Dupilumab for the treatment of chronic actinic dermatitis

Abstract

Dupilumab for the treatment of chronic actinic dermatitis 1 | INTRODUC TI ON Chronic actinic dermatitis (CAD) is an immune-mediated photodermatosis characterized by chronic, pruritic, eczematous, and often lichenified plaques distributed primarily upon sun-exposed skin. 1 The pathophysiology is believed to involve a delayed-type hypersensitivity reaction to an endogenous, photoinduced, cutaneous antigen, which has been speculated to be DNA. 1 First-line management options include strict photoprotection, topical corticosteroids (TCS), and topical calcineurin inhibitors (TCI). However, these are rarely sufficient on their own. Thus, many systemic therapies are often utilized with varying degrees of success. Dupilumab is a human monoclonal antibody that was initially approved in the United States for moderate-to-severe atopic dermatitis (AD); similar to CAD, AD is characterized by chronic, eczematous, pruritic skin lesions. Only one case of the use of dupilumab for the treatment of CAD has previously been reported. 2 Herein, we present five therapeutically challenging cases of CAD which were successfully managed with dupilumab.

Clearance of Chronic Actinic Dermatitis With Dupilumab Therapy in Chinese Patients: A Case Series

“…Furthermore, in the literature review, we identify three reports with a total of 10 patients ( 8 – 10 ). All the patients showed a moderate-to-complete reduction in disease severity.…”

“…All the patients showed a moderate-to-complete reduction in disease severity. Two patients developed conjunctivitis and were successfully treated with ophthalmic corticosteroids (20% of the cases) ( 8 ). Only one patient had to suspend the treatment with dupilumab because of the DFR (dupilumab facial redness).…”

Successful Treatment of Chronic Actinic Dermatitis with Dupilumab: A Case Report and Review of the Literature

“… 5 , 9 However, these treatments are not so effective in most patients with severe CAD; thus, thalidomide, colostrum-macrophage-activating factor, and biotherapy (tofacitinib and dupilumab) have been proposed to be particularly beneficial in improving outcomes in these cases. 4–6 , 10 , 11 Dupilumab, a monoclonal antibody that targets type 2 helper T-cell (Th2) cytokines, inhibits both IL-4 and IL-13 signaling pathways, decreasing subsequent effector cell function. 3 Only three previous studies have reported the treatment of seven patients with CAD with dupilumab, 4–6 as shown in Table 1 .…”

“… 4–6 , 10 , 11 Dupilumab, a monoclonal antibody that targets type 2 helper T-cell (Th2) cytokines, inhibits both IL-4 and IL-13 signaling pathways, decreasing subsequent effector cell function. 3 Only three previous studies have reported the treatment of seven patients with CAD with dupilumab, 4–6 as shown in Table 1 . All patients had failed to respond sufficiently to at least one line of previous therapy, such as topical corticosteroids, methotrexate, mycophenolate mofetil, azathioprine, hydroxychloroquine, apremilast, and cyclosporine.…”

“…Recently, dupilumab, a human monoclonal antibody developed for dampening Th2 signaling and inhibiting the effects of IL-4 and IL-13, 3 has shown promising results in small series and case reports on CAD. 4–6 In this study, we present a 45-year-old male with severe CAD who was successfully treated with dupilumab having had an unsatisfactory response to conventional treatments, and review all relevant cases.…”