Alopecia areata-like and psoriasis after dupilumab use for atopic dermatitis

Maiolini, Viviane Maria; Sousa, Nathalie Andrade; Marsillac, Paula Figueiredo de; Bressan, Aline Lopes

doi:10.1016/j.abd.2021.03.005

Cited by 12 publications

(6 citation statements)

References 5 publications

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“…Interestingly, instances of erythrodermic, plaque, acral, and scalp psoriasis have been reported during dupilumab treatment 9 ; however, this is the first report of the occurrence of reverse psoriasis after dupilumab treatment for AD management. The manifestation of reverse psoriasis in our patient further complements the types of psoriasis that appear after dupilumab treatment for AD management.…”

mentioning

confidence: 76%

A case of dupilumab‐induced reverse psoriasis in a patient with atopic dermatitis

Fan

Zhang

et al. 2022

Dermatologic Therapy

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confidence: 76%

A case of dupilumab‐induced reverse psoriasis in a patient with atopic dermatitis

Fan

Zhang

et al. 2022

Dermatologic Therapy

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“…However, the relationship between dupilumab and alopecia areata remains controversial as some patients experience improvement after starting treatment while others develop dupilumab-induced alopecia 13 with some studies suggesting that Th2 inhibition may amplify alternate pathways such as Th1 and Th17 resulting in hair loss 14 . Moreover, alopecia associated with dupilumab tends to follow an androgenetic pattern and usually has an eczematous pattern upon histopathological examination 15 . It is unclear whether dupilumab induces true AA or a form of drug-induced alopecia.…”

Section: Discussionmentioning

confidence: 99%

Complete hair regrowth in a young male with severe atopic dermatitis and alopecia areata after dupilumab: probably more than a coincidence

Matos¹,

Nogueira²,

Amoedo³

et al. 2023

PJDV

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We report the case of a 29-year-old male patient who has suffered from severe atopic dermatitis (AD) since early childhood and presented with a 6-month evolution of patchy hair loss in the temporal and occipital regions, clinically suggestive of alopecia areata (AA), which was confirmed by scalp biopsy. The patient started therapy for atopic dermatitis with the monoclonal antibody dupilumab, with a substantial response regarding atopic dermatitis, and with renewed hair growth on the scalp. Dupilumab blocks the α-subunit of the interleukin 4 receptor, interrupting the signaling cascade of IL-4 and IL-13 and thus leading to a reduced Th2 immune response. Some controversy exists regarding dupilumab and AA, with some reports describing improvement after starting this drug while others showing patients with dupilumab-induced alopecia. The patient demonstrated dramatic improvement in both AD and AA early on and tolerated the drug without significant side effects. His quality of life was significantly improved. Patient selection could play a crucial role in the future, and the predictors of a good response are currently being identified so the responders with severe atopic dermatitis and alopecia areata could benefit from dupilumab.

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“…Active skin lesions are usually consistent with clinicopathologic findings of AD and PV 10 . In addition to the co‐occurrence of both diseases in the same patient at the same time, few cases also report sudden phenotypic switches (AD ↔ PV) in the course of disease, either with or without biological treatment (so‐called paradoxical reactions 16–52 ; hereinafter referred to as “Flip‐Flop” (FF) patients). The possibly underestimated incidence of a switch from AD towards PV under dupilumab treatment is 1.7% 17 .…”

Section: Introductionmentioning

confidence: 85%

Development of a clinical algorithm to predict phenotypic switches between atopic dermatitis and psoriasis (the “Flip‐Flop” phenomenon)

Müller,

Welchowski,

Schmid

et al. 2023

Allergy

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BackgroundAtopic dermatitis (AD) and psoriasis vulgaris (PV) are almost mutually exclusive diseases with different immune polarizations, mechanisms and therapeutic targets. Switches to the other disease (“Flip‐Flop” [FF] phenomenon) can occur with or without systemic treatment and are often referred to as paradoxical reactions under biological therapy.MethodsThe objective was to develop a diagnostic algorithm by combining clinical criteria of AD and PV to identify FF patients. The algorithm was prospectively validated in patients enrolled in the CK‐CARE registry in Bonn, Germany. Afterward, algorithm refinements were implemented based on machine learning.ResultsThree hundred adult Caucasian patients were included in the validation study (n = 238 with AD, n = 49 with PV, n = 13 with FF; mean age 41.2 years; n = 161 [53.7%] female). The total FF scores of the PV and AD groups differed significantly from the FF group in the validation data (p < .001). The predictive mean generalized Youden‐Index of the initial model was 78.9% [95% confidence interval 72.0%–85.6%] and the accuracy was 89.7%. Disease group‐specific sensitivity was 100% (FF), 95.0% (AD), and 61.2% (PV). The specificity was 89.2% (FF), 100% (AD), and 100% (PV), respectively.ConclusionThe FF algorithm represents the first validated tool to identify FF patients.

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Alopecia areata-like and psoriasis after dupilumab use for atopic dermatitis

Cited by 12 publications

References 5 publications

A case of dupilumab‐induced reverse psoriasis in a patient with atopic dermatitis

A case of dupilumab‐induced reverse psoriasis in a patient with atopic dermatitis

Complete hair regrowth in a young male with severe atopic dermatitis and alopecia areata after dupilumab: probably more than a coincidence

Development of a clinical algorithm to predict phenotypic switches between atopic dermatitis and psoriasis (the “Flip‐Flop” phenomenon)

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