Treatment with dupilumab 300 mg, administered via subcutaneous injection every other week in a 13-year-old girl with atopic dermatitis (AD) and alopecia totalis (AT), was associated with significant improvement in symptoms of AD after 6 weeks of treatment and growth of pigmented, terminal hairs on approximately 60% of the patient’s scalp after 9 months. The results of this case study were published in JAMA Dermatology.
The interleukin (IL)-4 receptor alpha antagonist dupilumab was approved by the US Food and Drug Administration in March 2017 for the treatment of adult patients with moderate to severe AD that is not adequately controlled with topical therapies. Dupilumab is a fully human monoclonal antibody that binds to the alpha subunit of the IL-4 receptor and inhibits downstream signaling of IL-4 and IL-13. This report describes the first known case of hair regrowth in a patient with AT that is associated with the use of dupilumab.
The girl who was evaluated in this case report had had a history of extensive, treatment-resistant AD since 7 months of age, and persistent AT since 2 years of age. Over the years before this case report, the patient had received treatment with topical squaric acid and anthralin, which resulted in no improvement. Two months before this review, she had initiated a trial treatment with pulsed prednisone 50 mg on the first 3 days of each month, along with oral methotrexate. The methotrexate, which was started at 10 mg/week and gradually increased to 15 mg/week, demonstrated some improvement in her AD, but no hair growth. This regimen was thus discontinued 4 months later.
Approximately 2 years after her initial presentation (at 13 years of age), the patient began treatment with subcutaneous dupilumab 300 mg every other week for refractory AD that covered about 70% of her body surface area. During an 8-week period when the patient discontinued dupilumab for insurance purposes, she noted hair shedding. On resuming dupilumab and at the last follow-up (11 months after receiving the first dose of dupilumab), considerable hair regrowth was observed.
The investigators noted that the dual efficacy of dupilumab for both AD and AT may be attributable to their shared immune characteristics. Antagonism of the TH2 pathway by dupilumab could thus explain its use in both disorders. Larger controlled clinical trials are warranted to confirm these findings.
Penzi LR, Yasuda M, Manatis-Lornell A, et al. Hair regrowth in a patient with long-standing alopecia totalis and atopic dermatitis treated with dupilumab. JAMA Dermatol. 2018;154(11):1358-1360.