The Disease is Uncommon, the Symptom is Not — and Dupixent Seems To Help

Excessive type 2 inflammation is a feature of atopic dermatitis and many cases of asthma. But it also underlies less well-known conditions, such as a chronic urticaria (chronic hives).

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Chronic prurigo is on that list of fairly obscure conditions that stem from overzealous type 2 inflammation. Prurigo (pronounced prue-RYE-go) means itch, and chronic prurigo, as the name suggests, is an itch that lingers. Although mild itches, and the scratching that people do to relieve them, are everyday fact-of-life, chronic prurigo can lead to an itch-scratch cycle that often results in scarring and can have a profound effect the people’s quality of life.

Clinicians at the University Hospital Zurich recently a published a case series comprising 10 patients with chronic prurigo and the results of treatment with Dupixent (dupilumab), a monoclonal human IgG antibody that inhibits cytokines that are an important part of type 2 inflammation.

Corresponding author Jürg Hafner, senior staff physician in the hospital’s dermatology department, and colleagues used hospital records, photographs and answers to validated questionnaires to of conduct their study. The questionnaires included the dermatology life-quality index (DLQI), self-administered questionnaire that assesses quality of life over the past seven days for patient with skin conditions, and the itchy quality-of-life (ItchyQoL) questionnaire that is designed specifically for patients with chronic pruritis problems. They also had data from a numerical rating scale that asks people to rate their condition on a scale of 1-10.

Hafner and colleagues initially identified 15 patients at the hospital to include in the study, but four declined and one could not be reached, so there case series consisted of 10 patients. Six of them had pruriginous atopic dermatitis: chronic prurigo overlapping with atopic dermatitis. All of the patients had received Dupixent injections every two to five weeks and prior to Dupixent had used emollients, topical corticosteroids and ultraviolet light.

The researchers found that Dupixent resulted in significant improvement of chronic prurigo. For example, they calculated that after a year of treatment, the DLQI score changed by 42% and the ItchyQoL by 45%. They reported an overall result in the measures assessed by the questionnaires ranging from -42 % to -82%.

The side effects of headache and vertigo were reported by four patients, but Hafner and colleagues reported that the vertigo was “self limited” and that no serious side effects occurred. There was one case of eosinophilia but it was transient, according to the researchers.

The limitations of the study are those typical of a relatively small case series at a single institution.

The study was published online in June on the website of the journal Dermatology.