Prurigo nodularis (PN) is a chronic, debilitating dermatological condition marked by intensely pruritic nodules, often resulting in significant impairment in quality of life.While the exact etiology remains unclear, a strong link with atopic diathesis has been documented.A systematic review and meta-analysis reported a significantly higher risk of atopic dermatitis in patients with PN, showing a pooled unadjusted odds ratio of 16.85. 1ecent breakthroughs in managing this challenging condition include targeted biologics, notably dupilumab and nemolizumab, which recently gained food and drug administration, United States (US-FDA) approval.While these biologics specifically inhibit Interleukin (IL)-4/-13 and IL-31, respectively, additional cytokines such as IL-17, IL-22, and thymic stromal lymphopoietin (TSLP) also play crucial roles in PN pathogenesis. 1Furthermore, biologics such as dupilumab and nemolizumab are not yet available in countries like India.Thus, there is an unmet need for managing PN, particularly in patients who are refractory to conventional immunomodulators such as cyclosporine.Here, we present a case of an adult female with PN unresponsive to cyclosporine, who experienced marked improvement with abrocitinib, a selective Janus kinase 1 (JAK1) inhibitor.A 46-year-old woman presented with persistent itchy skin lesions over her back, arms, and legs lasting 2 years Figure 1A andB].Examination revealed numerous well-defined, erythematous to hyperpigmented papules and nodules with excoriation and mild scaling involving approximately 75% of her body surface Figure.She reported severe sleep disturbance due to intense itching, scoring 9 on the visual analog scale (VAS).She had a history of childhood atopic dermatitis.Routine laboratory tests, including eosinophil count and serum Immunoglobulin E levels, were normal.Histopathology demonstrated marked orthohyperkeratosis, focal parakeratosis, irregular acanthosis, reduced nerve fiber density, and a non-specific dermal infiltrate of lymphocytes, macrophages, eosinophils, and neutrophils Figure 1C.Based on clinical and histopathological findings, a diagnosis of PN was confirmed.
De et al. (Fri,) studied this question.