Successful Treatment of Upadacitinib in Prurigo Nodularis: A Case Report and Review of the Literature

Abstract

Background: Prurigo nodularis (PN), while rare, presents significant clinical challenges due to its diverse pathogenesis and presentation. Effective therapy recommendations for PN remain limited. Upadacitinib, an oral highly selective type 1 Janus-associated kinase (JAK, Intracellular tyrosine kinases that phosphorylate cytokine receptors). Inhibitor plays an excellent role in alleviating itching in atopic dermatitis (AD). This is a report on the treatment of PN with upadacitinib, which offers a new option for refractory PN.

Case presentation: We share our successful treatment experience of upadacitinib on a 43-year-old female patient with refractory PN failing to conventional therapies. She showed significant improvement at the follow-up visits and no obvious adverse effects happened. We also reviewed published case reports of PN patients and PN-related review researches and made a comprehensive discussion of the potential mechanism of JAK1 inhibitors in treating PN.

Conclusion: Upadacitinib may be a safe and potent alternative for patients with refractory PN.

Keywords: dermatology; immunotherapy; janus kinase inhibitor; prurigo nodularis; upadacitinib.

Figure 1

Manifestation of the skin lesions at baseline, week 8, and week 24 during the upadacitinib treatment: (Ai-Aii) lesions on the back; (Bi-Bii) lesions on the hands; (Ci-Cii) lesions on the upper extremities; (Di-Dii) lesions on the lower extremities.

Figure 2

The evolution of the symptom profile during the administration of upadacitinib. (A) Control of comorbid conditions (TNSS+TNNSS for allergic rhinitis, and UCT for chronic urticaria). (B) SCORAD score and its corresponding variation in magnitude. (C) EASI score and its corresponding variation in magnitude. (D) Alterations in NRS, BSA, and DLQI score.