Jenny Murase, MD: Emerging Therapies Bring Hope to Patients with Persistent Itch

At the 2024 Elevate-Derm West Conference, Jenny Murase, MD, director of medical consultative dermatology at the Palo Alto Foundation Medical Group and associate clinical professor at UCSF, brought fresh insights to the intersection of women's health and dermatology.

Murase, who has handled over 6,800 consultations for dermatologists and allergists across the Bay Area in nearly 2 decades, shared her expertise in managing complex dermatologic cases—especially those involving persistent itch and difficult-to-treat rashes.

She also emphasized the exciting potential for new therapies to address neuropathic conditions where traditional treatments often fall short. Murase said she envisions a future in which dermatologists can more effectively treat these conditions, delivering meaningful relief to patients who, until now, had few options.

"I think that this is an incredibly exciting time to be a dermatologist, because we have all these new therapeutics coming on the market for conditions that patients really haven't had anything to treat in the past," Murase said. "I think that our field is going to be changing rapidly within the next few weeks to months in terms of what we're able to do to care for these patients that are truly suffering."

Transcript

Jenny Murase, MD: My name is Dr Jenny Murase, and I am the director of medical consultative dermatology at the Palo Alto Foundation Medical Group, and I'm an associate clinical professor at UCSF. I just presented at NP Elevate in Arizona the past few days on 3 presentations related to women's health and dermatology.

I direct medical consultative dermatology at the Palo Alto Foundation Medical Group, and I've done, in the past 18 years, about 6800 consults for the dermatologists and allergists in the Bay Area. I have this huge clinic of a lot of very itchy patients with bad rash, and so I have seen, in the past few weeks, the most amazing results in terms of finally being able to manage itch well in patients that really had, before, recalcitrant disease that we weren't really able to treat effectively.

For example: I had one gentleman who had tried and failed 30 different topical and oral medications for this recalcitrant that felt like electric shocks. He had to quit his job because it was so severe debilitating. All throughout the day, we had tried everything that we could think of, from the JAK inhibitors to the IL-4 [and] 13 blockades with Dupixent to all the different neuropathic agents like Lyrica, Neurontin, and everything that we could use. We gave him a shot of nemolizumab, and within 10 days, after years of suffering with this itch, it disappeared, and it was gone for 12 days and came back just a tiny bit. I've seen that same phenomenon in about 18 patients the past 6 weeks.

I've even treated a patient with burning mouth. It wasn't just itch, but it was also burning. This woman, when the very first second she wakes up in the morning, she senses the burning, and it exists through the entire day, and it's the last thing she thinks about when she's going to sleep. Sometimes, she says it feels like there's a flame torch in her mouth. She emailed me a few days after being on therapy, and she said, "Is this what it feels like for my mouth not to burn?"

I think that this is an incredibly exciting time to be a dermatologist, because we have all these, not just nemolizumab, but all these new therapeutics coming on the market for conditions that patients really haven't had anything to treat in the past. I think that our field is going to be changing rapidly within the next few weeks to months in terms of what we're able to do to care for these patients that are truly suffering.

The conditions that I'm the most excited to use, particularly nemolizumab as a neuropathic agent, would be things like neurogenic rosacea, when patients have this horrible burning and this flushing, and we really have such a limited ability to control this significant burning that they have on their face. I'll have to cover the screens in the room, because the even the visible light can be so painful to them. Erythromelalgia, another condition on the extremities where they can get this severe pain that's related to flushing. I have no idea if it will work, but, and then especially these patients that have itch, and they may be a little dermatographic, meaning they scratch and the skin kind of welts up. We know that there's some kind of mast cell degranulation. It kind of feels like urticaria: We don't know what's ultimately causing the itch.

I think the main thing that you want to do, if you're using any itch medication, particularly nemolizumab, would be make sure that there's no underlying leukemia or lymphoma, because you don't want to mask the itch as the only sign. Make sure you do the chest X ray, you do the CBC. You can even do a leukemia/lymphoma flow cytometry panel; it's just a blood test to make sure that that's not the case. But if there's itching, and then there's prurigo nodularis, or there's itching and dramatically. It's just going to be very exciting in years to come to see how these patients are going to respond, because so far, the response has been really impressive, and I'm so happy to be able to help patients that had no recourse before.

[Transcript has been edited for clarity.]

For more news from Fall Clinical, subscribe to receive our eNewsletter.