vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v23i4.2784vsp-3571Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONSУспешное применение дупилумаба у подростка с гнездной алопецией и атопическим дерматитом: клинический случайSuccessful Dupilumab Administration in Adolescent with Alopecia Areata and Atopic Dermatitis: Clinical Casehttps://orcid.org/0000-0002-8232-8936АмбарчянЭ. Т.AmbarchyanEduard T.

Амбарчян Эдуард Тигранович, кандидат медицинских наук, заведующий отделением дерматологии 

117593, Москва, Литовский бульвар, д. 1а 

Moscow 

edo_amb@mail.ruhttps://orcid.org/0000-0002-6760-3119ИванчиковВ. В.IvanchikovVladislav V.

Москва

Moscow 

https://orcid.org/0000-0003-3003-9398КузьминоваА. Д.KuzminovaAnastasiya D.

Москва

Moscow 

https://orcid.org/0000-0003-1649-5493ПыжьяноваП. А.PyzhyanovaPolina A.

Москва

Moscow

https://orcid.org/0009-0001-8607-5120АглиулловаЛ. Р.AgliullovaLiana R.

Москва

Moscow

НИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»РоссияResearch Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of SurgeryRussian FederationРНИМУ им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202413092024234258265Copyright © Амбарчян Э.Т., Иванчиков В.В., Кузьминова А.Д., Пыжьянова П.А., Аглиуллова Л.Р., 20242024Амбарчян Э.Т., Иванчиков В.В., Кузьминова А.Д., Пыжьянова П.А., Аглиуллова Л.Р.Ambarchyan E.T., Ivanchikov V.V., Kuzminova A.D., Pyzhyanova P.A., Agliullova L.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/3571

Обоснование. Гнездная алопеция — аутоиммунное заболевание, характеризующееся выпадением волос, развивается при участии CD8+ Т-клеток иммунной системы и цитокинов, продуцируемых Т-хелперами 2-го типа (Th2). Лечение гнездной алопеции ограниченно эффективно. Потенциально эффективным методом терапии тяжелых форм гнездной алопеции при наличии атопического дерматита (АтД) является генно-инженерный биологический препарат дупилумаб — антагонист рецепторов интерлейкина 4, подавляющий Th2-ответ. Описание клинического случая. В отделение дерматологии поступил мальчик, возраст 11 лет, с жалобами на обострение АтД и многочисленные очаги выпадения волос. Назначен дупилумаб по 300 мг однократно каждые 4 нед. В течение 9 мес значительно уменьшилась выраженность эритематозно-папулезных высыпаний, уменьшилась интенсивность зуда. На местах прежних очагов гнездной алопеции отмечено полное восстановление роста волос. Заключение. Дупилумаб может быть эффективен в лечении тяжелых форм гнездной алопеции у детей с сопутствующим АтД. Для подтверждения этой гипотезы необходимы клинические исследования эффективности и безопасности такой терапии.

Background. Alopecia areata is an autoimmune disease characterized by hair loss that develops with the involvement of CD8+ T-cells of the immune system and cytokines produced by T-helper 2 cells (Th2). Efficacy of alopecia areata management is limited. The one potentially effective variant for treatment of severe forms of alopecia areata complicated with atopic dermatitis (AD) is genetically engineered biologic drug dupilumab (interleukin 4 receptor antagonist that suppresses Th2 response). Clinical case description. 11 years old boy was admitted to the dermatology department with complaints on aggravation of AD and numerous hair loss foci. Dupilumab, 300 mg, was prescribed once every 4 weeks. Severity of erythematous papular rashes significantly decreased within 9 months, as well as irritation intensity. Complete restoration of hair growth was noted in areas of former alopecia areata foci. Conclusion. Dupilumab can be effective in the management of severe forms of alopecia areata in children with comorbid AD. Clinical studies on the efficacy and safety of such therapy are needed to confirm this hypothesis.

гнездная алопециядупилумабатопический дерматитклинический случайдетиalopecia areatadupilumabatopic dermatitisclinical casechildrenReferencesАтопический дерматит: клинические рекомендации / Российское общество дерматовенерологов и косметологов, Российская ассоциация аллергологов и клинических иммунологов, Союз педиатров России. — 2021. — 81 с. Доступно по: https://cr.minzdrav.gov.ru/recomend/265?ysclid=lzbcnv5e9o902251649. Ссылка активна на 06.08.2024.Atopicheskii dermatit: Clinical guidelines. Russian Society of Dermatovenerologists and Cosmetologists, Russian Association of Allergists and Clinical Immunologists, Union of Pediatricians of Russia. 2021. 81 p. (In Russ). Доступно по: https://cr.minzdrav.gov.ru/recomend/265?ysclid=lzbcnv5e9o902251649. Ссылка активна на 06.08.2024.Weidinger S, Beck LA, Bieber T, et al. Atopic dermatitis. Nat Rev Dis Primers. 2018;4(1):1. doi: https://doi.org/10.1038/s41572-018-0001-zWeidinger S, Beck LA, Bieber T, et al. Atopic dermatitis. Nat Rev Dis Primers. 2018;4(1):1. doi: https://doi.org/10.1038/s41572-018-0001-zKim J, Kim BE, Leung DYM. Pathophysiology of atopic dermatitis: Clinical implications. Allergy Asthma Proc. 2019;40(2):84–92. doi: https://doi.org/10.2500/aap.2019.40.4202Kim J, Kim BE, Leung DYM. Pathophysiology of atopic dermatitis: Clinical implications. Allergy Asthma Proc. 2019;40(2):84–92. doi: https://doi.org/10.2500/aap.2019.40.4202Krishna MT, Subramanian A, Adderley NJ, et al. Allergic diseases and long-term risk of autoimmune disorders: longitudinal cohort study and cluster analysis. Eur Respir J. 2019;54(5):1900476. doi: https://doi.org/10.1183/13993003.00476-2019Krishna MT, Subramanian A, Adderley NJ, et al. Allergic diseases and long-term risk of autoimmune disorders: longitudinal cohort study and cluster analysis. Eur Respir J. 2019;54(5):1900476. doi: https://doi.org/10.1183/13993003.00476-2019Paller A, Jaworski JC, Simpson EL, et al. Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders. Am J Clin Dermatol. 2018;19(6):821–838. doi: https://doi.org/10.1007/s40257-018-0383-4Paller A, Jaworski JC, Simpson EL, et al. Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders. Am J Clin Dermatol. 2018;19(6):821–838. doi: https://doi.org/10.1007/s40257-018-0383-4Ivert LU, Wahlgren CF, Lindelöf B, et al. Association between atopic dermatitis and autoimmune diseases: a populationbased case-control study. Br J Dermatol. 2021;185(2):335–342. doi: https://doi.org/10.1111/bjd.19624Ivert LU, Wahlgren CF, Lindelöf B, et al. Association between atopic dermatitis and autoimmune diseases: a populationbased case-control study. Br J Dermatol. 2021;185(2):335–342. doi: https://doi.org/10.1111/bjd.19624Lu Z, Zeng N, Cheng Y, et al. Atopic dermatitis and risk of autoimmune diseases: a systematic review and meta-analysis. Allergy Asthma Clin Immunol. 2021;17(1):96. doi: https://doi.org/10.1186/s13223-021-00597-4Lu Z, Zeng N, Cheng Y, et al. Atopic dermatitis and risk of autoimmune diseases: a systematic review and meta-analysis. Allergy Asthma Clin Immunol. 2021;17(1):96. doi: https://doi.org/10.1186/s13223-021-00597-4Mohan GC, Silverberg JI. Association of vitiligo and alopecia areata with atopic dermatitis: a systematic review and meta-analysis. JAMA Dermatol. 2015;151(5):522–528. doi: https://doi.org/10.1001/jamadermatol.2014.3324Mohan GC, Silverberg JI. Association of vitiligo and alopecia areata with atopic dermatitis: a systematic review and meta-analysis. JAMA Dermatol. 2015;151(5):522–528. doi: https://doi.org/10.1001/jamadermatol.2014.3324Ito T, Kageyama R, Nakazawa S, Honda T. Understanding the significance of cytokines and chemokines in the pathogenesis of alopecia areata. Exp Dermatol. 2020;29(8):726–732. doi: https://doi.org/10.1111/exd.14129Ito T, Kageyama R, Nakazawa S, Honda T. Understanding the significance of cytokines and chemokines in the pathogenesis of alopecia areata. Exp Dermatol. 2020;29(8):726–732. doi: https://doi.org/10.1111/exd.14129Song T, Pavel AB, Wen HC, et al. An integrated model of alopecia areata biomarkers highlights both TH1 and TH2 upregulation. J Allergy Clin Immunol. 2018;142(5):1631–1634.e13. doi: https://doi.org/10.1016/j.jaci.2018.06.029Song T, Pavel AB, Wen HC, et al. An integrated model of alopecia areata biomarkers highlights both TH1 and TH2 upregulation. J Allergy Clin Immunol. 2018;142(5):1631–1634.e13. doi: https://doi.org/10.1016/j.jaci.2018.06.029Gruenstein D, Malik K, Levitt J. Full scalp hair regrowth in a 4-year-old girl with alopecia areata and atopic dermatitis treated with dupilumab. JAAD Case Rep. 2020;6(12):1286–1287. doi: https://doi.org/10.1016/j.jdcr.2020.10.010Gruenstein D, Malik K, Levitt J. Full scalp hair regrowth in a 4-year-old girl with alopecia areata and atopic dermatitis treated with dupilumab. JAAD Case Rep. 2020;6(12):1286–1287. doi: https://doi.org/10.1016/j.jdcr.2020.10.010Cho SK, Craiglow BG. Dupilumab for the treatment of alopecia areata in children with atopic dermatitis. JAAD Case Rep. 2021;16:82–85. doi: https://doi.org/10.1016/j.jdcr.2021.07.015Cho SK, Craiglow BG. Dupilumab for the treatment of alopecia areata in children with atopic dermatitis. JAAD Case Rep. 2021;16:82–85. doi: https://doi.org/10.1016/j.jdcr.2021.07.015Yan X, Tayier M, Cheang ST, et al. Hair repigmentation and regrowth in a dupilumab-treated paediatric patient with alopecia areata and atopic dermatitis: a case report. Ther Adv Chronic Dis. 2023;14:20406223231191049. doi: https://doi.org/10.1177/20406223231191049Yan X, Tayier M, Cheang ST, et al. Hair repigmentation and regrowth in a dupilumab-treated paediatric patient with alopecia areata and atopic dermatitis: a case report. Ther Adv Chronic Dis. 2023;14:20406223231191049. doi: https://doi.org/10.1177/20406223231191049Cai L, Wei Y, Zhao M, et al. Case report: Dupilumab therapy for alopecia areata in a 4-year-old patient resistant to baricitinib. Front Med (Lausanne). 2023;10:1253795. doi: https://doi.org/10.3389/fmed.2023.1253795Cai L, Wei Y, Zhao M, et al. Case report: Dupilumab therapy for alopecia areata in a 4-year-old patient resistant to baricitinib. Front Med (Lausanne). 2023;10:1253795. doi: https://doi.org/10.3389/fmed.2023.1253795Xing L, Dai Z, Jabbari A, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014;20(9):1043–1049. doi: https://doi.org/10.1038/nm.3645Xing L, Dai Z, Jabbari A, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014;20(9):1043–1049. doi: https://doi.org/10.1038/nm.3645Fukuyama M, Ito T, Ohyama M. Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines. J Dermatol. 2022;49(1):19–36. doi: https://doi.org/10.1111/1346-8138.16207Fukuyama M, Ito T, Ohyama M. Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines. J Dermatol. 2022;49(1):19–36. doi: https://doi.org/10.1111/1346-8138.16207Tokura Y, Hayano S. Subtypes of atopic dermatitis: From phenotype to endotype. Allergol Int. 2022;71(1):14–24. doi: https://doi.org/10.1016/j.alit.2021.07.003Tokura Y, Hayano S. Subtypes of atopic dermatitis: From phenotype to endotype. Allergol Int. 2022;71(1):14–24. doi: https://doi.org/10.1016/j.alit.2021.07.003Fania L, Moretta G, Antonelli F, et al. Multiple Roles for Cytokines in Atopic Dermatitis: From Pathogenic Mediators to Endotype-Specific Biomarkers to Therapeutic Targets. Int J Mol Sci. 2022;23(5):2684. doi: https://doi.org/10.3390/ijms23052684Fania L, Moretta G, Antonelli F, et al. Multiple Roles for Cytokines in Atopic Dermatitis: From Pathogenic Mediators to Endotype-Specific Biomarkers to Therapeutic Targets. Int J Mol Sci. 2022;23(5):2684. doi: https://doi.org/10.3390/ijms23052684Kageyama R, Ito T, Hanai S, et al. Immunological Properties of Atopic Dermatitis-Associated Alopecia Areata. Int J Mol Sci. 2021;22(5):2618. doi: https://doi.org/10.3390/ijms22052618Kageyama R, Ito T, Hanai S, et al. Immunological Properties of Atopic Dermatitis-Associated Alopecia Areata. Int J Mol Sci. 2021;22(5):2618. doi: https://doi.org/10.3390/ijms22052618Sterkens A, Lambert J, Bervoets A. Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options. Clin Exp Med. 2021;21(2):215–230. doi: https://doi.org/10.1007/s10238-020-00673-wSterkens A, Lambert J, Bervoets A. Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options. Clin Exp Med. 2021;21(2):215–230. doi: https://doi.org/10.1007/s10238-020-00673-wKing B, Zhang X, Harcha WG, et al. Efficacy and safety of ritlecitinib in adults and adolescents with alopecia areata: a randomised, double-blind, multicentre, phase 2b-3 trial. Lancet. 2023;401(10387):1518–1529. doi: https://doi.org/10.1016/S0140-6736(23)00222-2King B, Zhang X, Harcha WG, et al. Efficacy and safety of ritlecitinib in adults and adolescents with alopecia areata: a randomised, double-blind, multicentre, phase 2b-3 trial. Lancet. 2023;401(10387):1518–1529. doi: https://doi.org/10.1016/S0140-6736(23)00222-2Plachouri KM, Georgiou S. Dupilumab in pediatric dermatology. J Dermatolog Treat. 2022;33(2):682–684. doi: https://doi.org/10.1080/09546634.2020.1789049Plachouri KM, Georgiou S. Dupilumab in pediatric dermatology. J Dermatolog Treat. 2022;33(2):682–684. doi: https://doi.org/10.1080/09546634.2020.1789049Hendricks AJ, Yosipovitch G, Shi VY. Dupilumab use in dermatologic conditions beyond atopic dermatitis — a systematic review. J Dermatolog Treat. 2021;32(1):19–28. doi: https://doi.org/10.1080/09546634.2019.1689227Hendricks AJ, Yosipovitch G, Shi VY. Dupilumab use in dermatologic conditions beyond atopic dermatitis — a systematic review. J Dermatolog Treat. 2021;32(1):19–28. doi: https://doi.org/10.1080/09546634.2019.1689227Pham C, Sung C, Juhasz M, et al. The Role of Antihistamines and Dupilumab in the Management of Alopecia Areata: A Systematic Review. J Drugs Dermatol. 2022;21(10):1070–1083. doi: https://doi.org/10.36849/JDD.6553Pham C, Sung C, Juhasz M, et al. The Role of Antihistamines and Dupilumab in the Management of Alopecia Areata: A Systematic Review. J Drugs Dermatol. 2022;21(10):1070–1083. doi: https://doi.org/10.36849/JDD.6553Olbrich H, Sadik CD, Ludwig RJ, et al. Dupilumab in Inflammatory Skin Diseases: A Systematic Review. Biomolecules. 2023;13(4):634. doi: https://doi.org/10.3390/biom13040634Olbrich H, Sadik CD, Ludwig RJ, et al. Dupilumab in Inflammatory Skin Diseases: A Systematic Review. Biomolecules. 2023;13(4):634. doi: https://doi.org/10.3390/biom13040634Sachdeva M, Witol A, Mufti A, et al. Alopecia Areata Related Paradoxical Reactions in Patients on Dupilumab Therapy: A Systematic Review. J Cutan Med Surg. 2021;25(4):451–452. doi: https://doi.org/10.1177/1203475421995186Sachdeva M, Witol A, Mufti A, et al. Alopecia Areata Related Paradoxical Reactions in Patients on Dupilumab Therapy: A Systematic Review. J Cutan Med Surg. 2021;25(4):451–452. doi: https://doi.org/10.1177/1203475421995186Marks DH, Mesinkovska N, Senna MM. Cause or cure? Review of dupilumab and alopecia areata. J Am Acad Dermatol. 2023;88(3): 651–653. doi: https://doi.org/10.1016/j.jaad.2019.06.010Marks DH, Mesinkovska N, Senna MM. Cause or cure? Review of dupilumab and alopecia areata. J Am Acad Dermatol. 2023;88(3): 651–653. doi: https://doi.org/10.1016/j.jaad.2019.06.010Yamane S, Nakagawa Y, Inui S, Fujimoto M. Development of alopecia areata-like reactions in a patient treated with dupilumab. Allergol Int. 2022;71(3):420–422. doi: https://doi.org/10.1016/j.alit.2022.02.006Yamane S, Nakagawa Y, Inui S, Fujimoto M. Development of alopecia areata-like reactions in a patient treated with dupilumab. Allergol Int. 2022;71(3):420–422. doi: https://doi.org/10.1016/j.alit.2022.02.006Амбарчян Э.Т., Иванчиков В.В., Аракелян А.Л., и др. Клинический случай анти-TNF-α индуцированного псориаза и псориатической алопеции у подростка с язвенным колитом // Вопросы современной педиатрии. — 2023. — Т. 22. — № 5. — С. 470–476. — doi: https://doi.org/10.15690/vsp.v22i5.2635Ambarchyan ET, Ivanchikov VV, Arakelyan AL, et al. TNF-Inhibitor-Induced Psoriasis and Psoriatic Alopecia in Adolescent with Ulcerative Colitis: Clinical Case. Voprosy sovremennoi pediatrii — Current Pediatrics. 2023;22(5):470–476. (In Russ). doi: https://doi.org/10.15690/vsp.v22i5.2635Moosbrugger-Martinz V, Tripp CH, Clausen BE, et al. Atopic dermatitis induces the expansion of thymus-derived regulatory T cells exhibiting a Th2-like phenotype in mice. J Cell Mol Med. 2016;20(5):930–938. doi: https://doi.org/10.1111/jcmm.12806Moosbrugger-Martinz V, Tripp CH, Clausen BE, et al. Atopic dermatitis induces the expansion of thymus-derived regulatory T cells exhibiting a Th2-like phenotype in mice. J Cell Mol Med. 2016;20(5):930–938. doi: https://doi.org/10.1111/jcmm.12806

The authors declare that there are no conflicts of interest present.