TARGETED THERAPY IN THE TREATMENT OF NODULAR PRURIGO

Abstract

Pruritus is a rare chronic recurrent polyethological skin disease characterized by severe itching, resulting in the formation of skin elements such as papulo-vesicles, papules, nodules and plaques. The disease is often difficult to treat with standard therapy, and patients have been suffering debilitating symptoms for years. The article presents a clinical case of a patient who suffered from nodular pruritus for more than 20 years, which worsened in the last 4 years after suffering from a mild covid-19 infection, when the disease became continuously recurrent. The means of traditional therapy were practically ineffective. Upon admission to the allergological department of the Clinic of Immunopathology of the Federal State Budgetary Budgetary Institution "Scientific Research Institute of Fundamental and Clinical Immunology" in Novosibirsk in April 2024, rashes were common, severe itching disrupted sleep, and significantly reduced the patient's quality of life. On 04/16/2024, GIBT was initiated with dupilumab at an initial dose of 600 mg, according to the instructions, followed by 300 mg every 2 weeks. After the first administration of the drug, significant positive dynamics was noted in the form of a decrease in itching, rapid regression of rashes, and the patient's skin was almost completely cleansed by the 4th injection. By the time of writing, the skin remains clean, there is no itching, and sleep has returned to normal. The patient continues to use emollients and take 2nd generation antihistamines. The effectiveness of dupilumab therapy, which blocks IL-4 and IL-13 signaling by specifically binding to IL-4Ra, a subunit common to IL-4 and IL-13 receptor complexes, is due to the fact that neuroimmune regulation in the skin is leading to the pathogenesis of chronic pruritus with nodular pruritus. Interleukins 4 and 13 are considered important itchogenic cytokines of Th2 cells, which increase the expression of IL-31R and other pruritus-related receptors, enhance neuronal activation in inflamed skin, transmitting signals to nearby efferent neurons and the central nervous system, initiating itching sensation, forming a vicious cycle of itch-scratching, enhance sensitization of histamine-independent sensory neurons to pruritogens, stimulate fibroblast proliferation, migration, and production of profibrous factors. Since the main goal of treating nodular pruritus is to block the vicious cycle of itching and scratching, which promotes nodular healing, dupilumab therapy leads to remission of the disease, normalizing the interaction of the immune and nervous systems in the skin. In the treatment of adult patients with nodular pruritus, dupilumab was approved in Russia not so long ago - just over a year ago and has already shown its high effectiveness. The presented case demonstrates the possibilities of using modern immunotherapy methods in the treatment of dermatological diseases with torpid course.

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