Alopecia areata in 2 patients treated with dupilumab: New onset and worsening

Chung, Janice; Slaught, Christa; Simpson, Eric L.

doi:10.1016/j.jdcr.2019.03.019

Cited by 33 publications

(28 citation statements)

References 10 publications

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“…In this context, it is an interesting observation to evaluate the therapeutic effect of dupilumab on AA. The patterns of AA responsiveness to dupilumab are various in the reported cases, as AA was improved in 7 cases [ 11 , 16 , 25 , 26 , 27 , 28 , 29 ], AA was developed in 8 cases [ 13 , 14 , 15 , 27 , 33 , 34 , 35 , 36 ], and AA progressed in 2 cases [ 34 , 36 ]. In the present study, we had 7 AA patients with AD who were treated with dupilumab at our hospital: 6 extrinsic AD cases and one intrinsic AD case.…”

Section: Discussionmentioning

confidence: 99%

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Immunological Properties of Atopic Dermatitis-Associated Alopecia Areata

Kageyama

Ito

Hanai

et al. 2021

IJMS

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Alopecia areata (AA) is regarded as a tissue-specific and cell-mediated autoimmune disorder. Regarding the cytokine balance, AA has been considered a type 1 inflammatory disease. On the other hand, AA often complicates atopic dermatitis (AD) and AD is regarded as type 2 inflammatory disease. However, the immunological aspects of AA in relation to AD are still poorly understood. Therefore, we aim to clarify the immunological properties of AD-associated AA. In this study, we performed comparative analysis of the expression of intracytoplasmic cytokines (IFN-γ, IL-4, and IL-13), chemokine receptors (CXCR3 and CCR4) in peripheral blood which were taken from healthy controls, non-atopic AA patients, AA patients with extrinsic AD, and AA patients with intrinsic AD by flowcytometric analysis. We also compared the scalp skin samples taken from AA patients with extrinsic AD before and after treatment with dupilumab. In non-atopic AA patients, the ratios of CD4+IFN-γ+ cells to CD4+IL-4+ cells and CD4+IFN-γ+ cells to CD4+IL-13+ cells were higher than those in AA patients with extrinsic AD. Meanwhile, the ratio of CD8+IFN-γ+ cells to CD8+IL-13+ cells was significantly higher in the non-atopic AA than in the healthy controls. In AA patients with extrinsic AD, the skin AA lesion showed dense infiltration of not only CXCR3+ cells but also CCR4+ cells around hair bulb before dupilumab treatment. However, after the treatment, the number of CXCR3+ cells had no remarkable change while the number of CCR4+ cells significantly decreased. These results indicate that the immunological condition of AA may be different between atopic and non-atopic patients and between extrinsic and intrinsic AD patients. Our study provides an important notion that type 2 immunity may participate in the development of AA in extrinsic AD patients. It may be considered that the immunological state of non-atopic AA is different from that of atopic AA.

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Section: Discussionmentioning

confidence: 99%

“…On the other hand, there are also several case reports of the induction of AA by the treatment with dupilumab for AD [ 41 ]. This can be explained that dupilumab may improve AA with AD but induces AA in the patients with AD without AA [ 34 ]. McKenzie et al has used dupilumab for 16 pediatric AA patients with concomitant A [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Immunological Properties of Atopic Dermatitis-Associated Alopecia Areata

Kageyama

Ito

Hanai

et al. 2021

IJMS

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“…Meanwhile, another four case reports have also shown the improvement of preexisting AA following dupilumab therapy for AD. [68,69,74,75] Before starting dupilumab for AD, the possibility of causing new-onset AA, as well as the possibility of improving or exacerbating preexisting AA, should be carefully considered.…”

Section: Dupilumab Ad and A Amentioning

confidence: 99%

Understanding the significance of cytokines and chemokines in the pathogenesis of alopecia areata

Ito

Kageyama

Nakazawa

et al. 2020

Experimental Dermatology

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Alopecia areata has basically been understood as a type 1 inflammatory disease. Activated NKG2D+CD8+ cells produce the Th1 cytokine interferon‐γ, which leads to the disruption of immune tolerance of hair follicles and the exposure of self‐antigens. This results in dense inflammatory cell infiltration and apoptosis around hair follicles, inducing hair loss. A well‐known complication of alopecia areata is atopic dermatitis, a typical type 2 inflammatory disease. Hair scientists have shied away from confronting and understanding how alopecia areata, a type 1 inflammatory disease, and atopic dermatitis, a type 2 inflammatory disease, can occur together. This review summarizes the research on the cytokine balance in alopecia areata and then focuses on the classification of the cytokine balance in alopecia areata, including the classification of atopic dermatitis into extrinsic and intrinsic types. Dupilumab reportedly showed dual efficacy in a patient with concomitant atopic dermatitis and alopecia areata, supporting our own experience. Elevated Th2 cytokine levels have also been reported in patients with alopecia areata, with increased serum IL‐4, IL‐5, IL‐6 levels, high IgE levels and elevated eosinophil levels. Because local immunotherapy is a treatment that induces Th2‐type inflammation, it may worsen the condition of alopecia areata patients with extrinsic atopic dermatitis. It is desirable to select appropriate treatments with consideration of the cytokine balance.

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“…Rosella GALLO, Ilaria TRAVE and Aurora PARODI Classic AA was reported in 8 patients (5 men and 3 women, 20-51-year age range). The diagnosis was based on both clinical and dermatoscopic features in one patient (5) and on clinical features only in 7 (2)(3)(4)(6)(7)(8). None of the patients was biopsied.…”

Section: Massive Acute Alopecia Of the Scalp In A Patient Treated With Dupilumabmentioning

confidence: 99%

“…Its main adverse effects include injection site reactions, nasopharyngitis and conjunctivitis (1). Although it has been reported to improve alopecia areata (AA) (2) there have been increasing reports of AA and AA-like reactions in patients with AD treated with dupilumab (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). We report here a patient who developed massive hair shedding, mimicking AA, after 8 weeks of starting dupilumab.…”

mentioning

confidence: 97%