Dupilumab Therapy Reduces Systemic Inflammation in Prurigo Nodularis
Prurigo nodularis (PN), a chronic inflammatory skin disorder marked by severe itching and nodules, is linked to dysregulated type 2 inflammation and other immune pathways. A recent study published in the Journal of the American Academy of Dermatology reveals that dupilumab, a newly approved PN therapy, significantly reduces systemic inflammatory mediators, offering potential benefits beyond symptom relief.
Researchers collected plasma samples from 3 PN patients before and after at least 6 months of dupilumab therapy. These patients demonstrated substantial clinical improvement, defined by a 4-point reduction in the Worst Itch Numeric Rating Scale and an Investigator’s Global Assessment score of ≤1. An analysis of 2569 proteins revealed that 150 were differentially expressed post-treatment. Key inflammatory cytokines across Th1 (IFN-γ, TNF-α), Th2 (IL-4, IL-13), Th17/Th22 (IL-6, IL-22), and innate immune pathways (IL-19, TLR1, NOS2) were significantly downregulated. Markers associated with immune cell migration (CCL20, CD177) and fibrosis (IL-11) also showed marked decreases.
Gene set analyses confirmed significant reductions in Th2, Th17, and epithelial-mesenchymal transition pathway activity, suggesting broad immunomodulatory effects. Notably, IL-11 (R² = 0.99, P < 0.001), CCL20, and other inflammatory markers correlated strongly with pruritus severity, underscoring their potential role in PN pathogenesis and response to treatment.
This study highlights dupilumab’s ability to suppress systemic inflammation beyond its primary effect on type 2 pathways. By reducing a wide array of inflammatory mediators, the therapy may mitigate the risk of systemic disease comorbidities in patients with PN. Further research is warranted to explore these broader therapeutic implications.
Reference
Bao A, Cornman H, Ma E, Kollhoff A, Manjunath J, Kwatra S. Effect of dupilumab therapy on circulating blood inflammatory mediators in prurigo nodularis patients. J Am Acad Dermatol. 2024;91(3):AB190. doi:10.1016/j.jaad.2024.07.756
© 2025 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates.
The APP Institute is dedicated to educating and informing advanced practice providers on clinical topics and practical issues to support the profession and improve the quality of patient care across the spectrum of dermatology.
The APP Institute | Dermatology is designed for Advanced Practice Providers who specialize in Dermatology, to further their education and increase their knowledge to achieve better patient outcomes. Explore cutting-edge research, innovative treatment options, and new therapeutic methods, while remaining focused on the fundamental principles and terminology associated with Dermatology. Engage year-round with the Dermatology Learning Network to access clinical insights, interactive features, research news updates, accredited continuing education programs, and more.
