Efficacy of suplatast tosilate in a case of recurrent eosinophilic annular erythema

Mepolizumab Therapy for Recalcitrant Eosinophilic Annular Erythema in an Adult: A Case Report and Review of Treatment Options

“…Data from recent case reports underscore the efficacy of targeting Th2-type cytokines in the treatment of EAE. Suplatast tosilate, an anti-allergic medication that suppresses the production of IgE and synthesis of IL-4 and IL-5, was administered to one patient with EAE, resulting in complete resolution of the lesions within 2 weeks [16]. Dupilumab, an IL-4 receptor alpha antagonist, was also successfully used in a 14-year-old African-American girl with EAE [17].…”

“…A search of the literature revealed that only about 40 cases of EAE in adults and fewer than 10 cases in children have been reported to date. Among adult patients, a slight female preponderance has been noted (female:male ratio 1.14:1), and age at onset varies from 20 to 85 years [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Eosinophilic Annular Erythema- Successful Treatment with Dupilumab

“…Specifically, chloroquine inhibits eosinophilotaxis and the release of pro-inflammatory cytokines; suplatast tosilate suppresses the production of type 2 cytokines, such as IL-4 and IL-5 that promote eosinopoeisis; and, dapsone inhibits eosinophil peroxidase. 2,5,6 It is not surprising then that dupilumab, an IL-4 receptor alpha antagonist which blocks IL-4 and IL-13 signaling involved in the type 2 inflammatory response, worked to improve our patient's EAE. To our knowledge, this is the first adult case with response of EAE to dupilumab, though similar efficacy was noted in a pediatric case of EAE in 2018.…”

“…3 Other reports argue that EAE is a subtype of Well's syndrome, as flame figures are sometimes seen in biopsies of later lesions. 1,5 Nevertheless, distinct entity or subtype, therapeutic options for EAE, compared to Well's syndrome, have remain limited. This is likely because, while EAE is sometimes selflimited, it is predominantly characterized by a chronic course, high relapse rate, and significant resistance to treatment.…”

“…Therapies with reported efficacy include prednisone plus or minus hydroxychloroquine or cyclosporine, hydroxychloroquine alone, chloroquine, suplatast tosilate, dapsone, and narrowband ultraviolet B (UVB) treatment. 1,2,[5][6][7] Though the pathogenesis of EAE remains unknown, these drugs may work by targeting the type 2 inflammatory response associated with tissue eosinophilia. Specifically, chloroquine inhibits eosinophilotaxis and the release of pro-inflammatory cytokines; suplatast tosilate suppresses the production of type 2 cytokines, such as IL-4 and IL-5 that promote eosinopoeisis; and, dapsone inhibits eosinophil peroxidase.…”