关键词: 皮炎, 特应性, 痒疹, 皮肤表现, 共病现象, 结节性痒疹, 度普利尤单抗, 治疗结果

Abstract: 【Abstract】 Objective To compare clinical characteristics of patients with atopic prurigo nodularis （APN） versus non-APN （NAPN）, and to analyze differences in the therapeutic response to dupilumab. Methods A retrospective study was conducted. Clinical data were collected from patients with atopic dermatitis and those with prurigo nodularis, who visited the Department of Dermatology, Southwest Hospital, Army Medical University from January 2017 to December 2022. These patients were divided into the APN group and NAPN group according to the inclusion and exclusion criteria （types of skin lesions and the presence or absence of history of atopic diseases）. Clinical characteristics, laboratory examination results, and comorbidities were compared between the 2 groups, so were the eczema area and severity index （EASI） scores, investigator′s global assessment （IGA） scores and itch numeric rating scale （NRS） scores at 0, 4, 12 weeks after the treatment with dupilumab. Results A total of 233 patients with NAPN and 177 with APN were enrolled, and their ages were 57 （48, 68） and 43 （20, 57） years, respectively. Before the treatment, the serum IgE levels and eosinophil counts were significantly higher in the APN patients than in the NAPN patients （Z = -4.40, -3.92, respectively, both P < 0.001）; compared with the NAPN patients, the APN patients more frequently presented with skin lesions on the trunk （71.64% ［117/177］ vs. 54.08% ［126/233］, P < 0.05）, limbs （71.75% ［127/177］ vs. 61.37% ［143/233］, P < 0.05） and the whole body （28.36% ［53/177］ vs. 20.17% ［47/233］, P < 0.05）; the incidence rates of xeroderma, erythema, papules and crusting were significantly higher in the APN patients than in the NAPN patients （all P < 0.05）, and the APN patients more frequently presented with symmetrically distributed lesions; however, there were no significant differences in the incidence rates of secondary lesions such as scratches （38.98% ［67/177］ vs. 33.91% ［79/233］） and ulcers （18.64% ［33/177］ vs. 18.03% ［42/233］） between the two groups （both P > 0.05）. The proportions of patients with chronic kidney diseases, cardiovascular diseases, liver diseases and diabetes were significantly higher in the NAPN group than in the APN group （all P < 0.05）. There were 13 patients with APN and 5 with NAPN who received a 12-week dupilumab treatment and had complete follow-up results. No significant differences were observed in the EASI, IGA or NRS scores before the treatment between the 2 groups （all P < 0.05）; after the 12-week treatment, the improvement of EASI score was significantly higher in the APN group than in the NAPN group （P < 0.05）, while there were no significant differences in the improvement of NRS and IGA scores between the 2 groups （both P > 0.05）. Conclusion The clinical manifestations, laboratory examination results, and comorbidities differed between the NAPN and APN patients, however, they both showed good therapeutic response to dupilumab.

Key words: Dermatitis, atopic, Prurigo, Skin manifestations, Comorbidity, Prurigo nodularis, Dupilumab, Treatment outcome