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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 5  |  Page : 629
Effective treatment of prurigo nodularis with dupilumab: A case report


Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

Date of Web Publication29-Dec-2022

Correspondence Address:
Ping Wang
Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_459_21

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How to cite this article:
Liu C, Xiong JX, Chen Aj, Wang P. Effective treatment of prurigo nodularis with dupilumab: A case report. Indian J Dermatol 2022;67:629

How to cite this URL:
Liu C, Xiong JX, Chen Aj, Wang P. Effective treatment of prurigo nodularis with dupilumab: A case report. Indian J Dermatol [serial online] 2022 [cited 2023 Jan 31];67:629. Available from: https://www.e-ijd.org/text.asp?2022/67/5/629/366133




Sir,

Prurigo Nodularis (PN) is a chronic skin disease that is difficult to treat and always with severe pruritus. The lesions are usually symmetrically distributed on the extended sides of the extremities. Effective therapeutic options are limited, and long-term treatment with off-label systemic medications such as cyclosporine, methotrexate, or thalidomide may result in significant side effects. Dupilumab is a monoclonal antibody targeting the IL-4 and IL-13, which are the Th2 cytokines. Recent reports demonstrated that dupilumab may be a safe and efficient treatment in atopic and non-atopic PN. Here, we report a case of refractory PN, which was successfully treated by dupilumab.

A 51-year-old male came to our department presented with pruritic papules and nodules affecting his extremities and torso for over ten years [Figure 1] and [Figure 2]. Neither did he have a history of atopic diseases such as asthma, allergic rhinitis, or atopic dermatitis, nor did his first-degree relatives. He was treated with immunosuppressant, topical steroids, antihistamines and oral antibiotics without resolution before. According to his clinical manifestations and lesional histopathology, a diagnosis of PN was made. His serum total IgE was normal. The Dermatology Life Quality Index (DLQI) was 8, pruritus and sleep loss were 6/10 and 5/10 [Figure 1], respectively, on a numerical rating scale (NRS) (score 0–10). On treatment, the patient was first given Dupilumab 600 mg followed by 300 mg every 2 weeks subcutaneously, the total course of treatment being 16 weeks. After only 2 weeks (combined therapy of topical steroids with levocetirizine 5 mg per night), his itching was lessened. The NRS of pruritus and sleep loss, respectively, were only 2/10 and 1.5/10. Then, he stopped topical steroids and levocetirizine from the third week. After 16 weeks of treatment, the NRS of pruritus and sleep loss, respectively, were 0.5/10 and 0/10, resulting in a significant improvement in the quality of life, as evidenced by the DLQI score of 2 [Figure 1] and [Figure 2]. Obviously, with the notable reduction of pruritus, the lesions were also reduced. The hypertrophic plaques and nodules were flattened or disappeared, and some were left with pigmentation only [Figure 2].
Figure 1: Changes in clinical symptoms and medication regimen. TS, topical steriods; L, levocetirizine; DLQI, Dermatology Life Quality Index; NRSi and NRSs, numerical rating scale of itching and sleep loss; w, weeks

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Figure 2: Papules and nodules on the turnk and extremities noted before dupilumab treatment (upper lane) and the lesions significantly improved after 4 months of dupilumab injection (lower lane)

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The pathogenesis of PN is still not clear. Studies have shown that expression of the T-helper type 2 cytokines (IL-4 and IL-13) has been observed in PN biopsies, suggesting that these mediators are important in PN.[1] Dupilumab can block IL-4 and IL-13, which may be one of the reasons that it is effective in treating PN. According to our case and those previous reports,[2],[3] we believe that it is necessary to conduct further research to evaluate the long-term safety and effectiveness of dupilumab in PN.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Fukushi S, Yamasaki K, Aiba S. Nuclear localization of activated STAT6 and STAT3 in epidermis of prurigo nodularis. Br J Dermatol 2011;165:990-6.  Back to cited text no. 1
    
2.
Romano C. Safety and effectiveness of dupilumab in prurigo nodularis. J Investig Allergol Clin Immunol J Investig Allergol Clin Immunol 2021;31:162-3.  Back to cited text no. 2
    
3.
Calugareanu A, Jachiet M, Tauber M, Nosbaum A, Bouaziz JD. Effectiveness and safety of dupilumab for the treatment of prurigo nodularis in a French multicenter adult cohort of 16 patients. J Eur Acad Dermatol Venereol 2020;34:e74-6.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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