Massive Acute Alopecia of the Scalp in a Patient Treated with Dupilumab

Gallo, Rosella; Trave, Ilaria; Parodi, Aurora

doi:10.2340/00015555-3549

Cited by 15 publications

(5 citation statements)

References 19 publications

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“…The exact pathomechanism accounting for AA exacerbation and moderate improvement of AD in case 4 remains elusive; however, the observation may imply the complexity of AD pathophysiology in this case. The result of our literature review elucidated that 10 of 29 AD‐AA cases have experienced worsening/development of AA despite AD improvement 4,8,14‐21 . Accordingly, early detection of AA exacerbation and switching to alternative therapeutic modalities is crucial in such cases.…”

Section: Discussionmentioning

confidence: 95%

“…The result of our literature review elucidated that 10 of 29 AD-AA cases have experienced worsening/development of AA despite AD improvement. 4,8,[14][15][16][17][18][19][20][21] Accordingly, early detection of AA exacerbation and switching to alternative therapeutic modalities is crucial in such cases. Considering possible involvement of immunological skewing to type 1 immunity in those cases, 4 JAK inhibitors might be plausible substitutes.…”

Section: Discussionmentioning

confidence: 99%

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Two‐sided influence of dupilumab on alopecia areata co‐existing with severe atopic dermatitis: A case series and literature review

Fukuyama

Kinoshita‐Ise

Mizukawa

et al. 2022

J Cutaneous Imm & Allergy

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Objectives: Alopecia areata (AA) often coexists with atopic dermatitis (AD). Recently, several reports suggested that dupilumab, an interleukin 4 receptor α-antagonist, administration could be a promising medication not only for severe AD but also for AA concomitant with AD (AD-AA). At the same time, dupilumab has also been reported to exacerbate AA in AD-AA cases. Thus, the efficacy of dupilumab on AA in AD-AA cases remains controversial. Methods:In this study, we retrospectively analyzed four AD-AA cases treated with dupilumab to evaluate its influence on AD and AA.Results: All cases had suffered from severe AD since childhood and their average eczema area and severity index (EASI) scores prior to dupilumab administration was 43.2 ± 15.0. Three of four cases had moderate to severe multifocal AA, which successfully recovered in response to dupilumab, accompanied by the decrease in serum thymus and activation-regulated chemokine (TARC) levels and significant improvement of AD, achieving approximately 90% improvement of EASI scores within 3 months. In contrast, the remaining one case developed rapidly progressive hair loss 8 months after the initiation of dupilumab. In this case, AD was incompletely controlled by dupilumab with the elevation of serum TARC level despite AD improvement. The literature review found 39 dupilumab-treated AD-AA cases with elaborate description of clinical course; 24 cases with AA improvement, 15 cases with AA exacerbation, or new onset.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Two‐sided influence of dupilumab on alopecia areata co‐existing with severe atopic dermatitis: A case series and literature review

Fukuyama

Kinoshita‐Ise

Mizukawa

et al. 2022

J Cutaneous Imm & Allergy

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“…Our case report, alongside similar reports showing dupilumab’s success with treating AA, suggests that Th2 overactivity could be part of the immune dysregulation in the pathogenesis of AA. To complicate this relationship between Th2 blockade and auto-immunity, reports are emerging demonstrating a seemingly paradoxical relationship presented in this report in which patients experienced dupilumab-induced AA [ 9 – 11 ].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Efficacy of Dupilumab in Alopecia Areata

et al. 2022

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Patient: Male, 16-year-old Final Diagnosis: Alopecia areata Symptoms: Scalp hair loss Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Unusual or unexpected effect of treatment Background: Dupilumab is a relatively new immune-modulating drug that has transformed the way clinicians treat common immunologic conditions, including atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. Blocking signaling molecules involved within the Th2 immune response, dupilumab is a proven effective treatment for moderate to severe atopic dermatitis – a condition whose disease pathogenesis is heavily linked to the dysregulation of this immunologic pathway. Interestingly, dupilumab has found broader clinical utility, showing efficacy in treating other distinct dermatologic diseases, including alopecia areata. Case Report: A 16-year-old White male with a past medical history of moderate atopic dermatitis presented to our clinic with complete scalp hair, eyebrow, and eyelash loss. At this time, the patient was given a clinical diagnosis of alopecia totalis. Understanding that dupilumab has been previously used for treatment in adults of this specific autoimmune condition, we started this adolescent patient on dupilumab to concomitantly treat his atopic dermatitis and alopecia areata. The patient gradually experienced complete regrowth of his hair and almost complete resolution of his atopic dermatitis. Three years after starting dupilumab, the patient remains without signs of alopecia totalis. Conclusions: This case report demonstrates the long-term efficacy of dupilumab use in alopecia areata. More investigation is required to understand dupilumab’s broadening clinical indications. Additionally, this case highlights the complex relationship between dysregulation of the Th2 response and autoimmunity. Crosstalk between immune pathways within the disease spectrum of alopecia areata may explain why dupilumab has been reported to both treat and exacerbate alopecia areata.

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“…Most TNF inhibitors are ineffective for AA, while dupilumab was found to be modestly effective in a Phase IIa trial ( 46 ). Although AA is associated with atopic dermatitis and psoriasis, treatment for the latter does not always improve AA ( 47 ), and may sometimes worsen hair loss ( 48 ).…”

Section: Targeted Immunotherapy For Hair Regrowthmentioning

confidence: 99%

Targeted immunotherapy for hair regrowth and regeneration

Toh,

Wang

2023

Front. Med.

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Massive Acute Alopecia of the Scalp in a Patient Treated with Dupilumab

Abstract: Fig. 1. Patient's scalp. (a) Baseline; (b) 8 weeks after starting dupilumab; (c) tufts of hair held together by conglomerated scales or casts; (d) 12 weeks after starting dupilumab, diffuse hair loss on a background of erythema and scaling.

Cited by 15 publications

References 19 publications

Two‐sided influence of dupilumab on alopecia areata co‐existing with severe atopic dermatitis: A case series and literature review

Two‐sided influence of dupilumab on alopecia areata co‐existing with severe atopic dermatitis: A case series and literature review

Long-Term Efficacy of Dupilumab in Alopecia Areata

Targeted immunotherapy for hair regrowth and regeneration

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