13 other infections. Adjusting for age, race, sex and insurance coverage, PN was associated with higher cost (+30%, 95% CI +17 to +44%) and higher length of stay (+30%, 95% CI +18 to +44%) for any infection overall, and for several specific infections. These associations remained with alternate regression models adjusting for severity of illness. Conclusion There is a high infectious disease burden among patients with PN, corresponding to higher healthcare utilization and spending. Clinicians must be aware of these associations when treating these patients with immunomodulatory drugs.

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Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis

Cited by 50 publications

References 93 publications

Immunotargets and Therapy for Prurigo Nodularis

Immunotargets and Therapy for Prurigo Nodularis

Tofacitinib for Prurigo Nodularis: A Case Report

Association of prurigo nodularis and infectious disease hospitalizations: a national cross‐sectional study

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