Prurigo Nodularis

there may be more damage than you think

In prurigo nodularis (PN),

Learn more about a central mediator of neuroimmune dysfunction that ignites and fuels a pathologic process characterized by itch, inflammation, and the formation of fibrotic tissue in the skin of patients with PN.1,2

what-is-pn

PN is a distinct, underrecognized, and chronic inflammatory skin disease that is characterized by disfiguring, often excoriated nodules and intractable itch.2-4 Although PN is sometimes associated with atopic dermatitis (AD), most patients with PN do not have a history of AD.5-7

PN affects an estimated 72 per 100,000 adults aged 18 to 64 years in the United States, primarily middle-aged women and disproportionately people of African descent.2,5

PN is a distinct, damaging skin disease

Common diseases associated with PN

PN is associated with a variety of diseases, including2:

An icon containing a jagged line representing "Hypertension."
Hypertension
An icon containing damaged kidneys representing "Chronic kidney disease."
Chronic kidney disease
An icon containing a drop of blood labeled "T2D" representing "type 2 diabetes."
Type 2 diabetes
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HIV infection
An icon containing a scale representing "Obesity."
Obesity
disease-burden

PN severely impacts many aspects of patients’ lives—it leaves some suffering with intractable itch, disfiguring nodules, debilitating sleep disturbance, and impacts on their psychological well-being.8

Studies have shown that patients with PN experience a higher burden of disease than patients with several other chronic pruritic skin diseases. This may be due to the itch of PN being more severe than that of the other skin diseases.9

The burden of PN is oppressive

A square with text: "49% of adults with PN reported that itch was the most burdensome symptom of their skin disease6*"
A square with text: "21% of adults with PN reported that the visibility of nodules was the most burdensome symptom of their skin disease6*"

 

 

A square with text: "30% of adults with PN reported that sleep improvement was among their top 3 treatment goals10†"
A square with text: "15% of adults with PN reported having suicidal thoughts that related to their skin disease11‡"
Footnotes

*Results were based on a multicenter, cross-sectional European study of 509 adults with PN. This prospective, questionnaire-based study assessed the clinical profile of PN, as well as its associated burdens.6

†Results were based on a multicenter, cross-sectional European study of 509 patients with PN. This prospective, questionnaire-based study assessed patient perception of therapeutic goals, as well as previously used therapies, overall satisfaction with therapy, the efficacy of available therapeutic regimens, and out-of-pocket costs.10

‡Results were based on a multicenter European study of 3635 general dermatology outpatients and 1359 healthy controls. Twenty-seven of these general dermatology patients met study criteria for PN and were assessed for psychological burden of disease.11

drivers-of-pn
What’s driving PN?

A growing understanding of PN pathophysiology reveals that it is driven by neuroimmune dysfunction, which
manifests as2:

An icon that represents "Itch." A circle surrounding 3 diagonal lines.
Itch
An icon with 4 concentric circles that represents "Inflammation."
Inflammation
An icon that represents "Fibrotic tissue in the skin." A circle surrounding lines piling up under a bulging barrier.
Fibrotic tissue in the skin

IL-31 is at the centre of PN pathogenesis

A red circle labeled "IL-31" that overlaps with a white circle labeled "PN."
A red circle labeled "IL-31" that overlaps with a white circle labeled "PN."
A red circle labeled "IL-31."
promo2
A red circle labeled "IL-31." Two arrows extend from the circle, pointing to 2 more icons below it.
promo3
A red circle labeled "IL-31."
promo4
A red circle labeled "IL-31." One arrow extends from the circle, pointing to 1 more icon below it.
promo5
A red circle labeled "IL-31." Three arrows extend from the circle, pointing to 3 more icons below it.
A red circle labeled "IL-31." Three arrows extend from the circle, pointing to 3 more icons below it.
role-of-IL31

Ready to dive deeper?

Ready to dive deeper?

Press play for a closer look at the role of IL-31 in PN.

The unmet need in PN

It is difficult to treat itch in PN.16 Since there are currently no FDA- or EMA-approved therapies for PN, there is a need to relieve itch in affected patients.2,16,17 Many adults with PN identified the improvement of itch, nodules, and sleep as their top 3 most important treatment goals.10§

Footnote

§Results were based on a multicenter, cross-sectional European study of 509 patients with PN. This prospective, questionnaire-based study assessed patient perception of therapeutic goals, as well as previously used therapies, overall satisfaction with therapy, the efficacy of available therapeutic regimens, and out-of-pocket costs.10

Consider the damage being done in PN
resources

Useful resources

The images in this material are not of actual patients with AD or PN. They were created based on informed Galderma insights. AD and PN can manifest in individuals differently. 

1. Nemmer JM, Kuchner M, Datsi A, et al. Interleukin-31 signaling bridges the gap between immune cells, the nervous system and epithelial tissues. Front Med (Lausanne). 2021;8:639097. doi:10.3389/fmed.2021.639097 2. Williams KA, Roh YS, Brown I, et al. Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis. Expert Rev Clin Pharmacol. 2021;14(1):67-77. doi:10.1080/17512433.2021.1852080 3. Elmariah S, Kim B, Berger T, et al. Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus. J Am Acad Dermatol. 2021;84(3):747-760. doi:10.1016/j.jaad.2020.07.025 4. Whang KA, Mahadevan V, Bakhshi PR, et al. Prevalence of prurigo nodularis in the United States. J Allergy Clin Immunol Pract. 2020;8(9):3240-3241. doi:10.1016/j.jaip.2020.05.051 5. Huang AH, Canner JK, Khanna R, Kang S, Kwatra SG. Real-world prevalence of prurigo nodularis and burden of associated diseases. J Invest Dermatol. 2020;140(2):480-483.e4. doi:10.1016/j.jid.2019.07.697 6. Pereira MP, Hoffmann V, Weisshaar E, et al. Chronic nodular prurigo: clinical profile and burden. A European cross-sectional study. J Eur Acad Dermatol Venereol. 2020;34(10):2373-2383. doi:10.1111/jdv.16309 7. Kwon CD, Khanna R, Williams KA, Kwatra MM, Kwatra SG. Diagnostic workup and evaluation of patients with prurigo nodularis. Medicines (Basel). 2019;6(4):97. doi:10.3390/medicines6040097 8. Janmohamed SR, Gwillim EC, Yousaf M, Patel KR, Silverberg JI. The impact of prurigo nodularis on quality of life: a systematic review and meta-analysis. Arch Dermatol Res. 2021;313(8):669-677. doi:10.1007/s00403-020-02148-0 9. Steinke S, Zeidler C, Riepe C, et al. Humanistic burden of chronic pruritus in patients with inflammatory dermatoses: results of the European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) cross-sectional trial. J Am Acad Dermatol. 2018;79(3):457-463.e5. doi:10.1016/j.jaad.2018.04.044 10. Pereira MP, Zeidler C, Wallengren J, et al. Chronic nodular prurigo: a European cross-sectional study of patient perspectives on therapeutic goals and satisfaction. Acta Derm Venereol. 2021;101(2):adv00403. doi:10.2340/00015555-3726 11. Brenaut E, Halvorsen JA, Dalgard FJ, 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(1):157-162. doi:10.1111/jdv.15145 12. Mullins TB, Sharma P, Riley CA, Sonthalia S. Prurigo nodularis. In: StatPearls [Internet]. StatPearls Publishing; 2021. Accessed December 15, 2021.  https://www.ncbi.nlm.nih.gov/books/NBK459204/ 13. Belzberg M, Alphonse MP, Brown I, et al. Prurigo nodularis is characterized by systemic and cutaneous T helper 22 immune polarization. J Invest Dermatol. 2021;141(9):2208-2218.e14. doi:10.1016/j.jid.2021.02.749 14. Zeidler C, Ständer S. The pathogenesis of prurigo nodularis —'super-itch' in exploration. Eur J Pain. 2016;20(1):37-40. doi:10.1002/ejp.767 15. Singh B, Jegga AG, Shanmukhappa KS, et al. IL-31-driven skin remodeling involves epidermal cell proliferation and thickening that lead to impaired skin-barrier function. PLoS One. 2016;11(8):1-15. doi:10.1371/journal.pone.0161877 16. 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(12):2224-2229. doi:10.1111/jdv.15107 17. Ständer S, Pereira MP, Berger T, et al. IFSI-guideline on chronic prurigo including prurigo nodularis. Itch. 2020;5(4):e42. doi:10.1097/itx.0000000000000042

References:

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