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Objective:To evaluate the efficacy and safety of dupilumab in the treatment of adult prurigo nodularis.Methods:A prospective study was conducted on patients with prurigo nodularis who received the treatment with dupilumab in Peking University People′s Hospital from January 2021 to November 2021. Efficacy was assessed using the Investigator′s Global Assessment (IGA) , Numerical Rating Scale (NRS) and Dermatology Life Quality Index (DLQI) at weeks 0, 4 and 16. Wilcoxon signed-rank test and paired t test were used to analyze changes in the above parameters before and after treatment. Results:A total of 17 patients were enrolled in this study, including 12 females and 5 males, aged 48.47 ± 16.26 years. After 16-week treatment with dupilumab, the pruritus NRS score decreased from 8.00 ± 1.50 at baseline to 1.29 ± 0.85 ( t = 6.98, P < 0.001) , the sleeplessness NRS score decreased from 5.18 ± 2.98 at baseline to 0.12 ± 0.49 ( t = 12.55, P < 0.001) , and the DLQI score declined from 13.29 ± 4.03 at baseline to 0.88 ± 0.70 ( t = 16.39, P < 0.001) ; at week 16, the IGA grade of all the 17 patients decreased from 3 - 4 at baseline to 0 - 2, 16 achieved IGA grades 0 - 1, and 12 achieved IGA grade 0. During the treatment, mild conjunctivitis occurred in 2 cases, local injection reaction occurred in 1, and both conditions were improved after short-term symptomatic treatment. Conclusion:Dupilumab is markedly effective and safe in the treatment of adult prurigo nodularis.
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ABSTRACT:Objective To investigate the distributional characteristics of anaphylactogens in prurigo nodularis (PN)patients so as to provide clinical basis for selecting the method of allergy test.Methods We divided 262 PN patients into four groups and then used skin-prick (5 4 patients ),skin-patch (5 0 patients ),serum IgE allergen detection (56 patients)and serum IgG allergen detection (102 patients)to analyze anaphylactogen positive rate and their distribution differences in PN.Results For skin-prick test in 54 PN patients,the detection rates of platanus orientalis,artemisia argyi,poplar,dust mite,dirt mite,cod,peanut and tomato were higher than those in the control group (P<0.05 ).For skin-patch test in 50 PN patients,the detection rates of nickel sulfate,flavor compounds,black rubber,and carba mix were higher than those in the control group (P<0.05).For serum IgE test in 5 6 PN patients,the detection rates of house dust,scandent hop,cat/dog hair,bug,penicillium/neurospora and mutton were higher than those in the control group (P<0.05).For serum IgG test in 102 PN ones,the detection rates of crab,shrimp,beef and cod were higher than those in the control group (P<0.05).Conclusion Skin-prick test and serum IgE detection have high application values in PN patients.Serum IgG detection is of certain importance in adjusting PN patients’diet structure while skin-patch test applied in PN needs further exploration.
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Objective To investigate the clinical efficacy of fire needling plus moxibustion in treating prurigo nodularis. Methods Ninety patients with prurigo nodularis were randomly allocated to treatment and control groups, 45 cases. The treatment group received fire needling plus moxibustion and the control group, external application of halometasone ointment. Skin lesions and pruritus were scored in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups. Results There were statistically significant pre-/post-treatment differences in the skin lesion score and the pruritus score in the two groups (P<0.01,P<0.05). There were statistically significant post-treatment differences in the skin lesion score and the pruritus score between the treatment and control groups (P<0.01). The total efficacy rate was 81.8% in the treatment group and 60.5% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion Fire needling plus moxibustion is an effective way to treat prurigo nodularis.
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Objective To observe the efficacy of bloodletting therapy plus narrow band ultraviolet B (NB-UVB) in treating prurigo nodularis.Method According to the randomized controlled principle, the enrolled patients were divided into a treatment group and a control group. The treatment group was intervened by bloodletting cupping at the selected acupoints and the topical areas plus NB-UVB once every other day; the control group was by orally taking Mizolastine sustained release tablets and external application of Halometasone cream.Result The total effective rate was 85.7% in the treatment group versus 61.9% in the control group, and the difference was statistically significant (P<0.01).Conclusion Bloodletting therapy plus NB-UVB can produce a content efficacy in treating prurigo nodularis, with few adverse reactions.
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Prurigo Nodularis (PN) is a rare chronic skin disorder of unknown etiology. Here we are describing a case of 14 year old girl having prurigo nodularis with no other systemic illness.
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Medical treatment function vitiligo aims to restore color to use depigmented patches. Psoralen photochemotherapy (PUVA) may be used if there is extensive vitiligo. Possible long-term adverse effects of PUVA therapy include accelerated skin aging with wrinkle formation, telangiectasias, lentigines, elastosis, xerosis and pigmentary changes. Accidental burns during photochemotherapy have been reported though nodular prurigo has never been reported. Vitiliginous skin is more rone to burns.
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Generalized eczema with pruritus may be due to various causes including atopic dermatitis, contact allergy and drug ingestion. However, unexplained recalcitrant eczema may be associated with an underlying lymphoproliferative malignancy. A 41-year-old woman visited our clinic with a 3-month history of pruritic erythematous papules and nodules on the whole body. She was diagnosed as having prurigo nodularis and treated, but failed to respond to conventional treatment including steroids, cyclosporine and antihistamine. About 3 months later, the patient developed low-grade fever and night sweats. Computed tomography of the chest confirmed an enlarged lymph node suggestive of Hodgkin's lymphoma. Patients who have recalcitrant eczema should be evaluated with a careful examination for internal malignancies.
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Adult , Female , Humans , Cyclosporine , Dermatitis, Atopic , Eating , Eczema , Fever , Hodgkin Disease , Hypersensitivity , Lymph Nodes , Prurigo , Pruritus , Steroids , Sweat , ThoraxABSTRACT
Prurigo nodularis is a distressing, chronic disease, which is considered to be very resistant to therapy. Treatment choice is quite limited. Among them, opiate antagonist and phototherapy have been used with satisfactory results. We report a case of treatment-resistant prurigo nodularis. Narrow band-UVB phototherapy was performed twice weekly for 3 months. Naltrexone 50mg was also taken daily before sleep. Pruritus was midly reduced after 1 week, and had almost completely disappeared after 3 months of treatment.
Subject(s)
Chronic Disease , Naltrexone , Phototherapy , Prurigo , PruritusABSTRACT
BACKGROUND: Prurigo nodularis(PN) is a rare recalcitrant pruritic disease. Its pathophysiology is still debatable and a matter of speculation. And, there has been no large case study in Korea. OBJECTIVE: We tried to evaluate the epidemiologic aspects in Korea, and the clinicopathologic correlates of PN. METHODS: 51 patients were included in this study. The patients were divided into atopic and nonatopic groups. All the available clinical and laboratory data including total serum IgE were collected and analyzed. 48 slides were stained in hematoxylin-eosin. For immunophenotyping of cellular infiltrate and identification of neural tissue, 10 cases of them were stained immunohistochemically. They were examined under light microscope. RESULTS: The male to female ratio was 2.4:1. The age was varied from 3 to 64 years, averaging 36.6 years. The age of onset was varied from 2 to 64 years with two peaks in second and fifth decades. The site of predilection were the extremities (96%) and less commonly the trunk (49%). The underlying diseases were present in 23.5% of total patients. The atopic group has relatively younger age and higher total serum IgE level than non-atopic group. There was no significant difference in the recorded pathologic and immunohistopatholgic characteristics between two groups except the deep inflammatory infiltrate and dyskeratosis. There was prominent neural hyperplasia associated with vascular proliferation and inflammatory cellular infiltrate. CONCLUSIONS: There were some epidemiologic differences from western patients. There were about twice as more male patients. Age of onset had some predilections. Atopic and non-atopic groups were different in clinical and some pathologic variables. The former was younger, had higher total serum IgE, and histopathologically, showed more pronounced neural hyperplasia.
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Female , Humans , Male , Age of Onset , Extremities , Hyperplasia , Immunoglobulin E , Immunophenotyping , Korea , PrurigoABSTRACT
Prurigo nodularis is a troublesome chronic dermatosis that showed unsatisfactory response to conventional therapies. Since thalidomide has been applied to the treatment of prurigo nodularis, although the action mechanism is still uncertain, many dermatologists have confirmed its effectiveness. We treated a 54-year-old male patient who had prurigo nodularis affecting the whole body for 10 years with 100 to 300mg of thalidomide daily as the sole therapy for 4 months. The skin lesions were flattened leaving postinflammatory hyperpigmentation and the pruritus also sub-sided. Two years after stopping thalidomide, no recurrence was observed.
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Humans , Male , Middle Aged , Hyperpigmentation , Prurigo , Pruritus , Recurrence , Skin , Skin Diseases , ThalidomideABSTRACT
Objective To study the role of calcitonin-gene-related peptide (CGRP) and substance P (SP) in the pathogenesis of prurigo nodularis. Methods SABC immunohistochemical technique was used to examine the expression of CGRP and SP in lesional skin and uninvolved skin of 30 cases of prurigo nodularis and in skin of 15 normal controls. Results The strong expression of CGRP and SP was observed in the whole epidermis of lesional skin in 30 cases, with the expression surrounding cell membranes. The weak expression of CGRP and SP was observed in nonlesional and normal epidermis. CGRP and SP expression levels had significant differences in the lesional skin and in normal and uninvolved skin (P