Emerging treatment of prurigo nodularis with dupilumab.

Abstract

A 69-year-old woman presented to the allergy and immunology clinic in May 2023 with a recurrent pruritic rash on the arms and legs, which fi rst began within 24 – 48 h of taking Bactrim (sulfamethoxazole and trimethoprim) and persisted for 3 months after antibiotic cessation. The patient had a medical history of osteoarthritis, depression, and insomnia. The patient ’ s symptoms originally improved upon taking prednisone, and she was rash-free for 3 months. The patient was then evaluated by dermatology and was o ff ered a skin biopsy, but she declined in favor of wishing to trial medical management fi rst. Once the symptoms recurred, the patient did not experience symptomatic relief following treatment with topical triamcinolone and clobetasol or oral methyl-prednisolone and prednisone. The patient presented to our outpatient allergy and immunology clinic with excoriated nodular lesions of the extremities while on a current regimen of hydroxyzine. Given her history, biopsy was not advised. The patient was diagnosed with prurigo nodularis (PN), a chronic in fl ammatory skin condition for which dupilumab was recommended every 4 weeks (Figure 1). PN is associated with intensely pruritic and hyperker-atotic nodules that are symmetrically distributed along the extensor surfaces of the extremities [1]. Distinguishing features include light to bright red papules, nodules, and plaques that are excoriated and have hyperpigmented margins. These