Recalcitrant anal and genital pruritus treated with dupilumab

Abstract

Chronic anogenital pruritus can significantly impair affected patients’ quality of life by disrupting their sleep, mood, sexual function, and personal relationships. Although a significant portion of these patients can be managed with hygiene measures, topical therapy, oral anti-pruritics, and allergen avoidance after patch testing, guidelines to treat patients who do not respond to standard therapy have yet to be established. We describe the therapeutic response of a case of anogenital pruritus recalcitrant to multiple topical and systemic therapies. Treatment of this patient with dupilumab, an interleukin-4 receptor alpha blocker, resulted in clinical remission at 1 year from the initiation of the therapy, without significant adverse effects.

Treatment of patients with chronic pruritus of unknown origin with dupilumab

“…The study was not randomized, unblinded, and some variables could not be controlled like concomitant medications and assessment timepoints. Notwithstanding these limitations, our findings coupled with other recent studies (14,15), provide a scientific premise to support a proper evaluation of the efficacy of dupilumab for CPUO.…”

The use of dupilumab for the treatment of recalcitrant brachioradial pruritus

“… 9 Recent case reports have demonstrated the potential benefits of dupilumab in patients with pruritic conditions, such as refractory anogenital pruritus, uremic pruritus, prurigo nodularis, and chronic pruritus of unknown origin. 3 , 10 However, to our knowledge, this is the first study to suggest the efficacy of dupilumab in the treatment of BRP.…”

“…However, it is possible that these first-line agents may not provide adequate relief from BRP, particularly if the patient presents with more generalized pruritus 7 or has an underlying atopic dermatitis. 3 In these situations, dupilumab may be a highly beneficial and effective alternative.…”

“…Here, we describe a case of BRP that was refractory to numerous topical and systemic treatments and eventually showed remarkable improvement with dupilumab, a biologic agent that modulates cytokines involved in the type 2 helper T-cell response. 3 We also examine the pathophysiology of this condition and provide commentary on the use of dupilumab for the treatment of BRP.…”

Dupilumab for bullous pemphigoid with intractable pruritus

“…Dupilumab is a monoclonal antibody targeting interleukin 4 receptor alpha (IL4Rα), approved for the treatment of atopic dermatitis, as well as moderate to severe asthma and chronic rhinosinusitis with nasal polyposis. In recent reports, dupilumab has been successfully used off-label to treat a variety of pruritic disorders, including chronic spontaneous urticaria [1], anal and genital itch [2], allergic contact dermatitis [3], and prurigo nodularis [4,5]. We report here a case of an elderly patient with refractory BP whose symptoms of pruritus and blistering became well-controlled with the addition of dupilumab to the treatment regimen.…”