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

Abstract

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.

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

“…One case of incontinentia pigmenti-associated scalp alopecia was reported. Clinical responses were mostly measured by the severity of alopecia tool (SALT) with a score < 10 defined as complete response ( Table 4 ) [ 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 ]. Noticeably, 13 pediatric patients were treated effectively with dupilumab [ 172 , 173 , 174 , 175 , 176 , 177 ].…”

A case of atopic dermatitis with self‐healing acute diffuse and total alopecia during nemolizumab treatment

“…3 Studies on dupilumab, another treatment option for AD cases complicated by AA, have shown conflicting results regarding its effects on AA. 4 We diagnosed this case of AA as a self-healing ADTA (sADTA) after nemolizumab administration. sADTA is defined as a rapidly progressive subtype of AA (RP-AA) that exhibits spontaneous recovery.…”