IMPROVEMENT OF SEVERE ATOPIC DERMATITIS AND POST-INFLAMMATORY HYPERPIGMENTATION IN A HISPANIC PATIENT TREATED WITH DUPILUMAB

Abstract

<h3>Introduction</h3> Atopic dermatitis (AD) is a common chronic disease characterized by severe itching associated with recurrent eczematous lesions and has an enormous impact on patients' quality of life. Dupilumab, is the first biological agent approved for patients with moderate-to-severe AD. <h3>Case Description</h3> A 16-year-old male patient was evaluated in the allergy clinic at the age of 12, for eczema and chronic rhinitis. He developed eczema and nasal symptoms during childhood and despite an excellent adherence to treatment with topical steroids and moisturizers, there was no improvement. The patient presented severe generalized AD lesions and hyperpigmentation with a SCORAD of 56.8. During his evaluation, he resulted with positive skin prick tests to <i>Bromus spp., Cynodon dactylon, Holcus lanatus, Phleum pratense, Fraxinus americana, Prosopis spp. and Dermatophagoides pteronyssinus</i>. Subcutaneous (SC) immunotherapy was initiated along with a short course of oral and topical steroids, as well as skincare. However, he presented poor control of symptoms and poor quality of life, oral cyclosporine was started for 11 months. Despite treatment he continued with severe AD, cyclosporine was tapered to start management with dupilumab. Dupilumab was started at an initial dose of 600 mg SC, subsequently 300 mg SC every 2 weeks, presenting improvement in hyperpigmentation, pruritus and xerosis. Currently he has a SCORAD of 3.5 without any adverse effects to dupilumab. <h3>Discussion</h3> Dupilumab improves pruritus, quality of life and like in this case, may return the patient´s original skin tone after post-inflammatory hyperpigmentation occurs due to AD. This biological agent is the preferred treatment for moderate-to-severe AD. Clinical evolution of an adolescent with severe atopic dermatitis and use of dupilumab. A y C) Before treatment with dupilumab, severe generalized atopic dermatitis lesions and hyperpigmentation, B y D) After 10 months of treatment with dupilumb, improvement of atopic dermatitis and postinflammatory hyperpigmentation