BACKGROUND
Dupilumab is a relatively new immune-modulating
drug that has transformed the way clinicians treat common immunologic conditions, including
atopic dermatitis,
asthma, and chronic
rhinosinusitis with nasal polyposis. Blocking signaling molecules involved within the Th2 immune response,
dupilumab is a proven effective treatment for moderate to severe
atopic dermatitis - a condition whose disease pathogenesis is heavily linked to the dysregulation of this immunologic pathway. Interestingly,
dupilumab has found broader clinical utility, showing efficacy in treating other distinct dermatologic diseases, including
alopecia areata. CASE REPORT A 16-year-old White male with a past medical history of moderate
atopic dermatitis presented to our clinic with complete scalp hair, eyebrow, and eyelash loss. At this time, the patient was given a clinical diagnosis of
alopecia totalis. Understanding that
dupilumab has been previously used for treatment in adults of this specific autoimmune condition, we started this adolescent patient on
dupilumab to concomitantly treat his
atopic dermatitis and
alopecia areata. The patient gradually experienced complete regrowth of his hair and almost complete resolution of his
atopic dermatitis. Three years after starting
dupilumab, the patient remains without signs of
alopecia totalis. CONCLUSIONS This case report demonstrates the long-term efficacy of
dupilumab use in
alopecia areata. More investigation is required to understand
dupilumab's broadening clinical indications. Additionally, this case highlights the complex relationship between dysregulation of the Th2 response and autoimmunity. Crosstalk between immune pathways within the disease spectrum of
alopecia areata may explain why
dupilumab has been reported to both treat and exacerbate
alopecia areata.