Dupilumab Improves Skin Barrier Function in Adults with Atopic Dermatitis: A Prospective Observational Study

Abstract

Epidermal barrier dysfunction plays an important role in atopic dermatitis (AD). The difficulty of objectively assessing AD severity and the introduction of new biologicals into clinical practice highlight the need to find parameters to monitor clinical outcomes. The aim of this study is to evaluate the impact of dupilumab on skin barrier function and compare it with other treatments in patients with AD. A prospective observational study was conducted in adults with AD treated with topical corticosteroids (TCS), cyclosporine, or dupilumab. The main outcome measures after 16 weeks of treatment were Eczema Area and Severity (EASI)-50 (50% improvement in EASI), and transepidermal water loss (TEWL)-50 (50% improvement in TEWL). Forty-six patients with AD were included in the study. The proportion of patients who achieved EASI-50 at week 16 was significantly higher in patients receiving dupilumab (81.8% vs. 28.6% vs. 40%, p = 0.004). In eczematous lesions, TEWL decreased in patients receiving dupilumab (31.02 vs. 12.10 g·h−1·m−2, p < 0.001) and TCS (25.30 vs. 14.88 g·h−1·m−2, p = 0.047). The proportion of patients who achieved TEWL-50 at week 16 was higher for dupilumab than for cyclosporine or TCS. Temperature only decreased in the dupilumab group. Stratum corneum hydration increased in eczematous lesions and non-involved skin only in patients with dupilumab. In conclusion, dupilumab improves skin barrier function in patients with AD better than TCS or cyclosporine, both in eczematous lesions and in non-lesioned skin.

The impact of dupilumab on skin barrier function: A systematic review

“…Ceramide composition improved in the first 4 treatment‐weeks 15 . Temperature decreased both on eczematous lesion and non‐involved skin 20 . Furthermore, the temperature decreased on eczematous lesions was higher after receiving dupilumab than after topical corticosteroids or cyclosporine 20 …”

“…TEWL was the parameter most frequently used to assess skin barrier function (100% of the studies included this parameter), but it was measured in a different way depending on the study. About 66.7% (4/6) research used an open chamber device 15,16,18,20 . Cristaudo et al and Montero‐Vilchez et al used the Tewameter TM 300 16,20 and Lee et al 18 used the Tewameter TM210 apparatus.…”

New Concepts in Barrier Dysfunction in CRSwNP and Emerging Roles of Tezepelumab and Dupilumab

“…23,24 Dupilumab treatment of patients with AD resulted in restoration of skin barrier function by restoring skin lipid composition subsequently decreasing transepidermal water loss. 25,26…”

“…23,24 Dupilumab treatment of patients with AD resulted in restoration of skin barrier function by restoring skin lipid composition subsequently decreasing transepidermal water loss. 25,26 The rapid ability of dupilumab to improve sense of smell was investigated further in a transgenic mouse model with IL-13 specifically expressed within the olfactory epithelium. 27 Neuronal loss was seen associated with inflammatory infiltration by macrophages and increased expression of a mucin gene, MUC5AC, and eosinophil chemokines although eosinophil levels were unexpectedly low.…”

Intrinsic Atopic Dermatitis and Extrinsic Atopic Dermatitis: Similarities and Differences

“…Although dupilumab (anti-IL-4R α) has significantly improved AD patients' symptoms, including lesions, pruritus, and life quality, not all patients have a good efficacy. 40 Considering that AD is a systematic atopic disease, some patients usually have other concomitant diseases, including alopecia areata, chronic rhinosinusitis with nasal polyposis, and asthma. 41 Janus kinase inhibitor may have a better efficacy for refractory AD with concomitant diseases via blocking upstream signals.…”