Successful Treatment of Chronic Actinic Dermatitis with Dupilumab: A Case Report and Review of the Literature

Abstract

Chronic actinic dermatitis (CAD) is a rather rare photosensitive disease characterized by a persistent eczematous eruption in sun-exposed sites. The pathogenesis of CAD has not been completely elucidated. The clinical treatment of CAD is still challenging and not standardized. Some patients with severe CAD have achieved satisfactory clinical results with dupilumab when conventional therapies have failed. We herein report the case of a 45-year-old male with severe CAD who responded rapidly to combined treatment with dupilumab (600 mg for 1 week, and then 300 mg every 2 weeks) in 2 months. The patient experienced continuous improvement and no side effects from dupilumab (300 mg every month), having ceased other systemic medications. Dupilumab could be considered as an alternative or adjunctive treatment for CAD.

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

“…Dupilumab is an IL-4 receptor alpha antagonist that blocks Th2 proinflammatory cytokines IL-4 and IL-13. Although previous reports [8][9][10][11][12][13] and this study have found that dupilumab showed surprising efficacy in the treatment of CAD, it is challenging to speculate on the exact mechanism of dupilumab to improve the disease severity in patients with CAD. Ko et al found the role of Th1/Th2 misbalance in patients suffering severe CAD.…”

“…8,9 In the literature review, adverse events occurred in 33.33% (4/12) of patients after treatment of dupilumab and presented by dupilumab facial redness and conjunctivitis. [8][9][10][11][12][13] Only one of our patients experienced an injection site reaction at the first injection, and it was resolved within 3 hours after oral antihistamine.…”

“…There were also significant improvements in secondary outcome measures, such as ADCT, DLQI, and NRS scores compared to baseline. In the literature review, six studies [8][9][10][11][12][13] includes 12 cases were treated with dupilumab after failing conventional treatments. All 12 patients experienced a partial-to-complete response after the treatment of dupilumab.…”

“…[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.…”

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

“…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.…”