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Eczema (dermatitis)
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
The disorder is quite common in middle-aged individuals regardless of sex or race. It is a very stubborn disorder, which is very resistant to treatment and recurrences are frequent. Prurigo nodularis is similarly persistent.
Benign lesions
Published in Richard P. Usatine, Daniel L. Stulberg, Graham B. Colver, Cutaneous Cryosurgery, 2014
Richard P. Usatine, Daniel L. Stulberg, Graham B. Colver
Prurigo nodularis is a chronic severely pruritic condition with “itchy bumps.” It is seen along with lichen simplex chronicus in patients who find it hard to stop scratching their skin (psychocutaneous conditions). Initial therapy often starts with high-potency topical steroids and oral antihistamines. The intensely itchy nodules of prurigo nodularis are well served by fine nerve endings so that the itching may resemble neuropathic pain. Medications to treat neuropathy such as gabapentin are often used for recalcitrant cases of prurigo nodularis.27 Cryosurgery is known to create a degree of skin anesthesia and this property has been used to treat prurigo nodularis (Figure 8.26). In one case report, multiple freeze–thaw cycles with liquid nitrogen were used to create a blistering freeze for each nodule.28 The freeze times varied from 10 s to 30 s. The lesions took weeks to heal and there was much initial hypopigmentation. The itching resolved, the nodules flattened, and repigmentation occurred over time.28 Another treatment option involves using cryosurgery combined with intralesional injection of triamcinolone in a similar manner to keloids.
The Histopathology of Eczema
Published in Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld, Atopic Dermatitis and Eczematous Disorders, 2014
Cynthia M. Magro, A. Neil Crowson, Molly E. Dyrsen, Martin C. Mihm
Over time, the degree of acanthosis increases and the degree of spongiosis and inflammation diminishes to produce chronic dermatitis. In this particular setting, lesions are typically psoriasiform with regular elongation and thinning of rete ridges, but with thickening of the suprapapillary plates and diminished inflammation. Lichen simplex chronicus connotes a form of chronic dermatitis in which there is vertical fibrosis (namely collagen) laid down alongside elongated rete ridges as a function of persistent rubbing (Fig 19.8). The discriminating morphological distinction between subacute eczematous dermatitis and lichen simplex chronicus is the presence of inflammatory cells in the epidermis. If one observes changes of chronicity such as acanthosis and hyperkeratosis, but with supervening vesiculation and exocytosis of inflammatory cells, the designation of subacute eczematous dermatitis is used. If one sees changes of chronicity, but without any migration of inflammatory cells in the epidermis, then the designation is that of lichen simplex chronicus. If the patient persistently irritates and scratches a given site of lichen simplex chronicus, the epidermis can become so markedly acanthotic with contributions from the adnexal structures (the pilosebaceous units and the eccrine straight ducts) that lobules of rather banal squamous epithelium are present in the papillary and/or reticular dermis in a fashion that mimics squamous cell carcinoma. This hyperproliferative form of eczema is termed ‘prurigo nodularis.’
Identification of clinical predictors for dupilumab dose spacing in adults with atopic dermatitis: a real-world study
Published in Journal of Dermatological Treatment, 2023
Andrea Chiricozzi, Giacomo Dal Bello, Niccolò Gori, Lucia Di Nardo, Donatella Schena, Giacomo Caldarola, Martina Maurelli, Clara De Simone, Giampiero Girolomoni, Ketty Peris
All patients treated with dupilumab for at least 16 weeks were considered. All patients were encouraged to use emollients daily, while topical corticosteroids or topical calcineurin inhibitors were applied as needed. The following clinical and demographic data were collected from patient charts: sex, personal history of AD or/and other atopic manifestation, age at AD onset, total IgE serum levels, clinical phenotypes (13), topographical distribution of skin lesions, disease duration, comorbidities, previous and current therapies, age at treatment initiation, schedule of dupilumab administration. Disease severity was assessed by: a) Eczema Area Severity Index (EASI) varying from 0 to 72; b) itch Numeric Rating Scale (itch-NRS) ranging from 0 to 10; and c) Dermatology Life Quality Index (DLQI) varying from 0 to 30. Disease severity in patients affected by prurigo nodularis was assessed by a dedicated IGA score (14).
The NK1 receptor antagonist serlopitant for treatment of chronic pruritus
Published in Expert Opinion on Investigational Drugs, 2019
Sonja Ständer, Mary C. Spellman, Paul Kwon, Gil Yosipovitch
Pruritus is the most frequent presenting symptom in dermatology [1,2]. Studies have estimated the point prevalence of chronic pruritus at 14% to 17%, with a lifetime prevalence of 22% to 26% [3–6]. These data indicate that approximately 1 in 4 people experience chronic itch at some point in their lifetime. Chronic pruritus can be associated with a variety of underlying causes, including dermatologic, systemic, neuropathic, psychogenic, mixed, and unknown origin. Many inflammatory skin conditions cause itch; there is currently an unmet need to develop itch-specific drugs that target nonhistaminergic itch [7–9]. In addition, prurigo nodularis (PN) occurs with a lower frequency but is characterized by therapy-refractory pruritus. Patients with chronic pruritus of any etiology experience impaired quality of life comparable to that of patients with chronic pain [10].
Response: Management challenges in prurigo nodularis
Published in Journal of Dermatological Treatment, 2022
Jennifer M. Fernandez, Mitchel G. Hurlbert, Vivian Y. Shi
We read with great interest the Letter to the Editor by Maredia and Kwatra published in the January 2020 issue of the Journal of Dermatological Treatment (1). The authors provided a salient summary of therapeutics currently being used off-label and pipeline medications for prurigo nodularis (PN). They further described major challenges in PN management including the lack of FDA-approved drugs, multiple mechanisms contributing to the pathogenesis of PN (cutaneous, neurologic, psychiatric, and somatoform), and lack of standardized clinical evaluation tools to monitor treatment response (Figure 1). Recent evidence indicates that PN is associated with longer and more costly hospital stays compared to those without PN, highlighting the need to improve current management (2).