IgE-defined endotypes reveal distinct clinical profiles of prurigo nodularis compared with atopic dermatitis: a multicenter study in China

TL;DR

This study compares prurigo nodularis and atopic dermatitis in Chinese adults, finding distinct clinical profiles linked to IgE levels.

Contribution

The study identifies IgE-defined endotypes in prurigo nodularis, revealing distinct clinical profiles compared to atopic dermatitis in a Chinese population.

Findings

PN is associated with middle age, rural residence, lower education, smoking, and reduced atopic profiles compared to AD.

IgE-high PN patients show a type 2 immune response profile, including eosinophilia and allergen sensitization.

Sociodemographic differences between PN and AD are not consistently seen across IgE-defined PN subgroups.

Abstract

Prurigo nodularis (PN) is a chronic inflammatory dermatosis that often coexists with atopic dermatitis (AD) but represents a distinct entity. Evidence directly comparing PN and AD in Chinese populations remains limited.

To characterize clinical distinctions between PN and AD in Chinese adults and to explore whether total serum immunoglobulin E (IgE) status delineates distinct clinical profiles within PN.

This multicenter case–control study enrolled 2,621 adult patients (≥18 years) including 1,462 with PN and 1,159 with AD. Multivariable logistic regressions were used to evaluate independent associations differentiating PN from AD and to examine IgE-defined clinical heterogeneity within PN.

Compared with AD, PN was independently associated with middle age, rural residence, lower education, smoking, and an overall reduced atopic profile, and was more frequently accompanied by type 2 diabetes mellitus and psychiatric disorders. Within PN, the IgE-high subgroup displayed a pronounced type 2 immune response-associated inflammatory profile, including peripheral eosinophilia and allergen sensitization, whereas IgE-normal patients showed comparatively attenuated atopic markers. In contrast, sociodemographic correlates that distinguished PN from AD were not consistently different between IgE-defined PN subgroups.

In Chinese adults, PN exhibits clinical heterogeneity with two distinct patterns: one characterized by variability in type 2 immunity-associated and atopic features, and the other by a substantial burden of specific sociodemographic and metabolic comorbidities. Serum IgE may serve as a practical marker for stratifying type 2 immunity and atopic variability in PN.

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