Shawn Kwatra, MD, professor and chair of dermatology at the University of Maryland School of Medicine, presented key insights on atopic dermatitis (AD) and prurigo nodularis (PN) at Fall Clinical 2024, emphasizing the importance of addressing itch and utilizing emerging therapies.
Shared Pathophysiology of Itch in AD and PN
Kwatra highlighted the shared inflammatory pathways between AD and PN, noting the critical role of Type 2 inflammation. Cytokines such as IL-4, IL-13, and IL-31 are key contributors to itch in both conditions. Understanding these shared mechanisms is crucial for developing targeted therapies that can effectively reduce inflammation and itch severity.
Recent FDA Approvals and Emerging Therapies
The therapeutic landscape for AD and PN is rapidly evolving with new biologics and targeted therapies. Dupilumab, initially approved in 2017, remains a cornerstone treatment for both conditions. Newer agents like lebrikizumab (an IL-13 inhibitor) and nemolizumab (an IL-31 receptor inhibitor) offer additional options for managing AD and PN. JAK inhibitors, including abrocitinib and upadacitinib, have demonstrated efficacy in oral formulations, while topical ruxolitinib provides targeted relief for PN with a favorable safety profile. Kwatra's team has also been involved in trials for povorcitinib, another promising JAK1 inhibitor for PN.
The Importance of Standardized Itch Assessment
Kwatra stressed the necessity of incorporating standardized itch severity assessments into routine dermatology practice. He recommended using a 0-10 scale to measure itch intensity, as reductions in these scores directly correlate with improvements in patients' quality of life. This is particularly important for patients with skin of color, where itch severity may be underreported, contributing to health inequities.
Non-Steroidal Topicals as Alternatives to Corticosteroids
To mitigate the long-term adverse effects of corticosteroids, such as hypopigmentation and skin atrophy, Kwatra advocated for increased use of non-steroidal topicals. He discussed the benefits of agents like topical ruxolitinib, crisaborole, and roflumilast. Emerging treatments like tapinarof, an aryl hydrocarbon receptor modulator, represent a significant advancement in steroid-sparing regimens for chronic itch management. These alternatives offer effective symptom relief while minimizing the risks associated with prolonged corticosteroid use.
