Chronic Nodular Prurigo: A European Cross-sectional Study of Patient Perspectives on Therapeutic Goals and Satisfaction
DOI:
https://doi.org/10.2340/00015555-3726Keywords:
nodular prurigo, chronic nodular prurigo, patient-reported outcome, itch, pruritus, therapyAbstract
Chronic nodular prurigo is characterized by recalcitrant itch. Patient perspectives on therapeutic goals, satisfaction with therapy and efficacy of therapeutic regimens for this condition are unknown. This questionnaire study examined these issues in 406 patients with chronic nodular prurigo from 15 European dermatological centres. Improvements in itch, skin lesions and sleep were the most important goals. Emollients, topical corticosteroids and antihistamines were the most frequently used treatments, while a minority of patients were prescribed potent medications, such as systemic immunosuppressants and gabapentinoids. Most patients were not satisfied with their previous therapy (56.8%), while 9.8% did not receive any therapy despite having active disease. A substantial number of respondents (28.7%) considered none of the therapeutic options effective. Although chronic nodular prurigo is a severe disease, most patients were not treated with potent systemic drugs, which may contribute to the high levels of dissatisfaction and disbelief in available therapies. Specific guidelines for chronic nodular prurigo and the development of novel therapies are necessary to improve care.
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Pereira MP, Steinke S, Zeidler C, Forner C, Riepe C, Augustin M, et al. European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo. J Eur Acad Dermatol Venereol 2018; 32: 1059-1065.
DOI: https://doi.org/10.1111/jdv.14570
Zeidler C, Tsianakas A, Pereira M, Ständer H, Yosipovitch G, Ständer S. Chronic prurigo of nodular type: a review. Acta Derm Venereol 2018; 98: 173-179.
DOI: https://doi.org/10.2340/00015555-2774
Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Gimenez-Arnau AM, et al. European S2k guideline on chronic pruritus. Acta Derm Venereol 2019; 99: 469-506.
DOI: https://doi.org/10.2340/00015555-3164
Ständer S, Zeidler C, Augustin M, Bayer G, Kremer AE, Legat FJ, et al. S2k-Leitlinie zur Diagnostik und Therapie des chronischen Pruritus - update - Kurzversion. J Dtsch Dermatol Ges 2017; 15: 860-873.
DOI: https://doi.org/10.1111/ddg.13304_g
Ständer HF, Elmariah S, Zeidler C, Spellman M, Ständer S. Diagnostic and treatment algorithm for chronic nodular prurigo. J Am Acad Dermatol 2020; 82: 460-468.
DOI: https://doi.org/10.1016/j.jaad.2019.07.022
Siepmann D, Lotts T, Blome C, Braeutigam M, Phan NQ, Butterfass-Bahloul T, et al. Evaluation of the antipruritic effects of topical pimecrolimus in non-atopic prurigo nodularis: results of a randomized, hydrocortisone-controlled, double-blind phase II trial. Dermatology 2013; 227: 353-360.
DOI: https://doi.org/10.1159/000355671
Hammes S, Hermann J, Roos S, Ockenfels HM. UVB 308-nm excimer light and bath PUVA: combination therapy is very effective in the treatment of prurigo nodularis. J Eur Acad Dermatol Venereol 2011; 25: 799-803.
DOI: https://doi.org/10.1111/j.1468-3083.2010.03865.x
Brenninkmeijer EE, Spuls PI, Lindeboom R, van der Wal AC, Bos JD, Wolkerstorfer A. Excimer laser vs. clobetasol propionate 0.05% ointment in prurigo form of atopic dermatitis: a randomized controlled trial, a pilot. Br J Dermatol 2010; 163: 823-831.
DOI: https://doi.org/10.1111/j.1365-2133.2010.09858.x
Ständer S, Yosipovitch G, Legat FJ, Lacour JP, Paul C, Narbutt J, et al. Trial of nemolizumab in moderate-to-severe prurigo nodularis. N Engl J Med 2020; 382: 706-716.
DOI: https://doi.org/10.1056/NEJMoa1908316
Calugareanu A, Jachiet M, Lepelletier C, De Masson A, Rybojad M, Bagot M, et al. Dramatic improvement of generalized prurigo nodularis with dupilumab. J Eur Acad Dermatol Venereol 2019; 33: e303-e304.
DOI: https://doi.org/10.1111/jdv.15584
Almustafa ZZ, Weller K, Autenrieth J, Maurer M, Metz M. Dupilumab in treatment of chronic prurigo: a case series and literature review. Acta Derm Venereol 2019; 99: 905-906.
DOI: https://doi.org/10.2340/00015555-3243
Pereira MP, Basta S, Moore J, Ständer S. Prurigo nodularis: a physician survey to evaluate current perceptions of its classification, clinical experience and unmet need. J Eur Acad Dermatol Venereol 2018; 32: 2224-2229.
DOI: https://doi.org/10.1111/jdv.15107
Pereira MP, Hoffmann V, Weisshaar E, Wallengren J, Halvorsen JA, Garcovich S, et al. Chronic nodular prurigo: clinical profile and burden. A European cross-sectional study. J Eur Acad Dermatol Venereol 2020; 34: 2373-2383.
DOI: https://doi.org/10.1111/jdv.16309
Storck M, Zeidler C, Rehr M, Riepe C, Dugas M, Ständer S, et al. Validation of pruritus measures gathered with the electronic patient-reported outcome system MoPat. Acta Derm Venereol 2018; 98: 38-43.
DOI: https://doi.org/10.2340/00015555-2799
Blome C, Augustin M, Siepmann D, Phan NQ, Rustenbach SJ, Ständer S. Measuring patient-relevant benefits in pruritus treatment: development and validation of a specific outcomes tool. Br J Dermatol 2009; 161: 1143-1148.
DOI: https://doi.org/10.1111/j.1365-2133.2009.09328.x
Brenaut E, Halvorsen JA, Dalgard FJ, Lien L, Balieva F, Sampogna F, et al. The self-assessed psychological comorbidities of prurigo in European patients: a multicentre study in 13 countries. J Eur Acad Dermatol Venereol 2019; 33: 157-162.
DOI: https://doi.org/10.1111/jdv.15145
Jorgensen KM, Egeberg A, Gislason GH, Skov L, Thyssen JP. Anxiety, depression and suicide in patients with prurigo nodularis. J Eur Acad Dermatol Venereol 2017; 31: e106-e107.
DOI: https://doi.org/10.1111/jdv.13827
Ständer S, Weisshaar E, Mettang T, Szepietowski JC, Carstens E, Ikoma A, et al. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol 2007; 87: 291-294.
DOI: https://doi.org/10.2340/00015555-0305
Siepmann D, Luger TA, Ständer S. Antipruritic effect of cyclosporine microemulsion in prurigo nodularis: results of a case series. J Dtsch Dermatol Ges 2008; 6: 941-946.
DOI: https://doi.org/10.1111/j.1610-0387.2008.06745.x
Wiznia LE, Callahan SW, Cohen DE, Orlow SJ. Rapid improvement of prurigo nodularis with cyclosporine treatment. J Am Acad Dermatol 2018; 78: 1209-1211.
DOI: https://doi.org/10.1016/j.jaad.2018.02.024
Klejtman T, Beylot-Barry M, Joly P, Richard MA, Debarbieux S, Misery L, et al. Treatment of prurigo with methotrexate: a multicentre retrospective study of 39 cases. J Eur Acad Dermatol Venereol 2018; 32: 437-440.
DOI: https://doi.org/10.1111/jdv.14646
Spring P, Gschwind I, Gilliet M. Prurigo nodularis: retrospective study of 13 cases managed with methotrexate. Clin Exp Dermatol 2014; 39: 468-473.
DOI: https://doi.org/10.1111/ced.12365
Mazza M, Guerriero G, Marano G, Janiri L, Bria P, Mazza S. Treatment of prurigo nodularis with pregabalin. J Clin Pharm Ther 2013; 38: 16-18.
DOI: https://doi.org/10.1111/jcpt.12005
Metze D, Reimann S, Beissert S, Luger T. Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases. J Am Acad Dermatol 1999; 41: 533-539.
DOI: https://doi.org/10.1016/S0190-9622(99)80048-6
Brune A, Metze D, Luger TA, Ständer S. Antipruritische Therapie mit dem oralen Opiatrezeptorantagonisten Naltrexon. Hautarzt 2004; 55: 1130-1136.
DOI: https://doi.org/10.1007/s00105-004-0802-8
Ständer S, Pereira MP, Berger T, Zeidler C, Augustin M, Bobko S, et al. IFSI-Guideline on chronic prurigo including prurigo nodularis. ITCH 2020; 5: e42.
DOI: https://doi.org/10.1097/itx.0000000000000042
De Salins CA, Brenaut E, Misery L, Roguedas-Contios AM. Factors influencing patient satisfaction: assessment in outpatients in dermatology department. J Eur Acad Dermatol Venereol 2016; 30: 1823-1828.
DOI: https://doi.org/10.1111/jdv.13652
Mollanazar NK, Elgash M, Weaver L, Valdes-Rodriguez R, Hsu S. Reduced itch associated with dupilumab treatment in 4 patients with prurigo nodularis. JAMA Dermatol 2019; 155: 121-122.
DOI: https://doi.org/10.1001/jamadermatol.2018.3906
Beck KM, Yang EJ, Sekhon S, Bhutani T, Liao W. Dupilumab treatment for generalized prurigo nodularis. JAMA Dermatol 2019; 155: 118-120.
DOI: https://doi.org/10.1001/jamadermatol.2018.3912
Andersen TP, Fogh K. Thalidomide in 42 patients with prurigo nodularis hyde. Dermatology 2011; 223: 107-112.
DOI: https://doi.org/10.1159/000331577
Taefehnorooz H, Truchetet F, Barbaud A, Schmutz JL, Bursztejn AC. Efficacy of thalidomide in the treatment of prurigo nodularis. Acta Derm Venereol 2011; 91: 344-345.
DOI: https://doi.org/10.2340/00015555-0997
Lan CC, Lin CL, Wu CS, Chai CY, Chen WT, Chen GS. Treatment of idiopathic prurigo nodularis in Taiwanese patients with low-dose thalidomide. J Dermatol 2007; 34: 237-242.
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Copyright (c) 2021 Manuel P. Pereira, Claudia Zeidler, Joanna Wallengren, Jon Anders Halvorsen, Elke Weisshaar, Simone Garcovich, Laurent Misery, Emilie Brenaut, Ekin Şavk, Nikolay Potekaev, Andrey Lvov, Svetlana Bobko, Jacek C. Szepietowski, Adam Reich, Agnieszka Bozek, Franz J. Legat, Martin Metz, Markus Streit, Esther Serra-Baldrich, Margarida Gonçalo, Michael Storck, Teresa Nau, Vincent Hoffmann, Sabine Steinke, Ina Greiwe, Martin Dugas, Matthias Augustin, Sonja Ständer
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