VANISHING VITILIGO? DUPILUMAB AND AEROALLERGEN IMMUNOTHERAPY IMPROVE LONGSTANDING VITILIGO

Abstract

<h3>Introduction</h3> Dupilumab and aeroallergen immunotherapy (AIT) are effective therapies for atopic disease including atopic dermatitis and chronic rhinosinusitis. We present a case of a patient with substantial, incremental improvement in vitiligo after starting dupilumab and AIT for severe atopic dermatitis, asthma, and allergic rhinitis. Case Presentation: The patient is a 55 year-old female with a history of asthma, atopic dermatitis, allergic rhinitis, and vitiligo. Aeroallergen immunotherapy to multiple seasonal and perennial allergens was started with significant improvement in her asthma and rhinitis symptoms. Within one year of reaching maintenance dose, she also noted some improvement in vitiligo on her hands and ankles. She had been followed by the dermatology service for several years to manage her vitiligo to include light therapy without perceived improvement. She was not actively treating vitiligo with other therapies during AIT treatment but had slow, incremental repigmentation. She also had severe atopic dermatitis since childhood not controlled on topical regimens and was placed on dupilumab seven years after starting immunotherapy. After two months of initiation of dupilumab, she had accelerated repigmentation of her vitiligo lesions with almost complete resolution of her atopic dermatitis. <h3>Discussion</h3> This is the first documented case of temporal association of improvement in vitiligo with AIT and/or dupilumab. It is possible that the immunomodulating effects of both medical therapies shifting from the Th2 response may have other immunomodulating effects that can influence autoimmune diseases or increase T regulatory response.