SKIN 
 

December 2018     Volume 2 Supplemental Issue  
 

Copyright 2018 The National Society for Cutaneous Medicine 107 

RISING DERM STARS 
 

 
Off-Label Treatment of Prurigo Nodularis with Dupilumab: A Case Series 
Study 
 
Nicholas K. Mollanazar, MD, MBA1, Kevin Savage, BA1, Sylvia Hsu, MD1 
 

1Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, 
Pennsylvania 
 

 
 
Introduction: Prurigo nodularis (PN) is a 
chronic, debilitating disease of unknown 
etiology without any current FDA-approved 
treatments1. No randomized clinical for PN 
exist currently. Each treatment modality that 
has been described in the literature to date 
has offered minimal improvement with high 
risks of serious adverse side effects. In this 
case series, we present a promising potential 
new option for the treatment of prurigo 
nodularis. 
 
 
Methods: Case series of 3 female patients 
(age range 37-57 years) diagnosed with 
prurigo nodularis with history of multiple 
treatment failures. Each patient was treated 
with the standard FDA approved dosing 
regimen of dupilumab (Dupixent, Regeneron-
Sanofi), a fully human monoclonal IgG 
antibody that targets the alpha subunit 
receptor site of IL-4, blocking the effects of 
the IL-4 and IL-13 signaling pathway2. The 
standard dosing regimen included 600mg SQ 
injection induction dose followed by 300mg 
SQ injections every two weeks thereafter. To 
quantify the effectiveness of dupilumab in 
treating the itch of PN, average patient 
reported numeric rating scale itch intensity 
(NRSi) were calculated on a scale of 0-10 
before and during therapy with dupilumab. 

Additionally, all patients were monitored for 
adverse side effects during treatment.  
 
 
Results: Prior to initiation of therapy, two 
patients had NRSi scores of 10/10 and one 
patient had an NRSi of 6/10 giving an 
average of 8.6/10. During treatment with 
dupilumab, none of the patients experienced 
any adverse side effects including itchy or red 
eyes. After one month of therapy, one patient 
reported an NRSi of 3/10, while the other two 
patients reported NRSi of 0/10. At 3 month 
follow-up, all 3 patients reported NRSi of 
0/10. No side effects were reported.  
 
 
Discussion: In a recent retrospective study 
from a tertiary itch center, prurigo nodularis 
was a common cause of chronic pruritus with 
the highest reported mean NRSi (8.7 ± 1.7) 
and the lowest reduction in mean NRSi (-1.9 
± 3) after treatment3. Many potential 
treatments have been described in the 
literature with unsatisfactory response to 
treatment and serious adverse side effects1, 
4-5. Additionally, all of these treatments are 
currently used off-label for the treatment of 
PN. The three patients presented 
experienced an average NSRi of 8.6/10, 
which is in line with previous reports3. The 
average reduction in NRSi in our three 



SKIN 
 

December 2018     Volume 2 Supplemental Issue  
 

Copyright 2018 The National Society for Cutaneous Medicine 108 

patients (-8.6), however, is much higher than 
other reported treatment modalities. While 
this report is limited, with only three subjects 
presented, the magnitude of the response to 
dupilumab in our three patients with PN is 
remarkable. Our findings raise the specter of 
new potential therapy for the treatment of PN, 
warranting randomized clinical trials.   
 
 

References: 
References: 

1. Fostini AC, Girolomoni G, Tessari G. Prurigo 
nodularis: an update on etiopathogenesis 
and therapy. J Dermatolog Treat. 
2013;24(6):458-462. 
doi:10.3109/09546634.2013.814759 

2. Beck LA, Thaçi D, Hamilton JD, et al. 
Dupilumab Treatment in Adults with 
Moderate-to-Severe Atopic Dermatitis. N 
Engl J Med. 2014;371(2):130-139. 
doi:10.1056/NEJMoa1314768 

3. Mollanazar NK, Sethi M, Rodriguez RV, et al. 
Retrospective analysis of data from an itch 
center: Integrating validated tools in the 
electronic health record. J Am Acad 
Dermatol. 2018;75(4):842-844. 
doi:10.1016/j.jaad.2016.05.035 

4. Dawn AG, Yosipovitch G. Butorphanol for 
treatment of intractable pruritus. J Am Acad 
Dermatol. 2018;54(3):527-531. 
doi:10.1016/j.jaad.2005.12.010 

5. Hundley JL, Yosipovitch G. Mirtazapine for 
reducing nocturnal itch in patients with 
chronic pruritus: a pilot study. J Am Acad 
Dermatol. 2018;50(6):889-891. 
doi:10.1016/j.jaad.2004.01.045