Chronic actinic dermatitis successfully treated with methotrexate and dupilumab

McFeely, Orla; Doyle, Claire; Blasco, Marta Costa; Beatty, Paula; Murphy, Laura; O’Mahony, Sarah; Andrawis, Madonna; Salim, Asad

doi:10.1111/phpp.12851

Cited by 7 publications

(9 citation statements)

References 10 publications

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“…Chronic photodermatoses including chronic actinic dermatosis (CAD) and actinic prurigo are induced by exposure to UV-radiation and can resemble photosensitive AD. Reports showed efficacy of dupilumab in 16 cases of CAD ( Table 8 ) [ 252 , 253 , 254 , 255 , 256 , 257 , 258 ] as well as in a pediatric patient with actinic prurigo [ 259 ], leading to higher minimal erythema doses in repeated UV-phototesting in some cases.…”

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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“…These findings are in keeping with recently reviewed data demonstrating that dupilumab may be a viable treatment option for patients with refractory CAD regardless of a history of AD. 8 , 9 …”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] CAD is an immune-mediated photodermatosis and has been reported to have a similar Th2-mediated inflammatory pathogenesis to AD. According to previous reports, [8][9][10][11][12][13] dupilumab prescribed for CAD has shown promising results in the disease. However, the evidence supporting its efficacy in patients with CAD comes from small case series and case reports.…”

Section: Introductionmentioning

confidence: 96%

The Effectiveness and Safety of Dupilumab for the Treatment of Recalcitrant Chronic Actinic Dermatitis: A Case Series

Chen,

Yu,

et al. 2023

CCID

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Background Although dupilumab is an effective treatment approach for chronic actinic dermatitis (CAD) in some cases, its effectiveness and safety in CAD have not been sufficiently assessed. Purpose Evaluation of the effectiveness and safety of dupilumab in patients with recalcitrant CAD was performed. Methods We retrospectively reviewed the medical records of CAD patients treated with dupilumab. Data regarding demographics were collected, and disease severity scores were assessed using the following: Clinical Severity Score of CAD (CSS-CAD), Atopic Dermatitis Control Tool (ADCT), Dermatology Life Quality Index (DLQI), and Numeric Rating Scale (NRS)-itch scores. Results After 12 weeks of treatment, there was a significant decrease in disease severity scores of 16 CAD patients. Only one patient achieved a good response and most of the patients (62.5%, 10/16) had no significant symptom improvement after 4 weeks of treatment. However, after 12 weeks of treatment, 43.75% (7/16) of the patients reached excellent response (>75% improvement of CSS-CAD), 31.25% (5/16) good response (50%–75% improvement of CSS-CAD), 6.25% (1/16) partial response (25%–50% improvement of CSS-CAD), and only 18.75% (3/16) no response (<25% improvement of CSS-CAD). One patient complained of injection site reaction at the first injection. Conclusion This study supports dupilumab as an effective and safe treatment option for patients with recalcitrant CAD. Patients may require at least 4 weeks of treatment before the partial response is noted.

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“…5 Apart from these, in recent years, there have been different grades of improvement reported with dupilumab, 6 alone or combined with methotrexate. 7 This might be an alternative to consider for those patients with eczematous presentations and a CD4:CD8 ratio preserved, but it might not be as effective for every patient-CAD patients tend to show light or discrete increased CD8 populations outweighing the physiologic CD4 predominance in blood and peripheral tissues-. Alitretinoin (9-cis-retinoic acid) is a well-known drug in Dermatology for which we are still finding…”

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confidence: 99%

Successful treatment of chronic actinic dermatitis with alitretinoin: Should retinoids be included in the therapeutical arsenal?

Prados-Carmona

Ruiz‐Villaverde

Aranda

et al. 2023

Photoderm Photoimm Photomed

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Chronic actinic dermatitis (CAD) is an infrequent and underdiagnosed photodermatosis mostly reported in adult men. There are still unmet therapeutic needs regarding this condition, forcing us to look for off-label alternatives.A 62-year-old construction worker came to our Contact Eczema and Immunoallergic Department with severe hyperkeratotic plaques in sun-exposed areas. He had been suffering from chronic lesions on the dorsal side of his hands, knees, elbows, and upper back for 12 years that had progressively become lichenified (Figure 1). The

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Chronic actinic dermatitis successfully treated with methotrexate and dupilumab

Cited by 7 publications

References 10 publications

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

The Effectiveness and Safety of Dupilumab for the Treatment of Recalcitrant Chronic Actinic Dermatitis: A Case Series

Successful treatment of chronic actinic dermatitis with alitretinoin: Should retinoids be included in the therapeutical arsenal?

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