Characterization of Prurigo Nodules in Adults With Moderate‐To‐Severe Atopic Dermatitis in Japan: A 2‐Year Observational Study

Clinical phenotypes of atopic dermatitis (AD) can vary, with some individuals displaying difficult-to-treat prurigo nodularis-like lesions. We aimed to assess the real-world disease burden and treatment course of Japanese adults with AD-associated prurigo nodules (AD-Pn) receiving conventional AD treatments. Of the 300 participants with moderate-to-severe AD registered in the observational ADDRESS-J study between July 29, 2016 and July 4, 2017 (before the first biologic for AD was introduced), 285 had baseline and post-baseline prurigo assessments and were included in this exploratory analysis (108 with AD-Pn and 177 without Pn). Participants with AD-Pn versus those without Pn included more males (73.1% vs. 53.1%), and had more mean ± standard deviation (SD) visits for AD treatment in the previous year (11.5 ± 16.1 vs. 8.7 ± 6.6 visits), a higher proportion with an Investigator's Global Assessment (IGA) 4 score (39.9% vs. 18.6%), a higher mean ± SD Eczema Area and Severity Index (EASI) score (28.4 ± 15.1 vs. 23.5 ± 15.5), and a higher mean ± SD Patient-Oriented Eczema Measure (POEM) score (18.8 ± 6.2 vs. 15.6 ± 6.8). At baseline, 14.8% and 7.4% of participants with AD-Pn had been treated with oral immunosuppressants and oral corticosteroids, respectively, compared with 8.5% and 2.3%, respectively, of those without Pn. Individuals with AD-Pn previously received more intensive topical treatments. At 2 years, participants with AD-Pn had more severe AD than those without Pn, as assessed by IGA 4 scores (9.1% vs. 0.9%), and higher mean ± SD EASI total scores (12.5 ± 10.7 vs. 7.0 ± 8.1). In summary, individuals with AD-Pn were mostly males, whose AD was more severe and had improved less than those without Pn while receiving mostly conventional AD treatments over 2 years. AD-Pn might be an indicator for targeted treatment to improve long-term AD outcomes. Clinical Trial Registration: ADDRESS-J (UMIN Clinical Trial Registration: UMIN000022623).