Resolution of Treatment-Refractory Prurigo Nodularis With Dupilumab: A Case Series

Abstract

Prurigo nodularis is a pruritic skin condition that can present therapeutic challenges. We present a series of three patients diagnosed with prurigo nodularis who had failed several commonly trialed therapies, but experienced relief from symptoms and improvement in skin lesions following initiation of dupilumab therapy. All patients in this series lacked a diagnosis of atopic dermatitis and had lesions on the lower extremities, although other locations such as the trunk were also involved. Continued study of dupilumab in patients with prurigo nodularis is advocated.

Effectiveness of Dupilumab for an Elderly Patient with Prurigo Nodularis Who Was Refractory and Contradicted to Traditional Therapy

“… Pruritus improved with in 4 weeks. Pruritus and skin lesions approximately disappeared within 16 weeks No Wieser et al 11 66 Female No NA Topical corticosteroids, antihistamines, prednisone, methotrexate Pruritus improved with in 20 weeks, skin lesions improved with in 16 weeks No Wieser et al 11 65 Male No NA Thalidomide, intralesional triamcinolone, gabapentin, phototherapy Pruritus and skin lesions improved with in 4 weeks No Wieser et al 11 65 Female No NA Topical corticosteroids, tacrolimus 0.1% ointment, antihistamines, gabapentin, hydroxyzine Pruritus and skin lesions improved with in 28 weeks No …”

Dupilumab: A Review of Present Indications and Off-Label Uses

“…Additionally, the LIBERTY AD CAFÉ trial evaluated dupilumab 300 mg administered weekly or fortnightly to adults with an inadequate not an indication for dupilumab. Published clinical cases and the case series (Table 1) bring together 118 patients diagnosed with chronic prurigo nodularis [77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96] and include patients with and without a history of atopy. Only one involved a child.…”

Clinical phenotypes of adult atopic dermatitis and related therapies

“…In the published clinical cases, 118 patients diagnosed with prurigo nodularis (with and without a history of atopic dermatitis) have been treated with dupilumab at the dose labelled for atopic dermatitis [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81]. Improvement of the disease was achieved in all the patients, with reduction pruritus intensity and decrease of the number and size of the lesions.…”

“…Pruritus generally responded earlier than nodules, and both continued to decrease throughout the treatment. Patients with a history of atopy showed an earlier efficacy of the treatment [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81]. Despite this, no differences were observed in the final response rate between atopic and nonatopic patient [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81].…”