Peer-review started: October 14, 2022
First decision: November 4, 2022
Revised: November 10, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 16, 2023
Prurigo nodularis (PN) is a chronic condition characterized by a papulonodular pruriginous eruption of unknown aetiology. Currently, there are no medications for PN that the United States Food and Drug Administration has approved, which leads to very variable practices in the prescription of off-label treatments. Treatment of PN is based on clinical experience rather than controlled trials. We present our case of generalized PN, in which we had a dramatic response with dupilumab.
A 58-year-old female patient was admitted to our clinic with severe itchy, erythematous nodular lesions that were widespread all over her body, especially on the legs and back. It was learned that the patient's complaints started 4 years ago, and there was a significant increase in the lesions in the last period. Dermatological examination revealed diffuse firm erythematous excoriated nodular lesions all over the body. In the blood tests of the patient, serum Immunoglobulin E (IgE) was measured at 9330 IU/mL. The patient was diagnosed with generalized prurigo nodularis together with clinical and histopathological findings. Due to severe clinical findings and the presence of comorbidities, dupilumab treatment was planned for the patient. In the follow-up 4 mo later, it was observed that all nodular lesions healed with postinflammatory hypopigmentation. The IgE value decreased to 1500 IU/mL after 4 mo of dupilumab treatment.
Dupilumab treatment stands out as an effective and safe systemic treatment agent among existing systemic treatments.
Core Tip: Prurigo nodularis (PN) is a difficult disease to treat and causes frustration to both the patient and the treating doctor. Treatment of PN is based on clinical experience rather than controlled trials. PN is a disease that negatively affects the quality of life of patients due to severe itching. Patients often receive limited benefit from first-line treatments and require systemic therapy. Dupilumab treatment stands out as an effective and safe systemic treatment agent among existing systemic treatments. In this case, we show how effective and well tolerated treatment with dupilumab is in the treatment of recalcitrant PN.