Effectiveness of Dupilumab for the Treatment of Generalized Prurigo Nodularis Phenotype of Adult Atopic Dermatitis

Background Generalized prurigo nodularis (GPN) is a debilitating, inflammatory skin disease characterized by chronic pruritus, signs of prolonged scratching, and multiple pruriginous papules and nodules. Recent studies identified several forms of GPN as a clinical phenotype of adult atopic dermatitis (AD). Objective The aim of the study was to evaluate the effectiveness of dupilumab (D) in adults affected by persistent AD showing a clinical feature of GPN. Methods A retrospective study was performed on adult patients affected with GPN clinical variant of AD, treated with D from July 2018 to March 2019. Atopic dermatitis severity was evaluated using the Eczema Area and Severity Index, visual analog scales ranging from 0 to 10 for pruritus, and Dermatology Life Quality Index. Results Ninety AD patients (52 males [57.7%]; mean age = 44.6 years; range = 18-66 years) were treated with D. In 9 (10.0%) of 90 cases, GPN pattern was observed. A significant improvement in Eczema Area and Severity Index, Dermatology Life Quality Index, and pruritus visual analog scale score was observed after treatment with D. Conclusions Generalized prurigo nodularis is currently considered to be a rather common clinical pattern of adult AD. Dupilumab can be an efficacious treatment of this condition, especially in cases where history of atopy is recorded and conventional treatments are ineffective.