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Massachusetts General Hospital (MGH) physicians report an unexpected side effect of treatment with dupilumab, approved by the FDA for the treatment of moderate-to-severe eczema, also known as atopic dermatitis. In their case report published in JAMA Dermatology, doctors describe how their 13-year-old patient, who suffers from total alopecia – a total lack of scalp hair – as well as eczema, experienced significant hair regrowth when treated with dupilumab, a drug marketed under the Dupixent brand.
"We were quite surprised to find that this patient had not developed hair on the scalp since the age of 2 years and that other treatments that can help hair loss do not did not, "said Maryanne Makredes Senna, MD, Department of Dermatology of the British General Hospital. principal author JAMA Dermatology report. "As far as we know, this is the first report of hair regrowth by dupilumab in a patient with any degree of alopecia areata."
In addition to a longstanding alopecia, this patient was suffering from extensive eczema, resistant to treatment, since the age of 7 months. Treatment with prednisone and methotrexate, drugs capable of suppressing the hyperactive immune system, resulted in limited improvement in the patient's eczema but no regrowth of the hair and was therefore discontinued. In July 2017, she began receiving weekly injections of dupilumab, recently approved by the FDA. After six weeks of treatment, which resulted in a significant improvement in the symptoms of eczema, she also noticed the appearance of fine, light hair, called vellus hair, on her scalp.
After seven months of treatment with dupilumab, the patient had developed a significant amount of pigmented hair that usually developed on the scalp. Due to the change in her insurance coverage, she had to discontinue treatment with dupilumab for a period of two months, during which time she noticed the loss of newly regrown hair. But after being able to resume treatment in April 2018, hair growth resumed and continued.
Senna explains that the mechanism of dupilumab consisting of targeting a key immune system pathway known for its hyperactivity in eczema could explain its action against alopecia, recent studies suggesting that other elements of the same route could induce autoimmune hair loss. "At the moment, it's unclear whether dupilumab could induce hair growth in other patients with alopecia, but I guess it might be helpful in patients with extensive active eczema and active alopecia, "she says. "We have submitted a proposal for a clinical trial using dupilumab in this patient population and hope to be able to study it further in the near future." Senna is the principal investigator of the Hair Academic Innovative Research Clinical Research Unit (HAIR) of the British General Hospital and Dermatology Instructor of Harvard Medical School.
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