López JLH, García HL

Language: Spanish
References: 8
Page: 36-39
PDF size: 170.65 Kb.

ABSTRACT

Dupilumab is a monoclonal antibody targeting the alpha subunit of the interleukin-4 receptor (IL-4Rα), used to treat atopic dermatitis (AD). However, its effect on alopecia areata (AA) is heterogeneous, with reports of both improvement and de novo onset or exacerbation.
We report a 60-year-old male with a history of childhoodonset AD and glaucoma secondary to chronic steroid use who started dupilumab in April 2024, achieving a good clinical response with improvement in disease severity and quality-of-life scores. During the first three months, he developed dupilumab-associated facial erythema. After thirteen months of continuous therapy, he developed multiple asymptomatic alopecic patches on the vertex and bilateral parietal regions. Trichoscopy revealed yellow dots and black dots, consistent with AA. Given the temporal association and lack of response to topical corticosteroids, a diagnosis of dupilumab-associated AA was made, prompting discontinuation of dupilumab. Treatment with abrocitinib was initiated, with an adequate clinical response.
Dupilumab-associated AA has been attributed to an immunologic phenomenon dependent on the patient’s Th1/ Th2 profile. Early recognition and individualized therapeutic decisions are essential to optimize management. This case highlights the importance of clinical and trichologic surveillance in patients with AD treated with dupilumab and the emerging role of JAK inhibitors as an effective therapeutic alternative.

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