Abstract:

Objective To evaluate the clinical efficacy of thalidomide plus mometasone furoate cream under occlusion and ultraviolet irradiation for the treatment of prurigo nodularis. Methods A non-randomized, parallel, controlled study was carried out. Eighty patients with prurigo nodularis were divided into 3 groups, i.e., control group （no irradiation）, ultraviolet A1 （UVA1） group, and ultraviolet B （UVB） group. All the patients were treated with oral thalidomide and topical mometasone furoate cream under occlusion. Additionally, the patients in UVA1 group and UVB group received UVA1 and NB-UVB irradiation, respectively, thrice a week for no less than 8 weeks. Patients were evaluated at the baseline, and on day 30 after the beginning of treatment. Clinical outcome parameters included disease severity score and visual analogue scales for pruritus. Peripheral blood eosinophils were counted during each visit. Rank sum test was performed to compare the clinical efficacy between the 3 groups, and the relationship between peripheral blood eosinophile count and visual analogue scales for pruritus was analyzed. Results After 30 days of treatment, skin lesions were markedly improved in 5 （21.74%）, 13（43.33%） and 9 （37.5%） patients, and improved in 7 （30.43%）, 12（40%） and 7（29.17%） patients, in the control group, UVA1 group and UVB group respectively; a marked response in pruritus was noted in 7（30.43%）, 18（60.00%） and 14 （58.33%） patients respectively in the control group, UVA1 group and UVB group. The efficacy on skin lesions and pruritus was significantly stronger in the UVA1 group and UVB group than in the control group （skin lesions: Z = 8.21, 5.22, both P < 0.01; pruritus: Z = 4.50, 4.50, both P < 0.01）, but similar between the UVA1 group and UVB group （skin lesions: Z = 0.50, P > 0.05; pruritus: Z = 0.35, P > 0.05）. Peripheral blood eosinophil count was positively correlated with the visual analogue scale for pruritus in the patients（r = 0.53, P < 0.01）. Conclusions Thalidomide combined with mometasone furoate cream under occlusion and ultraviolet irradiation shows notable efficacy for the treatment of prurigo nodularis, and the combination with UVA1 or NB-UVB irradiation enhances the efficacy of thalidomide and mometasone furoate cream under occlusion.

Key words: serum eosinophile count