Dermatological Conditions CE/CME ACCREDITED Watch Time: 49 mins

touchPANEL DISCUSSION Prurigo nodularis: Improving awareness, diagnosis, management and quality of life

Watch three experts discuss the symptom burden faced by patients with prurigo nodularis, and how clinicians can optimize diagnosis and treatment of the disease.
**Now including 2023 UPDATE (scroll to chapter 5)**

Prof. Sonja Ständer

University of Münster, Münster, Germany

CHAIR

Panelists:
Dr Shawn Kwatra, Prof. Matthias Augustin
 
**2023 UPDATE**
(scroll down to chapter 5)
Video Chapters
Introduction

Chair Prof. Sonja Ständer introduces panellists Dr Shawn Kwatra and Prof. Matthias Augustin

view bio and disclosures
1/5 Next Chapter
 
What are the clinical challenges associated with PN that contribute to the overall burden of the disease?

Watch experts discuss the clinical characteristics and disease burden of prurigo nodularis.

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2/5 Next Chapter
 
How can PN be differentiated from other skin conditions and what are the current management options?

Watch experts discuss how to effectively diagnose prurigo nodularis and the treatment options currently available.

view bio and disclosures
3/5 Next Chapter
 
Which emerging treatments may help to address the current unmet needs for patients with PN?

Watch experts discuss the changing treatment landscape for prurigo nodularis and novel therapies on the horizon.

view bio and disclosures
4/5 Next Chapter
 
2023 UPDATE: Key developments relating to the management of PN

Watch experts discuss the key developments in the management of prurigo nodularis since the core activity recording in December 2022.

view bio and disclosures
5/5 Take CE/CME Test
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Overview & Learning Objectives
Overview

In this activity, three experts share their experience and guidance on diagnosing and caring for patients with prurigo nodularis, and discuss the available guidelines and treatment options for the disease.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of dermatologists, internal medicine specialists, nurse practitioners, physician assistants, advanced practice clinicians, managed care/pharmacy directors/pharmacists and family practice/general practice/primary care physicians.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Sonja Ständer discloses: Advisory board, panel and consultancy fees from AbbVie, Almirall, Beiersdorf, Bellus Health, Benevolent, Bionorica, Cara, Celgene, Cello Health, Clexio, DS Biopharma, Eli Lilly, Escient Pharmaceuticals, Galderma, Grünenthal, Integrity CE, Kiniksa, Klinge Pharma, LEO Pharma, Maruho, Menlo (now trading as VYNE Therapeutics), Merz, Perrigo, Pfizer, Sanofi, Sienna, Symbio Research, Trevi Therapeutics, Vanda Pharmaceuticals, Vifor and WebMD; Grants/research support from Almirall, Beiersdorf, LEO Pharma, Menlo (now trading as VYNE Therapeutics), Novartis, Sanofi and Trevi Therapeutics; Speaker’s bureau Almirall, Beiersdorf, Bristol Myers Squibb, Eli Lilly, Sanofi, Galderma, LEO Pharma, L’Oréal, Menlo, moroscience, Novartis, Omnicuris, P.G. Unna Academy, Pfizer, Pierre Fabre, Sanofi, UCB and Vifor.

Dr Shawn Kwatra discloses: Advisory board, panel and consultancy fees from AbbVie, Arcutis Biotherapeutics, ASLAN Pharmaceuticals, Celldex Therapeutics, Galderma, Genzada Pharmaceuticals, Incyte, Johnson & Johnson, Novartis, Pfizer, Regeneron Pharmaceuticals and Sanofi; Investigator for Galderma, Pfizer and Sanofi.

Prof. Matthias Augustin discloses: Advisory board, panel and consultancy fees from Beiersdorf, LEO Pharma, Sanofi, Trevi Therapeutics; Grants/research support Beiersdorf, LEO Pharma and Sanofi.

Content reviewer

Angela M Hill, PharmD, CRPh has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Contributors

Alison Scott and Christina Mackins-Crabtree have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Pharmacists

USF Health is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge-based program has been approved for 1.0 contact hour (0.1 CEUs). Universal program number is as follows: 0230-9999-23-017-H01-P.

Date of original release: 08 December 2022. Date credits expire: 21 September 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Define the burden of disease and unmet need for prurigo nodularis
  • Identify the differential diagnoses for patients with prurigo nodularis and recall the range of treatment and management options available
  • Evaluate the emerging treatment options for the management of prurigo nodularis and how these may impact current clinical practice
Faculty & Disclosures
Prof. Sonja Ständer

University of Münster, Münster, Germany

Sonja Ständer is a professor of dermatology and neurodermatology at the University of Münster and the head of the interdisciplinary Center for Chronic Pruritus (KCP) at the University Hospital Münster. read more

In 2001, she received her board certification in dermatology, allergology and phlebology. Following this, she remained at the Department of Dermatology as an IZKF-funded research fellow. In 2006, she became board certified in dermatopathology after training in Münster and at the Ackermann Academy in New York. Shortly after completing her habilitation, she established the interdisciplinary Center for Chronic Pruritus and played a leading role in the foundation of the first international and national societies for itch.

In 2011, Prof. Ständer obtained the title of Professor of Dermatology (W3) from the University of Münster and dedicated herself to translational neurodermatology and pruritus research, becoming a world leader in this field. Her research group has received several recognized research grants, including from the DFG, BMBF, IZKF and BMWi. The University of Wroclaw, Poland, awarded her with a doctor honoris causa title in 2015 for her research efforts.

Prof. Sonja Ständer discloses: Advisory board, panel and consultancy fees from AbbVie, Almirall, Beiersdorf, Bellus Health, Benevolent, Bionorica, Cara, Celgene, Cello Health, Clexio, DS Biopharma, Eli Lilly, Escient Pharmaceuticals, Galderma, Grünenthal, Integrity CE, Kiniksa, Klinge Pharma, LEO Pharma, Maruho, Menlo (now trading as VYNE Therapeutics), Merz, Perrigo, Pfizer, Sanofi, Sienna, Symbio Research, Trevi Therapeutics, Vanda Pharmaceuticals, Vifor and WebMD; Grants/research support from Almirall, Beiersdorf, LEO Pharma, Menlo (now trading as VYNE Therapeutics), Novartis, Sanofi and Trevi Therapeutics; Speaker’s bureau Almirall, Beiersdorf, Bristol Myers Squibb, Eli Lilly, Sanofi, Galderma, LEO Pharma, L’Oréal, Menlo, moroscience, Novartis, Omnicuris, P.G. Unna Academy, Pfizer, Pierre Fabre, Sanofi, UCB and Vifor.

Dr Shawn Kwatra

Johns Hopkins University School of Medicine, Baltimore, MD, USA

Dr Shawn Kwatra, MD is an associate professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore, MD, USA and director of the Johns Hopkins Itch Center. read more

His areas of clinical expertise include prurigo nodularis, chronic pruritus, atopic dermatitis and dermatology for ethnic skin. Dr Kwatra is funded by the National Institutes of Health and multiple foundations, and is a member of the board of directors of the Skin of Color Society. Dr Kwatra has been an author or co-author of over 200 publications in peer-reviewed international journals.

Dr Shawn Kwatra discloses: Advisory board, panel and consultancy fees from AbbVie, Arcutis Biotherapeutics, ASLAN Pharmaceuticals, Celldex Therapeutics, Galderma, Genzada Pharmaceuticals, Incyte, Johnson & Johnson, Novartis, Pfizer, Regeneron Pharmaceuticals and Sanofi; Investigator for Galderma, Pfizer and Sanofi.

Prof. Matthias Augustin

University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Prof. Augustin is chair of health economics and dermatology at the University Medical Center Hamburg-Eppendorf. read more

His research focuses on health services research, health economics, epidemiology and clinical research. The main indications involved are psoriasis, atopic dermatitis, allergies, chronic wounds and skin cancer.

Prof. Augustin is the founding director of the Institute for Health Services Research in Dermatology and Nursing (IVDP), established in 2010. Prof. Augustin is also a founding director of the Hamburg Institute for Health Economics (HCHE), the largest centre in this discipline in Germany.

On a national and international level, he is involved in atopic dermatitis and psoriasis networks, the German skin cancer assembly and several WHO projects. Prof. Augustin is also a senior consultant to the German Ministry of Health, the Federal Joint Committee (GBA), and multiple statutory health insurance and pharmaceutical companies. As a dermatologist and allergologist, he holds more than two decades of clinical experience and remains active in his own clinic. Prof. Augustin has authored 60 medical books and about 850 scientific and medical papers.

Prof. Matthias Augustin discloses: Advisory board, panel and consultancy fees from Beiersdorf, LEO Pharma, Sanofi, Trevi Therapeutics; Grants/research support Beiersdorf, LEO Pharma and Sanofi.

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Question 1/5
When making a diagnosis of PN, for which of these potential comorbidities would you be most vigilant for to ensure your patients receive appropriate tests and referrals?

HIV, human immunodeficiency virus; IBD, inflammatory bowel disease; PN, prurigo nodularis.
Correct

Studies have shown that patients with PN have increased association with mental health disorders, HIV infection and type 2 diabetes, as well as chronic kidney disease and dermatologic, haematologic and solid-organ malignancies.1,2

Abbreviations

HIV, human immunodeficiency virus; PN, prurigo nodularis.

References

  1. Williams KA, et al. Expert Rev Clin Pharmacol. 2021;14:67–77.
  2. Larson VA, et al. J Am Acad Dermatol. 2019;81:1198–201.
Question 2/5
Your 45-year-old female patient is attending for her first visit following referral by a primary care physician for a 3-year-history of chronic pruritus and significant sleep disturbance. During clinical examination, you identify 10 PN lesions on her trunk. Which of these options would be your next step in addition to prescribing first-line treatment?

HIV, human immunodeficiency virus; PN, prurigo nodularis.
Correct

Patients with PN can experience a high burden of disease that can significantly impact their quality of life and mental health. It is therefore important to assess the severity of their disease and requirement for mental health support at the initial visit.1

The IFSI guideline recommends performing a biopsy in case of clinically atypical or refractory PN or clinical signs or symptoms of conditions that requires a biopsy for their diagnosis, which does not apply to this patient.1,2

Malignancy screening is recommended if suspected during the physical examination; however, pruritus for >1 year in the absence of other systemic symptoms is unlikely to be related to malignancy.1

HIV testing is recommended as an additional test to consider based on findings from the clinical examination and patient risk factors.1

Abbreviations

HIV, human immunodeficiency virus; IFSI, International Forum for the Study of Itch; PN, prurigo nodularis.

References

  1. Elmariah S, et al. J Am Acad Dermatol. 2021;84:747–60.
  2. Ständer S, et al. Itch. 2020;5:e42.
Question 3/5
Your 52-year-old female patient was diagnosed with PN over a year ago. She has hundreds of PN lesions and has experienced limited improvement with an H1-antihistamine, topical corticosteroids, UV phototherapy and gabapentin. Her quality of life remains significantly impaired, and her pruritus severity (measured by NRS) has not improved. Assuming all options are available in your region, what would you do next?

NRS, numerical rating scale; PN, prurigo nodularis; UV, ultraviolet.
Correct

Topical calcineurin inhibitors and intralesional corticosteroids are in steps 1 and 2, respectively, of the treatment ladder recommended by IFSI.1 Dupilumab was recently approved by the FDA for the treatment of adults with prurigo nodularis.2 Adding an antidepressant to the current therapy would not address the continued pruritus that the patient is experiencing.

Abbreviations

FDA, US Food and Drug Administration; IFSI, International Forum for the Study of Itch; PN, prurigo nodularis.

References

  1. Ständer S, et al. Itch. 2020;5:e42.
  2. FDA. Dupilumab PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2022/761055s044lbl.pdf (accessed November 2022)
Question 4/5
You are conducting a clinical examination of your patient who has signs of suspected PN. Which of these conditions do you anticipate being the greatest challenge in making a differential diagnosis?

PN, prurigo nodularis.
Correct

Pemphigoid nodularis is a rare variant of bullous pemphigoid, and is characterized by pruritic nodules, papules or plaques that resemble PN clinically and histologically. Both conditions affect a similar age group (people in their 50s and 60s) with female preponderance.

Abbreviation

PN, prurigo nodularis.

Reference

Williams KA, et al. Expert Rev Clin Pharmacol. 2021;14:67–77.

Question 5/5
Which of these investigational agents for PN targets the IL-31 receptor, thus modulating the immune system, including the recruitment of inflammatory cells?

IL, interleukin; PN, prurigo nodularis.
Correct

Nemolizumab is an immunomodulator that targets the IL-31 receptor.1 Dupilumab targets the IL-4 receptor and abrocitinib targets JAK-1.1 Nalbuphine is a mixed κ-opioid agonist/μ-opioid antagonist.2,3

Abbreviations

IL, interleukin; JAK, Janus kinase.

References

  1. Labib A, et al. Immunotargets Ther. 2022;11:11–21;
  2. Ständer, et al. Presented at: 31st EADV Congress, Milan, Italy. 7–10 September 2022. Abstr 3630.
  3. Elmariah S, et al. J Am Acad Dermatol. 2021;84:747–60.
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