Dupilumab an Option After Treatment Failure in Patients With Refractory Dyshidrotic Eczema

Dupilumab was well-tolerated and effective for treating patients with dyshidrotic eczema who previously experienced treatment failure with topical corticosteroids, according to study findings published in the Journal of the American Academy of Dermatology.

The study sample included 15 consecutive patients from the Connecticut Veterans Affairs and University of Connecticut departments of dermatology with dyshidrosis who were being treated with dupilumab. Previously, all participants experienced treatment failure in response to topical corticosteroids, and 73% had experienced treatment failure of at least 1 cycle of oral immunosuppressants and/or phototherapy (n=11). In addition, 7 patients had previously received other biologic medications to treat palmoplantar psoriasis.

All participants reported decreased erythema and pruritus, and 6 participants reported complete clearance of their dyshidrotic eczema. All except 1 patient remained on dupilumab through the study period, and 7 patients remained on dupilumab for more than a year; the average treatment duration was 12.5 months. The only patient to discontinue dupilumab reported concern about possible long-termadverse events. A participant with concomitant plaque psoriasis received ustekinumab 45 mg for 12 weeks in addition to dupilumab; no treatment-related adverse events were reported, and the patient achieved psoriasis clearance and near clearance of dyshidrotic eczema. Two participants reported partial response to dupilumab treatments, and their dosing frequency was subsequently increased to a weekly dupilumab regimen and was well tolerated. Overall, only 3 patients reported adverse events, including conjunctivitis and facial redness, which were refractory to therapy.

Limitations of the study included the retrospective design and lack of diagnostic criteria available for dyshidrosis, which may have resulted in misclassification bias.

In patients in whom topical corticosteroids failed to elicit a response, the investigators suggest that dupilumab was well tolerated and effective to treat patients with dyshidrotic eczema.

Reference      

Waldman RA, DeWane ME, Sloan B, Grant-Kels JM, Lu J. Dupilumab for the treatment of dyshidrotic eczema in 15 consecutive patients [published online January 8, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.12.053