Patient Consent Statement
Written informed consent was obtained from the patient to published this
report in accordance with the journal’s patient consent policy.
Prurigo nodularis (PN) is a chronic skin disease that manifests with
severe itchy, firm, hyperkeratotic nodules distributed on the trunk and
the extremities symmetrically. The treatment of prurigo nodularis(PN)
has always been a great challenge for dermatologist. Here we report a
case of refractory PN successfully treated with selective Janus Kinase
1(JAK1) inhibitor abrocitinib.
A 46-year-old man presented with visible dark bown nodules on the face,
ears, hands and back neck for 2 years (Figure1). The patient complained
of itchy skin all day especially at night that affects his night
sleeping quality heavily. More important it occurs on visible sites such
as the face and hans, which has profound psychosocial impacts on him.
Laboratory evaluation of routine blood test, thyroid fuction , liver and
kidney fuction tests, HIV, syphilis test and the serum total IgE levele
showed normal. The patient denied a personal history of allergic
rhinitis, asthma, infantile eczema and other systemic disease, and also
denied a family history of allergies and photosensitivity.
Therefore, a diagnosis of non-atopic PN was made.. At first we gave oral
prednisolone 30mg daily and compound clobetased propionate ointment
twice daily. After 1-month treatment Visual Analogue Scale(VAS)
decreasing form 9 to 3. The 2-month prednisolone dose is given 20mg
daily. After 2 month above treatment, the itching was obviously
relieved. But the patient gain 5Kg, especially the facial swelling is
obvious. We have to stop the treatment. Therefore, thalidomide 50mg
twice daily was prescribed concomitantly with high potency topical
corticosteroids. Unfortunately,the treatment was interrupted again due
to dizziness. Because the patient is a driver he can not concentrating
on driving. As a result, the lesions aggravated with even more severe
pruritus and VAS rising to 10. The patient refused to use those
medicines with storng side effects but could not bear expenses of
dupliumab. Therefore abrocitinib 100mg daily was prescribed. The
pruritus markedly improved in 3 days with peak VAS decreasing from 10 to
3. Sustained effectiveness was achieved after 2 month treated with only
a few nodules and mostly pigmentation on above area. Abrocitinib
treatment was well tolerated.
Abrocitinib is an oral small molecule inhibitor of Janus kinase 1(JAK1)
for the treatment of moderate-to-severe atopic dermatitis(AD). The
reported success cases of tofacitinib[1] and baricitinib [2] for
PN both demonstrate the effectiveness of the Jak inhibitor for the
treatment of PN. So we choose abrocitinib to treat this patient, it has
also shown great efficacy.
Therefore, Abrocitinib as an inhibitor of Jak is a promising choice for
the treatment of PN, especially those patients who are resistant to
conventional treatments or can not afford dupliumab.
REFERENCES
Molloy OE, Kearney N, Byrne N, Kirby B. Successful treatment of
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He Y, Ji S, Yu Q. Effectiveness of baricitinib in prurigo-type atopic
dermatitis: a case report. Dermatol Ther. 2021;34:e14878.
DOI:10.1111/dth.14878.