Abstract
Introduction
Prurigo nodularis (PN) is a chronic, inflammatory skin condition characterized by intensely pruritic, hyperkeratotic nodules most commonly showing a symmetric distribution on arms, legs, and torso. PN is divided into an early-onset atopic and a late-onset nonatopic form.
1
The pathogenic mechanisms behind PN remain unclear, but patients’ skin exhibits alterations in nerve density and inflammation including activation of various proinflammatory pathways such as interleukin (IL) 4, IL-13, IL-31, and neuropeptides.
2
Dupilumab is a fully human monoclonal antibody blocking the IL-4 receptor α thereby inhibiting IL-4/IL-13 signaling and is used in the treatment of moderate-to-severe atopic dermatitis (AD), moderate-to-severe asthma, chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, and PN. IL-4, IL-13, and IL-31 are all part of type 2 inflammation driven by the T helper (Th)2 cells. It has been suggested that inhibition of IL-4 and IL-13 can lead to increased IL-17 activity, which has been proposed as the mechanism behind paradoxical development of both psoriasis
3
and arthritis
4
after dupilumab treatment.
Paradoxical development of psoriasis after dupilumab treatment has been described previously,
5
,
6
particularly in patients with AD, but to our knowledge only one case of scalp psoriasis has been reported after dupilumab treatment of PN.
7
Here, we describe a patient with PN, who experienced widespread psoriasis after dupilumab treatment, but obtained complete resolution of all symptoms after subsequent treatment with adalimumab.
Prurigo nodularis (PN) is a chronic, inflammatory skin condition characterized by intensely pruritic, hyperkeratotic nodules most commonly showing a symmetric distribution on arms, legs, and torso. PN is divided into an early-onset atopic and a late-onset nonatopic form.
1
The pathogenic mechanisms behind PN remain unclear, but patients’ skin exhibits alterations in nerve density and inflammation including activation of various proinflammatory pathways such as interleukin (IL) 4, IL-13, IL-31, and neuropeptides.
2
Dupilumab is a fully human monoclonal antibody blocking the IL-4 receptor α thereby inhibiting IL-4/IL-13 signaling and is used in the treatment of moderate-to-severe atopic dermatitis (AD), moderate-to-severe asthma, chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, and PN. IL-4, IL-13, and IL-31 are all part of type 2 inflammation driven by the T helper (Th)2 cells. It has been suggested that inhibition of IL-4 and IL-13 can lead to increased IL-17 activity, which has been proposed as the mechanism behind paradoxical development of both psoriasis
3
and arthritis
4
after dupilumab treatment.
Paradoxical development of psoriasis after dupilumab treatment has been described previously,
5
,
6
particularly in patients with AD, but to our knowledge only one case of scalp psoriasis has been reported after dupilumab treatment of PN.
7
Here, we describe a patient with PN, who experienced widespread psoriasis after dupilumab treatment, but obtained complete resolution of all symptoms after subsequent treatment with adalimumab.
Originalsprog | Engelsk |
---|---|
Tidsskrift | JAAD Case Reports |
Vol/bind | 52 |
Sider (fra-til) | 146-149 |
Antal sider | 4 |
DOI | |
Status | Udgivet - 2024 |