Dupilumab For Refractory Alopecia Areata Associated with Atopic Dermatitis

Small Case Series Demonstrates Benefits of Dupilumab for Patients with Alopecia Areata Who have Eczema

Recent studies have suggested that the drug dupilumab may be a treatment option for patients with alopecia areata who also have atopic dermatitis. A few months ago, I reviewed a study pertaining to the use of Dupilumab in children with alopecia areata. A new study published in the British Journal of Dermatology outlines the benefits of dupilumab in adults with both alopecia areata and atopic dermatitis.

Dupilumab is a monoclonal antibody against the alpha subunit of the IL4/IL13 receptor. The drug is approved for treating atopic dermatitis (also known commonly as “eczema”). Some studies have suggested the drug may help treat alopecia areata. However, some studies suggest the drug may actually trigger alopecia areata.

Harada and colleagues from Tokyo Japan evaluated the benefits of dupilumab in 7 patients with refractory alopecia areata. By “refractory” I simply mean the patients had failed to respond to other standard treatments for alopecia areata like topical steroids, steroid injections, diphencyprone. In this study, treatment for these patients was initiated with dupilumab - 600 mg for the first dose followed by 300 mg every 2 weeks.

The average age of the 7 patients in this study was 40 years and the average age of onset of their alopecia areata was 36 years (range 33-52). 3 patients had alopecia areata multilocularis (multiple patches), 3 had alopecia totals and 1 had alopecia universalis. 6 of the 7 patients responded to treatment. 3 patients had a very cosmetically significant improvement with SALT score less than 11 and 3 had a moderate improvement. One patient failed to respond to treatment at all.

Of the 4 patients in the study with alopecia totals and universalis who used dupilumab, 1 had significant regrowth, 3 had mild regrowth but not complete. 1 patient with alopecia totalis did not respond at all to Dupilumab therapy. ,

All patients who responded to dupilumab for their alopecia areata and regrew hair also had an improvement in their eczema (atopic dermatitis).

This study supports the notion that patients with concomitant alopecia areata and atopic dermatitis may be candidates for dupilumab if they fail to respond to standard treatments.

Reference

Harada K et al. The effectiveness of dupilumab in patients with alopecia areata who have atopic dermatitis: a case series of seven patients. Br J Dermatol. 2020 Aug;183(2):396-397.