Long-Term Efficacy of Dupilumab in Alopecia Areata

Abstract

Patient: Male, 16-year-old Final Diagnosis: Alopecia areata Symptoms: Scalp hair loss Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Unusual or unexpected effect of treatment Background: Dupilumab is a relatively new immune-modulating drug that has transformed the way clinicians treat common immunologic conditions, including atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. Blocking signaling molecules involved within the Th2 immune response, dupilumab is a proven effective treatment for moderate to severe atopic dermatitis – a condition whose disease pathogenesis is heavily linked to the dysregulation of this immunologic pathway. Interestingly, dupilumab has found broader clinical utility, showing efficacy in treating other distinct dermatologic diseases, including alopecia areata. Case Report: A 16-year-old White male with a past medical history of moderate atopic dermatitis presented to our clinic with complete scalp hair, eyebrow, and eyelash loss. At this time, the patient was given a clinical diagnosis of alopecia totalis. Understanding that dupilumab has been previously used for treatment in adults of this specific autoimmune condition, we started this adolescent patient on dupilumab to concomitantly treat his atopic dermatitis and alopecia areata. The patient gradually experienced complete regrowth of his hair and almost complete resolution of his atopic dermatitis. Three years after starting dupilumab, the patient remains without signs of alopecia totalis. Conclusions: This case report demonstrates the long-term efficacy of dupilumab use in alopecia areata. More investigation is required to understand dupilumab’s broadening clinical indications. Additionally, this case highlights the complex relationship between dysregulation of the Th2 response and autoimmunity. Crosstalk between immune pathways within the disease spectrum of alopecia areata may explain why dupilumab has been reported to both treat and exacerbate alopecia areata.

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

“…Clinical responses were mostly measured by the severity of alopecia tool (SALT) with a score < 10 defined as complete response ( Table 4 ) [ 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 ]. Noticeably, 13 pediatric patients were treated effectively with dupilumab [ 172 , 173 , 174 , 175 , 176 , 177 ]. However, 15 of a total of 66 reported patients did not experience clinical improvement; notably, one case series with 10 patients found no significant improvements throughout the investigated cohort [ 178 ].…”

Cytokine-targeted treatment in alopecia areata - new possibilities?

“…There are a number of case reports where patients with concurrent atopic dermatitis and alopecia areata received a saturating dose of dupilumab of 600 mg, followed by subcutaneous injections every 2 weeks at a dose of 300 mg. The visible effect of the treatment in patients in the form of hair regrowth was seen after a period of several days to several weeks or months [33][34][35][36][37][38][39][40][41][42]. In another case report of a patient suffering simultaneously from atopic dermatitis and alopecia areata, treatment was started at a dose of 200 mg subcutaneously every two weeks.…”

Effects of dupilumab on hair in patients with atopic dermatitis - a review of the literature

“…Trzy lata po rozpoczęciu stosowania dupilumabu, efekt leczenia nadal się utrzymywał. Autorzy uważają, że niezbędne są dalsze badania, w celu zrozumienia złożoności odpowiedzi immunologicznej po zastosowaniu dupilumabu w innych procesach chorobowych [5].…”