Post-Stroke Asymmetric Prurigo Nodularis Responding to Dupilumab Treatment: A Case Report

Abstract

Prurigo nodularis (PN) is a dermatological condition characterized by nodular hyperkeratotic lesions mainly on the legs and arms. Asymmetrical PN is a rare dermatological condition often associated with paralysis and stroke. In this paper, we present the case of a 77-year-old woman who developed post-ictal PN which responded to dupilumab, an anti-interleukin-4/13 drug approved for the management of AD, with an extreme reduction in itch sensation. Dupilumab and other therapies reducing Th2 inflammation may, in the future, become an alternative treatment for post-ictal pruritus/PN nonresponding to traditional therapies. Of course, larger studies will be necessary to confirm our case’s findings.

Spontaneous resolution of intractable prurigo nodularis after subinsular cortex stroke

“…New onset of central neurogenic itch has been reported following a stroke in multiple brain regions including the brainstem, thalamus, parietal, and frontal lobes. 2 , 3 , 6 , 7 , 8 , 9 Despite variable stroke locations, all prior reports have noted unilateral paralysis and itch after contralateral stroke, leading prior authors to suggest that loss of descending corticospinal or extrapyramidal pathways may contribute to dysregulation of itch percepts. 8 In 1 case, new onset unilateral PN developed after a contralateral left lateral medullary stroke.…”

“…Pathogenesis of PN implicates dysregulation of neuroimmunologic circuits that potentiate the itch-scratch cycle. 1 Development of unilateral PN after contralateral strokes in various brain regions have been reported, 2 , 3 suggesting a role of the central nervous system (CNS) in the pathophysiology of PN. Here, we present a case of a patient with a decades-long history of treatment-refractory bilateral PN with a dramatic, spontaneous, and persistent resolution of pruritus and skin nodules after a unilateral subinsular cortex stroke.…”

Dupilumab for the treatment of prurigo nodularis: A systematic review

“…The other 13 articles were excluded when they were further studied, leaving behind only 24 articles that fulfilled the selection criteria and were included in the study (Figure 1). The 24 publications included only 1 prospective study (11), 5 retrospective studies (12-16), 5 case series (17-21), and 13 case reports (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34).…”