Dupilumab (Dupixent) for Treating Alopecia Areata: Does it help AA or trigger AA?

Dupilumab May Help Some Improve their Alopecia Areata and May Trigger the Disease Onset in Others

The exact cause of alopecia areata has not yet been worked out.  It is known that many parts of the immune system are activated and the underlying activations and degree of activation may not be the same in all patients with alopecia areata. Both Th1 and Th2 immune responses have a role.

Recently, the drug dupilumab (DUPIXENT) an interleukin (IL)-4 receptor antagonist that downregulates Th2 response, has been suggested to help some patients with alopecia areata.  The drug is FDA approved for treating atopic dermatitis as well as some types of asthma and some forms of sinusitis. Paradoxically, the drug also appears to trigger the development of alopecia areata in some patients as well.  

 To date there have been a handful of patients reported in the medical journals who have  developed alopecia areata type hair loss with use of dupilumab and continued reports of patients with alopecia areata who regrew hair back with use of dupilumab. 

 We don’t yet fully understand which patients with alopecia areata who going to grow back hair with dupilumab and which patients will not and may worsen. So far, the small number of patients who got worse with dupilumab were male patients who were being treated for atopic dermatitis. These males were otherwise healthy with no severe asthma or food allergies.   The patients who regrew hair were female patients who had severe atopic dermatitis (eczema) since early childhood.  Many of these female patients also had food allergies and asthma.

Whether these differences will hold true in further studies is yet to be determined. For now, it does seem that patients with alopecia areata who have had severe atopic dermatitis (eczema) since childhood are the best candidates. The studies are far too small yet to know if there are really differences between males and females and to really understand exactly how well dupixent really helps advanced alopecia areata

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Darrigade A-S, Legrand A, Andreu N, et al. Dual efficacy of dupilumab in a patient with concomitant atopic dermatitis and alopecia areata. Br J Dermatol. June 2018. doi:10.1111/bjd.16711 

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Harada, K., Irisawa, R., Ito, T., Uchiyama, M. and Tsuboi, R. (2020), The effectiveness of dupilumab in patients with alopecia areata who have atopic dermatitis: a case series of seven patients. Br J Dermatol, 183: 396-397. doi:10.1111/bjd.18976

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