Dupilumab improve acquired reactive perforating collagenosis characterized by type 2 inflammation

Abstract

BackgroundAcquired reactive perforating collagenosis (ARPC) is a clinically challenging disease with an unclear pathogenesis.ObjectiveTo evaluate the efficacy and safety of dupilumab for the treatment of ARPC, and analyze the expression of type 2 inflammation-related molecules in ARPC lesions.MethodsThis retrospective cohort study included 20 patients with ARPC; 10 received dupilumab and 10 received conventional therapy. The efficacy and safety of dupilumab were evaluated at 12 weeks. Immunohistochemical and immunofluorescence analyses of T- and B-cell markers, and type 2 inflammation-related cytokines, were performed on skin samples from ARPC patients, atopic dermatitis (AD) patients, and healthy controls.ResultsSignificantly more patients showed improvements in the Investigator Global Assessment score (100% vs. 0%; p < 0.0001) and itching (90%/8.33%, P =.001) in the dupilumab group compared to the conventional group at 12 weeks. There were no adverse effects in the dupilumab group. The ARPC lesions showed enhanced dermal infiltration of CD3+ T-cells, with a predominance of Th2 cells, similar to AD lesions. IL-4 and IL-13 were co-localized with GATA3 in ARPC lesions.ConclusionDupilumab improved ARPC charaterized with type 2 inflammation.

A potential new treatment with upadacitinib for acquired reactive perforating collagenosis

“…In a retrospective cohort study, predominance of T helper 2 cells and the upregulated cytokines IL-4 and IL-13 were observed in ARPC, indicating the involvement of the T helper 2 axis immune response in its pathogenesis. 1 Given that the Janus kinase/signal transducers and activator of transcription signal mediates T helper 2 cytokines, regulates the epidermal barrier, and modulates peripheral nerves of pruritus transduction, 8 upadacitinib should be a promising potential therapy for refractory ARPC, despite the limitation of a single case report.…”

“…Treatments including topical steroids, oral antihistamines, allopurinol, UV-B phototherapy, and dupilumab have been reported as effective but can be unpredictable. 1 …”

Recalcitrant Reactive Perforating Collagenosis Successfully Treated with Dupilumab: A Case Report

“… 7 Liu et al found enhanced dermal infiltration of CD3 + T-cells with a predominance of Th2 cells. 8 In addition, the cytokines interleukin (IL)-4 and IL-13 were also significantly upregulated in RPC. 8 …”

“… 8 In addition, the cytokines interleukin (IL)-4 and IL-13 were also significantly upregulated in RPC. 8 …”

“… 10 Based on existing reports in the literature, the treatment of RPC mainly targets the comorbidities and control of itching. 11 Dupilumab may represent a potential treatment option for RPC patients because of the blockade of IL-4 and IL-13 signaling pathways and Th2-type inflammation, 8 and could be considered as a substitute for systemic steroids or immunosuppressants. The patient’s rapid response to dupilumab may help to illustrate the probable pathogenic agent and the unclear pathogenesis of RPC.…”