Impact of anti-IL4/IL-13 receptor blockade on brain activity and itch perception in atopic dermatitis

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease that is associated with substantial patient burden. Individuals mostly suffer from chronic pruritus leading to intense scratching with severe damage of the skin barrier and increased stress for the patient. Itch perception is mediated by specialized cutaneous nerve fibres via the spinal cord into the central nervous system (CNS). This highlights the essential role of the CNS in atopic dermatitis. The introduction of the first IL4/IL-13 receptor antagonist was a major turning point in the treatment of atopic dermatitis. Treatment of patients with Dupilumab leads to a massive improvement of cutaneous symptoms but also to an attenuation of itch and itch related comorbidities including sleeplessness, anxiety and depression. Itch-related brain activity has not yet been investigated in detail in major pruritic diseases including atopic dermatitis. Therefore, we want to evaluate and compare brain activity to peripheral itch-related stimuli of healthy individuals and patients with atopic dermatitis with and without Dupilumab treatment using MRI scans. We hypothesize that systemic IL-4/IL-13 receptor blockade critically modulates brain activity and central nervous itch perception and hope to identify brain regions which might be affected by Dupilumab treatment.