Photodynamic Therapy and Medicare Expenditures—Reply

Abstract

pathophysiology of the disease and its connection to the aging immune system. Dupilumab is a fully humanized monoclonal antibody that binds the IL-4 receptor and inhibits type 2 helper T lymphocyte (T H 2) cytokine signaling, especially that mediated by IL-4 and IL-13. These cases suggest the role of T H 2 pathways in Grover disease as a possible manifestation of an aging immune system.The substantial improvement of recalcitrant disease and the associated itch with dupilumab suggests a novel treatment option. Evidence supporting this finding includes the fact that IL-4 infusions may induce Grover disease and that the immunophenotype of the immune cells infiltrating Grover disease demonstrate a T H 2 cytokine phenotype. 3,6 Grover disease as a T H 2 disease is also consistent with known age-related changes of the immune system called immunosenescence. Additional studies are needed to better understand the pathophysiology of Grover disease specifically as a marker for an aging immune system. Dupilumab appears to provide a safe and effective treatment option in this vulnerable population.