The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Shawn G. Kwatra - One of the best experts on this subject based on the ideXlab platform.
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Prurigo nodularis: Pathogenesis and management
Journal of the American Academy of Dermatology, 2020Co-Authors: Kyle A. Williams, Amy H. Huang, Micah Belzberg, Shawn G. KwatraAbstract:Prurigo nodularis is a chronic skin condition characterized by severely pruritic nodules that cause a profound negative impact on quality of life. The second article in this 2-part continuing medical education series focuses on reviewing the pathogenesis of Prurigo nodularis and exploring management algorithms for this condition. In addition, we discuss some emerging and novel therapies for treating Prurigo nodularis. The first article in this 2-part series describes the broader epidemiology, patient demographics, physical examination findings, and symptoms to aid in the timely recognition and diagnosis of Prurigo nodularis.
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Breaking the Itch-Scratch Cycle in Prurigo nodularis.
The New England journal of medicine, 2020Co-Authors: Shawn G. KwatraAbstract:Prurigo nodularis is a chronic dermatologic condition that features intensely itchy, excoriated nodules on the extensor surfaces of the arms and legs and on the trunk. The disorder is most common i...
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Thalidomide for the treatment of chronic refractory Prurigo nodularis.
Dermatology online journal, 2018Co-Authors: Crystal Aguh, Shawn G. Kwatra, Ginette A. OkoyeAbstract:Prurigo nodularis (PN) is a highly pruritic skin condition that is caused by chronic scratching. It occurs in patients with chronic itch and is characterized by multiple hyperkeratotic papules and nodules. The pathogenesis of PN is unclear, but involves a complex interplay of numerous pathways including neurogenic and inflammatory factors. As such, PN is very difficult to treat and patients are often refractory to multiple medications before finding a treatment that is effective. We present a woman with a 20-year history of exuberant Prurigo nodularis who failed multiple therapies, including dapsone, azathioprine, mycophenolic acid, prednisone, topical steroids, and phototherapy. She only obtained significant relief of chronic pruritus and lesion flattening with thalidomide 100mg daily. Thalidomide is an antipruritic and anti-inflammatory agent that has shown to be very effective in treating a variety of dermatologic conditions. However, its use today is limited by concerns for its teratogenic and neuropathic side effects. With strict adherence to medication protocols, these adverse effects can be minimized. As such, thalidomide should be considered for patients with refractory dermatologic conditions.
Sonja Stander - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology of Prurigo nodularis compared with Psoriasis in Germany: A Claims Database Analysis.
Acta dermato-venereologica, 2020Co-Authors: Sonja Stander, Miriam Ketz, Nils Kossack, Divine Akumo, Marc Pignot, Sylvie Gabriel, Rajeev ChavdaAbstract:Prurigo nodularis is an itchy skin disease with unknown epidemiology. This study aimed to describe the epidemiology of Prurigo nodularis compared with that of psoriasis. The German sickness fund claims database, with 2,783,175 continuously insured patients, included 1,720 patients diagnosed with Prurigo nodularis and 51,390 with psoriasis. Patients with Prurigo nodularis were averagely 8 years older than psoriasis patients and more often were women (p < 0.001). Annual incidence was a constant 0.02% in Prurigo nodularis, and decreased steadily from 0.53 to 0.42% in psoriasis; cumulative incidence was 0.1% for Prurigo nodularis and 1.9% for psoriasis. Prevalence was 0.1% for Prurigo nodularis and 4.7% for psoriasis, with a 1-year mortality of 5.4% for Prurigo nodularis and 1.2% for psoriasis (p < 0.001). The most frequent pre-existing comorbidities in patients with Prurigo nodularis were inflammatory dermatoses and depression. This epidemiological study found a low prevalence of Prurigo nodularis, manifesting different demographics and comorbidities compared with psoriasis.
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Trial of Nemolizumab in Moderate-to-Severe Prurigo nodularis
The New England journal of medicine, 2020Co-Authors: Sonja Stander, Gil Yosipovitch, Franz J. Legat, Jean-philippe Lacour, Carle Paul, Joanna Narbutt, Thomas Bieber, Laurent Misery, Andreas Wollenberg, Adam ReichAbstract:Abstract Background Prurigo nodularis is a chronic pruritic skin disease with multiple nodular skin lesions. Nemolizumab is a monoclonal antibody targeting the interleukin-31 receptor, which is inv...
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Prurigo nodularis and Its Management.
Dermatologic clinics, 2018Co-Authors: Claudia Zeidler, Gil Yosipovitch, Sonja StanderAbstract:Prurigo nodularis occurs with chronic pruritus and the presence of single to multiple symmetrically distributed, hyperkeratotic, and intensively itching nodules. Diverse dermatologic, systemic, neurologic, or psychiatric conditions can lead to Prurigo nodularis. Structural analysis demonstrated a reduced intraepidermal nerve fiber density and increased dermal levels of nerve growth factor and neuropeptides such as substance P and calcitonin gene-related peptide. Novel therapy concepts such as inhibitors at neurokinin-1, opioid receptors, and interleukin-31 receptors have been developed. The mainstays of Prurigo nodularis therapy comprise topical steroids, capsaicin, calcineurin inhibitors, phototherapy, and the systemic application of anticonvulsants, μ-opioid receptor antagonists, or immunosuppressants.
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Prurigo nodularis Management.
Current problems in dermatology, 2016Co-Authors: Athanasios Tsianakas, Claudia Zeidler, Sonja StanderAbstract:Characterized by the clinical presentation of individual to multiple symmetrically distributed, hyperkeratotic, and intensely itchy papules and nodules, Prurigo nodularis (PN) is a rare disease that emerges in patients with chronic pruritus due to continuous scratching over a long period of time. The itching and scratching of the lesions contribute to the vicious cycle that makes this disease difficult to treat, thus reducing the quality of life of affected patients. The pathogenesis of PN is ambiguous, although immunoneuronal crosstalk is implicated. Its etiology was found to be heterogenous. It can emerge as the symptom of various dermatological, neurological, psychiatric, and systemic diseases. There is currently no approved therapy for PN. However, contemporary therapies consist of calcineurin inhibitors, capsaicin, topical steroids, UV therapy, and a systemic application of antihistamines, anticonvulsants, μ-opioid receptor antagonists, and immunosuppressants. Multimodal therapy should be utilized in order to achieve optimal results, including topical and systemic symptomatic therapies.
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Prurigo nodularis – an update on an important disease
Journal of the Egyptian Womenʼs Dermatologic Society, 2016Co-Authors: Athanasios Tsianakas, Claudia Zeidler, Claudia Riepe, Sonja StanderAbstract:Prurigo nodularis (PN) is defined as a clinical pattern of mostly symmetrically papules and nodules and belongs to the group of chronic pruritic diseases. Underlying diseases can be skin diseases (e.g. atopic dermatitis or lichen planus), internal medical diseases (e.g. hepatic or renal diseases), a
Paola Di Carlo - One of the best experts on this subject based on the ideXlab platform.
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Prurigo nodularis due to Mycobacterium tuberculosis.
Journal of Medical Microbiology, 2009Co-Authors: Laura Saporito, Ada Maria Florena, Claudia Colomba, Diego Pampinella, Paola Di CarloAbstract:Prurigo nodularis (PN) is a rare chronic skin disorder of unknown origin. Here we describe what is believed to be the first case of PN associated with tuberculosis. For the first time, culture and PCR analysis of skin biopsy confirmed the presence of Mycobacterium tuberculosis complex in PN skin lesions. The pruritus and skin lesions resolved following antitubercular therapy. Our case provides further evidence in favour of a link between PN and mycobacterial infection.
Neal S. Penneys - One of the best experts on this subject based on the ideXlab platform.
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Merkel cells and Prurigo nodularis
Journal of the American Academy of Dermatology, 1994Co-Authors: George T. Nahass, Neal S. PenneysAbstract:Background: Increased numbers of dermal nerves have been demonstrated in Prurigo nodularis and have been theoretically linked to the intense pruritus. We hypothesized that the neuronal proliferation in Prurigo nodularis might be associated with an increased density of Merkel cells because they are also a component of the neurocutaneous system. Methods: We examined skin biopsy specimens from 20 cases of Prurigo nodularis for Merkel cells with the use of a standard immunohistochemical assay (avidin-biotin-peroxidase complex system) with an antibody to cytokeratin 8 (CAM 5.2). Six cases of lichen simplex chronicus were examined as controls. Results: Merkel cells were present in the interfollicular area of the basal cell layer in 15(75%) of 20 Prurigo nodularis cases and in one (17%) of six cases of lichen simplex chronicus. Conclusion: Merkel cells are increased in number in Prurigo nodularis and may be a component of the neurocutaneous abnormality associated with this disorder.
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Demonstration by S-100 protein staining of increased numbers of nerves in the papillary dermis of patients with Prurigo nodularis.
Journal of the American Academy of Dermatology, 1992Co-Authors: Brian Harris, Keith Harris, Neal S. PenneysAbstract:Background: We hypothesized that hyperplasia of papillary dermal nerves was a constant feature of Prurigo nodularis. Objective: We tested this hypothesis by examining sections from 25 cases of Prurigo nodularis, 25 cases of skin lesions characterized by epidermal hyperplasia without clinical pruritus, and 22 cases of clinically pruritic dermatoses with variable degrees of epidermal response for the presence of papillary dermal nerves. Methods: We used a standard immunohistochemical assay with an antibody to S-100 protein as a means of identification of nerves. Results: In 24 of 25 cases of Prurigo nodularis, papillary dermal nerves were identified by immunostaining. Cutaneous nerves were present in 1 of 22 cases of epidermal hyperplasia with pruritus and were absent in the papillary dermis in nonpruritic cases. Conclusion: We conclude that hypertrophy of Cuaneous papillary dermal nerves is a relatively constant feature of Prurigo nodularis. The presence of papillary dermal nerves suggests a neurocutaneous component in the pathogenesis of Prurigo nodularis.
J M Carrascosa - One of the best experts on this subject based on the ideXlab platform.
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Phototherapy for Prurigo nodularis: Our Experience and a Review of the Literature.
2021Co-Authors: A Arrieta, A Jaka, E Del Alcázar, M Blanco, J M CarrascosaAbstract:Abstract Background and objective Prurigo nodularis is a chronic inflammatory skin disease characterized by highly pruritic nodular lesions that cause constant itching and scratching and significant quality-of-life impairment. It has been described in a range of conditions, including skin diseases (mainly atopic dermatitis) and metabolic, neurological, and psychiatric disorders. The pathophysiological mechanisms are largely unknown. Various modalities of phototherapy have been described as appropriate and safe treatments for achieving clinical control and alleviating symptoms. In this article, we describe our experience with phototherapy in patients with Prurigo nodularis. Material and methods Retrospective observational study of patients who received their first cycle of phototherapy to treat Prurigo nodularis between March 2011 and October 2019. Information was collected on epidemiological and clinical characteristics, concomitant treatments, type and duration of phototherapy, maximum dose reached, and response to treatment. Results We studied 44 patients (30 women and 14 men) with a median age of 65.5 years. The most common form of phototherapy used was narrowband UV-B phototherapy (34 cycles, 77.27%) followed by a combination of UV-B and UV-A phototherapy (8 cycles). Response to treatment was considered satisfactory (clearance rate of ≥ 75%) in 24 patients (55.4%). Conclusions Phototherapy is a suitable treatment for Prurigo nodularis in a considerable proportion of patients. It can be used as monotherapy or combined with other treatments.
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Phototherapy for Prurigo nodularis: Our Experience and a Review of the Literature.
Actas dermo-sifiliograficas, 2020Co-Authors: A Arrieta, A Jaka, E Del Alcázar, M Blanco, J M CarrascosaAbstract:Prurigo nodularis is a chronic inflammatory skin disease characterized by highly pruritic nodular lesions that cause constant itching and scratching and significant quality-of-life impairment. It has been described in a range of conditions, including skin diseases (mainly atopic dermatitis) and metabolic, neurological, and psychiatric disorders. The pathophysiological mechanisms are largely unknown. Various modalities of phototherapy have been described as appropriate and safe treatments for achieving clinical control and alleviating symptoms. In this article, we describe our experience with phototherapy in patients with Prurigo nodularis. Retrospective observational study of patients who received their first cycle of phototherapy to treat Prurigo nodularis between March 2011 and October 2019. Information was collected on epidemiological and clinical characteristics, concomitant treatments, type and duration of phototherapy, maximum dose reached, and response to treatment. We studied 44 patients (30 women and 14 men) with a median age of 65.5years. The most common form of phototherapy used was narrowband UV-B phototherapy (34 cycles, 77.27%) followed by a combination of UV-B and UV-A phototherapy (8 cycles). Response to treatment was considered satisfactory (clearance rate of ≥75%) in 24 patients (55.4%). Phototherapy is a suitable treatment for Prurigo nodularis in a considerable proportion of patients. It can be used as monotherapy or combined with other treatments. Copyright © 2020 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.
