Dupilumab cuts both ways

Abstract

Dupilumab has revolutionized management of atopic dermatitis (AD). The human monoclonal antibody reduces T-helper cell type 2 inflammation by blocking the shared receptor subunit for interleukin (IL) 4 and IL-13. Dermatologists eagerly go “off-label” with new medications, especially when there is a good rationale to do so. Hendricks et al 1 Hendricks A.J. Yosipovitch G. Shi V.Y. Dupilumab use in dermatologic conditions beyond atopic dermatitis—a systematic review. J Dermatolog Treat. 2019; 12: 1-10 Google Scholar identified effective use of dupilumab for the following entities: chronic pruritus, prurigo nodularis, eczematous eruption of aging, allergic contact dermatitis, chronic hand eczema, alopecia areata, urticaria, eosinophilic annular erythema, bullous pemphigoid, and papuloerythroderma of Ofuji. Progression of cutaneous T-cell lymphoma after dupilumab: Case review of 7 patientsJournal of the American Academy of DermatologyVol. 83Issue 1PreviewTo the Editor: Dupilumab is a fully human monoclonal antibody that binds the interleukin (IL) 4 receptor-α subunit and inhibits signaling of IL-4 and IL-13. It was approved by the Food and Drug Administration for the treatment of moderate to severe atopic dermatitis in adults and adolescents, with efficacy in reducing pruritus.1 The 2 most common subtypes of cutaneous T-cell lymphoma are mycosis fungoides and Sézary syndrome. Mycosis fungoides, Sézary syndrome and atopic dermatitis are similarly driven by T-helper 2 cytokine profiles2 and may present with similar morphology (ie, erythema, lichenification, fissuring) with pruritus,3 disruption of the skin barrier, and impetiginization. Full-Text PDF Dupilumab as a novel therapy for bullous pemphigoid: A multicenter case seriesJournal of the American Academy of DermatologyVol. 83Issue 1PreviewBullous pemphigoid (BP) is an autoimmune blistering disorder occurring mostly in the elderly that lacks adequate treatments. Full-Text PDF Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigoJournal of the American Academy of DermatologyVol. 83Issue 1PreviewChronic nodular prurigo (CNPG) is a multifactorial skin disease characterized by itchy papules and nodules, usually resistant to standard treatment and associated with markedly impaired quality of life. Full-Text PDF