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Sleep disturbances in prurigo nodularis
Adverse cardiovascular outcomes and increased C-reactive protein levels are associated with sleep disturbances in adults with prurigo nodularis, poster presented at Fall Clinical 2022

Data was presented in collaboration with Johns Hopkins Medicine at the 2022 Fall Clinical conference in Las Vegas. Prurigo nodularis (PN) is a relatively rare disease in which patients develop numerous, intensely itchy hyperkeratotic nodules.1  Specific comorbidities associated with PN include heart failure, hypertension, and chronic kidney disease.1-3 Sleep disruption is also common due to evening and nocturnal pruritus.4 Despite these implications, there is a lack of research on large cohorts examining the association between PN, sleep-related comorbidities, and systemic inflammation. Therefore, the objective of this study was to correlate PN with sleep-related comorbidities and to characterize the impact of PN sleep disorders on inflammatory markers and adverse cardiovascular (CV) outcomes.

A retrospective analysis was performed using TriNetX, a network consisting of 73 million de-identified health records. Patients with PN were selected by having at least 2 diagnosed instances of PN (ICD-10 code L28.1) from 2015–2020. A total of 73,181 patients and matched controls (no atopic dermatitis or pruritic conditions) were identified. Patients with PN were at a higher risk for all-inclusive sleep-related conditions (eg, insomnia, sleep deprivation) than those without PN. C-reactive protein (CRP), a known mediator of inflammation associated with poor CV outcomes, increases with poor sleep quality. When CRP was measured, patients with PN had overall higher levels than those without PN (12.7 mg/L vs 7.6 mg/L, P<0.001). Among patients with PN, those with sleep disorders had higher CRP levels than those without sleep disorders (16.2 mg/L vs 10.6 mg/L, P<0.001), signaling increased inflammation. This same group also had a higher risk of adverse CV outcomes than patients with PN and without sleeping disorders (P<0.01). Therefore, sleep disorders and CV complications are potential issues in patients with PN that further impact their quality of life.5


1. Huang AH, Williams KA, Kwatra SG. Prurigo nodularis: epidemiology and clinical features. J Am Acad Dermatol. 2020;83(6):1559-1565. doi:10.1016/j.jaad.2020.04.183

2. Huang AH, Canner JK, Khanna R, et al. Real-world prevalence of prurigo nodularis and burden of associated diseases. J Invest Dermatol. 2020;140(2):480-483.e4. doi:10.1016/j.jid.2019.07.697

3. Boozalis E, Tang O, Patel S, et al. Ethnic differences and comorbidities of 909 prurigo nodularis patients. J Am Acad Dermatol. 2018;79(4):714-719.e3. doi:10.1016/j.jaad.2018.04.047

4. Gwillim EC, Nattkemper L, Yosipovitch G. Impact of itch on sleep disturbance in patients with prurigo nodularis. Acta Derm Venereol. 2021;101(3):adv00424. doi:10.2340/00015555-3778

5. Parthasarathy V, Lee K, Deng J, et al. Sleep disturbance in adults with prurigo nodularis is associated with increased circulating C-reactive protein levels and adverse cardiovascular outcomes. Poster presented at: Fall Clinical; October 20-23, 2022; Las Vegas, NV.

*Expert author(s), speaker(s) or contributor(s) where indicated are paid Galderma consultants.

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