Massachusetts General Hospital (MGH) doctors report an unexpected side effect of dupilumab treatment, 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 physicians describe how their 13-year-old patient, who had alopecia totalis – a total lack of head hair – along with eczema, had significant hair growth while receiving dupilumab, a drug , which is marketed under the brand name Dupixent.
"We were quite surprised that this patient had no hair since the age of two and other treatments that could help with hair loss were not her case," says Maryanne Makredes Senna, MD, the MGH Department of Dermatology, Senior author of the JAMA Dermatology report. "As far as we know, this is the first report on regrowth of hair with dupilumab in a patient with alopecia areata."
In addition to long-term alopecia, this patient has had extensive, treatment-resistant eczema of 7 months since age. Treatment with prednisone and methotrexate, drugs that can suppress the overactive immune system, resulted in a limited improvement in the patient's eczema but no hair regrowth and was therefore discontinued. In July 201
After seven months of dupilumab treatment, the patient had a significant amount of pigmented hair that typically grows on the scalp. Due to a change in her insurance cover, she had to interrupt dupilumab for two months, during which time she noticed that the recently regrown hair disappeared. But after she resumed treatment in April 2018, hair growth regained and continued.
Senna explains that Dupilumab's mechanism of targeting an important immune system pathway that is known to be overactive in eczema might explain its action against alopecia. Suggested other elements of the same pathway may induce autoimmune hair loss. "At the moment it's hard to say if dupilumab could trigger hair growth in other alopecia patients, but I suspect it might be helpful in patients with extensive active eczema and active alopecia areata," she says. "We have submitted a proposal for a clinical trial of dupilumab in this patient population and we hope to be able to conduct further investigations in the near future." Senna is the principal investigator of the HAI Clinical Research Research Division at MGH and a lecturer in dermatology at Harvard Medical School.
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