Successful treatment of recalcitrant dyshidrotic eczema with dupilumab in a child

Weins, Andreas Benedikt; Biedermann, Tilo; Eyerich, Kilian; Moeckel, Sigrid; Schnopp, Christina

doi:10.1111/ddg.13929

Cited by 5 publications

(3 citation statements)

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“…Frequent clinical phenotypes include chronic hyperkeratotic/fissured and recurrent dyshidrotic/vesicular HE among others. Reports of a total of 162 patients demonstrated clinical effectiveness of dupilumab in various subtypes of CHE for patients that had failed various topical and systemic therapies including most frequently topical and systemic steroids, topical calcineurin inhibitors, retinoids, ciclosporin A and phototherapy ( Table 1 ) [ 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ]. A prospective study following 72 patients with chronic fissured or vesicular HE for 52 weeks showed a mean reduction of 89% of the hand eczema severity index (HECSI, 95%; confidence interval 93.1–84.5%) and a 90% improvement of HECSI met by 62.9% with no difference between clinical subtypes [ 66 ].…”

Section: Resultsmentioning

confidence: 99%

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

et al. 2023

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Dupilumab was first approved for the treatment of atopic dermatitis (AD) and blocks the signaling of interleukin (IL)-4 and -13. Several other chronic skin conditions share mechanistic overlaps with AD in their pathophysiology, i.e., are linked to type 2 inflammation. Most recently, dupilumab was approved by the U.S. Food and Drug Administration for prurigo nodularis (PN). Given its relatively good safety profile, effective off-label use of dupilumab has been reported for a multitude of dermatologic diseases and several clinical trials for dermatologic skin conditions are currently ongoing. We conducted a systematic review of applications of dupilumab in dermatology other than AD and PN by searching the databases PubMed/Medline, Scopus, Web of Science and Cochrane Library as well as the clinical trial registry ClinicalTrials.gov. We found several reports for effective treatment of bullous autoimmune diseases, eczema, prurigo, alopecia areata, chronic spontaneous urticaria, Netherton syndrome and a variety of other chronic inflammatory skin diseases.

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Section: Resultsmentioning

confidence: 99%

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

et al. 2023

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“…Regarding dupilumab-associated adverse events, 1 case report showed injection site pain and ongoing pruritic conjunctivitis; 10 1 case series reported 2 facial redness and 1 ocular surface disease; 19 2 cases mentioned no adverse events associated with dupilumab; 13 , 14 the prospective observational study showed 27.8% mild conjunctivitis, 3 severe conjunctivitis with limbitis, 1 multiple verrucae filiforme and blood eosinophilia; 21 and the other studies did not report related adverse reactions. That means dupilumab is safe in patients with hand eczema, consistent with dupilumabin special populations.…”

Section: Discussionmentioning

confidence: 99%

Quick Treatment of Very Severe Refractory Hand and Foot Eczema with Dupilumab: A Case Report and Literature Review

Xiao

Sun

et al. 2023

JAA

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Previously case reports showed dupilumab may benefit for hand eczema treatment, but relatively comprehensive assessments are lacking. A 45-year-old male with multiple severe vesicles, bullae and pustule on the palmar aspects of both hand and foot diagnosed dyshidrotic eczema by pathology was treated with dupilumab at an initial dose of 600 mg subcutaneously, followed by 300 mg every 2 weeks. The physician's assessment of the patient revealed an excellent response to the treatment with dupilumab; the lesions and symptoms achieved dramatic improvement on the third day, and at 6 weeks, the hands and feet became completely normal without relapse in the past 1.5 years of discontinuation. Systematic literature searches were performed, and 6 case reports, 5 case series, 2 prospective observational studies and 1 retrospective review with a total of 150 patients were identified to describing the evaluation of efficacy and safety of dupilumab treatment for hand and foot eczema. Dupilumab appears to be safe and well tolerated with clinical benefit in recalcitrant hand and foot eczema. Larger randomized controlled trials using validated outcome measures and detailed hand eczema type and population classification are needed before dupilumab can be applied in clinical settings.

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“…Previous studies suggested that Th2 cytokines (IL-4 and IL-13) reduce involucrin expression via the STAT-6 signaling pathway. 13 Given the association between pompholyx and atopic dermatitis, 1,26 as well as the reported cases of pompholyx being successfully treated with dupilumab and IL-4 and IL-13 inhibitors, [27][28][29][30] it is suggested that Th2 cytokines play a role in the pathogenesis of pompholyx and contribute to decreased involucrin expression compared to PPP. Additionally, the overexpression of involucrin in PPP aligns with previous studies that observed premature involucrin expression in psoriatic lesions.…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical evaluation of keratins and involucrin in differentiating between palmoplantar pustulosis and pompholyx

Oh,

Kim,

Jang

et al. 2024

Int J Dermatology

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BackgroundPalmoplantar pustulosis (PPP) and pompholyx are chronic diseases characterized by pustules and vesicles on the palms and soles. These disorders often have similar clinicopathological features, which lead to diagnostic difficulties. We aimed to investigate the expression patterns of keratins and involucrin in PPP and pompholyx using immunohistochemical staining.MethodsSkin biopsies from patients with PPP (n = 40) and pompholyx (n = 22) were immunohistochemically analyzed for Keratin 5, 9, 14, and involucrin expression.ResultsK5 expression was higher in PPP than in pompholyx, with diffusely positive expression in the basal, spinous, and granular layers. K14 expression did not differ between groups. K9 expression was observed near the pompholyx vesicle (P = 0.014) and stratum spinosum (P < 0.001) but was almost absent around PPP pustules. Involucrin expression was diffused around the PPP pustules and partially around the pompholyx vesicles, but without statistical significance (P = 0.123). Involucrin expression was elevated in the basal layer of the PPP compared with that in the pompholyx (P = 0.023).ConclusionPPP and pompholyx exhibited distinctive differentiation in the expression of K5, K9, and involucrin.

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Successful treatment of recalcitrant dyshidrotic eczema with dupilumab in a child

Cited by 5 publications

References 0 publications

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

Quick Treatment of Very Severe Refractory Hand and Foot Eczema with Dupilumab: A Case Report and Literature Review

Immunohistochemical evaluation of keratins and involucrin in differentiating between palmoplantar pustulosis and pompholyx

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