ORIGINAL RESEARCH article
Front. Allergy
Sec. Skin Allergy
IgE-Defined Endotypes Reveal Distinct Clinical Profiles of Prurigo Nodularis Compared with Atopic Dermatitis: A Multicenter Study in China
Shihua Ling 1,2
Yan Liao 1
Chaofeng Chen 1
Ruimiao Wu 1
Mengting Yin 1
Lu Wei 1
Jiaying Chen 1
Haiyan Huang 1,3
Xia Dou 1,3
1. Department of Dermatology, Shenzhen Hospital, Peking University, Shenzhen, China
2. Shantou University Medical College, Shantou, China
3. Shenzhen Key Laboratory for Translational Medicine of Dermatology, Institute of Dermatology, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
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Abstract
Background: 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. Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.
Summary
Keywords
atopic dermatitis, case-control study, China, Immunoglobulin E, prurigo nodularis
Received
17 December 2025
Accepted
06 February 2026
Copyright
© 2026 Ling, Liao, Chen, Wu, Yin, Wei, Chen, Huang and Dou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Haiyan Huang; Xia Dou
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