Successful Dupilumab Administration in Adolescent with Alopecia Areata and Atopic Dermatitis: Clinical Case
Eduard T. Ambarchyan,
Vladislav V. Ivanchikov,
Anastasiya D. Kuzminova,
Polina A. Pyzhyanova,
Liana R. Agliullova https://doi.org/10.15690/vsp.v23i4.2784
Abstract
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.
About the Authors
Eduard T. Ambarchyan
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
Russian Federation
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
Receiving research grants from pharmaceutical companies Eli Lilly, Novartis, AbbVie, Pfizer, Amryt Pharma plc, scientific consultant of Johnson & Johnson.
Vladislav V. Ivanchikov
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
Russian Federation
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
The other contributors confirmed the absence of a reportable conflict of interests.
Anastasiya D. Kuzminova
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
Russian Federation
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
The other contributors confirmed the absence of a reportable conflict of interests.
Polina A. Pyzhyanova
Pirogov Russian National Research Medical University
Russian Federation
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
The other contributors confirmed the absence of a reportable conflict of interests.
Liana R. Agliullova
Pirogov Russian National Research Medical University
Russian Federation
Disclosure of interest:
Russian Federation
Moscow
Disclosure of interest:
The other contributors confirmed the absence of a reportable conflict of interests.
References
1. 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.
2. 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-z
3. Kim 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.2019.40.4202
4. Krishna 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/10.1183/13993003.00476-2019
5. Paller 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/s40257-018-0383-4
6. Ivert 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.19624
7. Lu 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/s13223-021-00597-4
8. Mohan 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.2014.3324
9. Ito 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.14129
10. Song 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.2018.06.029
11. Gruenstein 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.2020.10.010
12. Cho 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.2021.07.015
13. Yan 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/10.1177/20406223231191049
14. Cai 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.2023.1253795
15. Xing 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.3645
16. Fukuyama 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/10.1111/1346-8138.16207
17. Tokura 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.2021.07.003
18. Fania 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/ijms23052684
19. Kageyama 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/ijms22052618
20. Sterkens 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-w
21. King 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)00222-2
22. Plachouri KM, Georgiou S. Dupilumab in pediatric dermatology. J Dermatolog Treat. 2022;33(2):682–684. doi: https://doi.org/10.1080/09546634.2020.1789049
23. Hendricks 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/10.1080/09546634.2019.1689227
24. Pham 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.6553
25. Olbrich 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/biom13040634
26. Sachdeva 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/10.1177/1203475421995186
27. Marks 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.2019.06.010
28. Yamane 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.2022.02.006
29. Ambarchyan 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.v22i5.2635
30. Moosbrugger-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
Review
For citations:
Ambarchyan E.T., Ivanchikov V.V., Kuzminova A.D., Pyzhyanova P.A., Agliullova L.R. Successful Dupilumab Administration in Adolescent with Alopecia Areata and Atopic Dermatitis: Clinical Case. Current Pediatrics. 2024;23(4):258-265. (In Russ.) https://doi.org/10.15690/vsp.v23i4.2784
Views:
330
Email this article 
