Interview with Dr. Pereira: Chronic Itch in AD and PN
In this insightful interview, Dr. Manuel P. Pereira MD, PhD, dermatologist and researcher at Charité University Hospital Berlin, Germany discusses chronic itch in atopic dermatitis (AD) and prurigo nodularis (PN) with Ylva Kaiser PhD, Medical Advisor, Sanofi.
Experience this valuable discussion in your preferred format. The complete interview is available as a podcast.
Did you find the interview insightful? Access our comprehensive webinar on "Itch and Pain in Atopic Dermatitis and Prurigo Nodularis – Clinical Challenges in Achieving Disease Control.
Key Highlights
Understanding Prurigo Nodularis
- Distinct Disease Entity: Chronic prurigo is a separate condition from atopic dermatitis (AD), with specific diagnostic criteria
- Diagnostic Criteria: Chronic itch (lasting at least six weeks), prolonged history of scratching, and development of pruriginous lesions (typically nodules)
- Disease Mechanism: "It all starts with itch. Patients have to scratch because of the itch, and in predisposed patients, they develop these nodules."
Pathophysiology of Chronic Itch
- Neuro-immune Connection: Important interaction between skin, nerves, and immune cells
- Key Cytokines: IL-4, IL-13, and IL-31 play crucial roles in initiating the itch signal
- Neurogenic Inflammation Loop: Nerves release neuropeptides that modulate immune response, creating a self-perpetuating cycle
Treatment Approaches
- Individualized Therapy: Treatment selection depends on patient phenotype, comorbidities, and side effect profiles
- Targeting Inflammation: Treatment options to reduce itch by improving underlying inflammation
- Combination Therapy: Some patients may need antinociceptive drugs (gabapentinoids, antidepressants) to target persistent itch even after skin lesions improve
Disease Burden
- Quality of Life Impact: Severe sleep disruption affecting work productivity and academic performance
- Financial Burden: High out-of-pocket costs for non-reimbursed treatments like emollients
- Social Stigma: Visible lesions lead to social isolation and increased risk of depression and anxiety
Clinical Challenges
- Limited Approved Treatments: Many itch conditions lack approved therapies
- Access Issues: Even for conditions with approved drugs, access is limited due to few specialized itch centers
- Need for Education: Medical education programs are essential to improve awareness and treatment access
Patient Monitoring
- Validated Assessment Tools: Numerical Rating Scale for itch intensity, Prurigo Control Test for patient-reported outcomes
- Disease-Specific Measures: IGA (Investigator Global Assessment) for prurigo, EASI and SCORAD for atopic dermatitis
- Quality of Life Assessment: DLQI for dermatological conditions and ItchyQoL for itch-specific quality of life
Future Directions
- Emerging Targets: JAK inhibitors in Phase 3 trials for prurigo
- Novel Approaches: OX40 targeting and mast cell-depleting therapies under investigation
- Expanding Options: "We can expect an expansion of the pharmaceutical landscape in both of these conditions in the near future."
Dr. Manuel P. Pereira MD, PhD
Charité - Universitätsmedizin Berlin Institute of Allergology and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP Allergology and Immunology Hindenburgdamm 27, 12203 Berlin, Germany
Manuel P. Pereira is dermatologist at the Institute of Allergology at Charité – Universitätsmedizin Berlin, Germany and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology. He received his medical education at the University of Porto (Portugal) and at Charité – Universitätsmedizin Berlin (Germany). He completed his training in Dermatology at the University Hospital Münster (Germany). Additionally, he obtained a Ph.D. from the Neuroscience Graduate School at the University of Copenhagen. His main research interests include translational and clinical research in chronic itch, chronic prurigo and atopic dermatitis.
