Dupilumab Treatment of Very Severe Refractory Atopic Hand Eczema

Oosterhaven, Jart A F; Romeijn, Geertruida L E; Schuttelaar, Marie L A

doi:10.1001/jamadermatol.2018.2027

Cited by 27 publications

(21 citation statements)

References 21 publications

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“…A 72‐year‐old female patient with >35 year history of CHE achieved complete clearance in 6 weeks, a 65‐year‐old female patient with >10 year history of CHE achieved 90% improvement in 6 weeks, and a 48‐year‐old male with 9‐year history of CHE achieved 80% improvement in 3 months, based on investigator subjective improvement (Zirwas, ). In a separate report, a 50‐year‐old female with an 18‐year history of severe atopic CHE refractory to potent TCS, psoralen UV‐A, cyclosporine, alitretinoin, and tacrolimus was successfully treated with dupilumab (loading dose of 600 mg subcutaneously and 300 mg once every 2 weeks) concomitantly with prednisolone 7.5 mg/day, for 12 weeks (Oosterhaven, Romeijn, & Schuttelaar, ). Her hand eczema severity index (HESCI) score improved from 244/260 (severe) at baseline to 11/360 (almost clear) at 16 weeks (Oosterhaven et al, ).…”

Section: Systemic Agentsmentioning

confidence: 99%

Current and emerging therapies for hand eczema

Lee

Maarouf

Hendricks

et al. 2019

Dermatologic Therapy

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Although hand eczema (HE) and chronic hand eczema (CHE) are common conditions with significant disease burden, they traditionally have had limited treatment options beyond topical and short‐term systemic corticosteroids. We reviewed published and preliminary evidence on the current and emerging topical and systemic therapeutic agents for HE and CHE. The etiologies of various HE subtypes are discussed, and remaining knowledge and practice gaps are highlighted to encourage further investigations. A comprehensive search of http://clinicaltrials.gov and PubMed was completed for clinical trials that utilized known and emerging treatment options for HE and CHE. Several agents that target IL‐4 and IL‐13 signaling, keratinocyte proliferation, inflammatory cytokine production, bacterial protein synthesis, and inflammatory mediator (TNF‐α, JAK1, JAK2, and JAK3) proliferation are shown to be involved in the pathogenesis of CHE. Systemic agents include dupilumab, alitretinoin, acitretin, cyclosporine, azathioprine, and probiotics. Topical agents include delgocitinib, retapamulin, halometasone/triclosan, calcipotriol/betamethasone, tacrolimus, and pimecrolimus. These modalities have demonstrated varying degrees of clinical efficacy, evaluated by subjective assessments and scoring indexes. Targeted therapies are emerging for HE, but options are still limited, partially due to our narrow understanding of this heterogeneous condition. Additional and targeted therapeutic options are needed to match the rising prevalence and burden of HE. Keypoints Hand eczema (HE) is a heterogenous dermatosis with limited therapeutic options due to a lack of international guidelines regarding classification of HE subtypes and treatment. This review discusses current and emerging topical and systemic agents and their efficacies in the treatment of different types of hand eczema.

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Section: Systemic Agentsmentioning

confidence: 99%

Current and emerging therapies for hand eczema

Lee

Maarouf

Hendricks

et al. 2019

Dermatologic Therapy

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“…Initial case reports have shown favorable results for the use of dupilumab for hand dermatitis, suggesting there may be similarities in the pathophysiology of atopic dermatitis and hand dermatitis. Oosterhaven et al [3] first observed a female patient with very severe chronic atopic hand eczema and severe atopic dermatitis that had tried and failed alitretinoin, cyclosporine, azathioprine, mycophenolic acid, tacrolimus, and methotrexate showing “striking improvement” with dupilumab. At the beginning of treatment, her Hand Eczema Severity Index Score (HESI) was 244 out of 360, and by week 16, her hand eczema was “almost clear,” with a HESI of 16 out of 360.…”

mentioning

confidence: 99%

A Retrospective Review of Dupilumab for Hand Dermatitis

et al. 2019

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“…Patient 1, a lifeguard, presented with a BSA over 80%. Her dermatitis was most severe in a bathing suit distribution and under the bra elastic (Figure 1 (Zirwas, 2018) or no improvement with allergen avoidance (Oosterhaven, Romeijn, & Schuttelaar, 2018 Dermatitis of the back secondary to rubber accelerators suggested by more marked involvement underneath the patient's bra elastic (left) with resolution following dupilumab treatment (right)…”

Section: Resultsmentioning

confidence: 99%

“…Prior reports of severe, recalcitrant hand dermatitis responding to dupilumab, either noted no relevant allergens on patch testing (Zirwas, ) or no improvement with allergen avoidance (Oosterhaven, Romeijn, & Schuttelaar, ). Characteristics of the three patients presented here support the hypothesis that for our cases dramatic clinical improvement was based on dupilumab suppressing ACD reactions.…”

Section: Discussionmentioning

confidence: 99%

A case series of dupilumab-treated allergic contact dermatitis patients

Goldminz

Scheinman

2018

Dermatologic Therapy

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Atopic dermatitis is characterized by skin barrier abnormalities and immune dysregulation with increased TH2 signaling playing a central role. Investigations of allergic contact dermatitis suggest that certain allergens may also activate particular T cell signatures such as TH2‐dominant responses to fragrance and rubber. We present a case series of patients with allergic contact dermatitis who were successfully treated with dupilumab, a biologic developed for atopic dermatitis that dampens TH2 signaling. In our cohort of three patients, two had extensive allergic contact dermatitis on their torso and extremities primarily due to textile and rubber allergens. The third was a hairdresser with severe hand dermatitis due to occupational allergens. Two of the three patients had no history of atopic dermatitis during childhood. Each patient experienced at least 90% improvement in body surface area involvement and continues to maintain their clinical response on dupilumab (range 6‐13 months). Our hypothesis that dupilumab suppressed contact allergic reactions is supported by the identification of clinically relevant contact allergens on patch testing, acute onset and/or worsening of dermatitis in adulthood, and absence of childhood atopic dermatitis in two cases. Further, larger investigations to understand which factors affect responses of allergic contact dermatitis to dupilumab are warranted.

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Dupilumab Treatment of Very Severe Refractory Atopic Hand Eczema

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Cited by 27 publications

References 21 publications

Current and emerging therapies for hand eczema

Current and emerging therapies for hand eczema

A Retrospective Review of Dupilumab for Hand Dermatitis

A case series of dupilumab-treated allergic contact dermatitis patients

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