Dupilumab: Is it Among the Potential New "Targeted" Treatments for Alopecia Areata?

Dupilumab for Alopecia Areata:

Dupilumab is a treatment that helps patients with eczema (atopic dermatitis). Dupilumab is an interleukin 4 (IL-4) receptor α-antagonist that inhibits IL-4 and IL-13 signaling through blockade of the shared IL-4α subunit. The drug was approved by the US Food and Drug Administration in March 2017 and Health Canada in Dec 2017 for the treatment of adult patients with moderate to severe atopic dermatitis not adequately controlled with topical therapies. The drug blocks a group of white blood cells know as TH2 cells which are known to play a role in eczema.

Dupilumab has been reported to trigger hair regrowth in some patients with alopecia areata and atopic dermatitis (ie eczema).

In 2018, Penzi and colleagues reported that dupilumab helped regrow hair in a patient with alopecia totalis who was receiving dupilumab as treatment for their eczema. Several other case reports have now reported improvements in hair regrowth with dupilumab including reports by Smogorzewski and colleagues and Uchida and colleagues. Interestingly, some studies have reported development of alopecia areata during the course of treatment with dupilumab.

Side effects of dupilumab include injection-site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, and dry eye. The side effect of hair regrowth in patients with alopecia areata is serendipitous and likely will fuel further research in the use of this drug in alopecia areata.

Reference

Penzi et al.Hair Regrowth in a Patient With Long-standing Alopecia Totalis and Atopic Dermatitis Treated With Dupilumab. JAMA Dermatol 2018