Dupilumab for treatment‐refractory prurigo nodularis

The anti-interleukin 4 receptor alpha antibody, dupilumab, was recently approved for the treatment of atopic dermatitis (AD) and severe bronchial asthma. In clinical trials, dupilumab significantly improved adult and adolescent AD. Over 80 % of patients treated with 300 mg dupilumab every other week (EOW) achieved an improvement of the Eczema Area and Severity Index by 50 % or more within 12–16 weeks [1, 2]. We report on an 80-year old female patient who presented with a highly pruritic erythematous rash and dry skin on the entire integument. She reported intensive itching with 10/10 on a numerical rating scale (NRS) and no previous signs or symptoms of AD. After a full medical examination (including extensive laboratory parameters, sonography of the abdomen, skin biopsies and chest x-ray) no conclusive diagnosis was reached. Based on clinical signs and symptoms with high total IgE levels and an elevated value of the Erlangen atopy score (9) the patient was diagnosed with late onset AD. Treatment with very potent topical corticosteroids (0.5 mg/g clobetasol propionate), narrow band UVB irradiation and oral antihistamines was initiated. This led to a significant improvement of her condition, but this relapsed rapidly after switching to topical betamethasone and withdrawal of phototherapy. During follow-up, she developed extremely itchy erythematous papules/nodules disseminated over the entire integument (Figure 1a). Based on this clinical Clinical Letter