Successful Treatment of Pediatric Atopic Prurigo Nodularis with Dupilumab

Yuping Zhang,* Lizhu Liang,* Chen Li Department of Dermatology, Zhongshan City People’s Hospital, Zhongshan City, Guangdong Province, 528403, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chen Li, Department of Dermatology, Zhongshan City People’s Hospital, No. 2 Sunwen East Road, Zhongshan City, Guangdong Province, 528403, People’s Republic of China, Tel +86-18686883773, Fax +86-0760-89880669, Email [email protected]: This study aims to evaluate the efficacy and safety of Dupilumab in treating pediatric atopic prurigo nodularis (PN).Patient and Methods: We present a case of an 11-year-old child with refractory prurigo nodularis for 9 months, accompanied by concurrent allergic rhinitis for 2 years. Conventional therapies and Janus kinase 1 (JAK1) inhibitors had not provided satisfactory results. At presentation, the child presented with a Peak Pruritus Numerical Rating Scale (PP-NRS) score of 9 on a scale of 10, the Investigator’s Global Assessment (IGA) score of 3 out of 3, and the Children’s Dermatology Life Quality Index (CDLQI) score of 12 out of 30.Dupilumab was administered subcutaneously, starting with an initial dose of 600 mg, followed by 300 mg every three weeks for four months. Subsequently, the injection interval was extended to once every four weeks for an additional two months.Results: Two weeks after initiating dupilumab treatment, the patient showed initial symptom relief, as evidenced by a reduction in PP-NRS, IGA, and CDLQI scores to 7, 2, and 6, respectively. By the fourth week, the patient experienced significant improvement in pruritus and skin lesions. Specifically, the PP-NRS, IGA, and CDLQI scores decreased by 7 points, 2 points, and 10 points, respectively. The patient discontinued medication after six months of treatment, and no recurrence was observed during the subsequent six-month follow-up period.Conclusion: Dupilumab appears to be an effective therapy for refractory prurigo nodularis with atopic features.Keywords: prurigo nodularis, pediatric dermatology, biologics, interleukins, dupilumab