Dupilumab to treat severe recalcitrant atopic dermatitis in a young child

Abstract

Aims/Introduction: Atopic dermatitis is a common skin disease that may result in significant morbidity and impaired quality of life in the paediatric population. In severe and treatment-refractory cases, more efficacious therapies with a favourable side effect profile are needed. Dupilumab, a fully human monoclonal antibody which inhibits IL-4 and IL-13 cytokine signalling and thereby suppresses the inflammatory process of atopic dermatitis, has recently emerged as the first and only targeted immunological agent in the treatment of moderate to severe atopic dermatitis. To date, dupilumab has demonstrated excellent efficacy with few adverse effects. However, data is lacking in the efficacy and safety of dupilumab in young children due to its limited use in this population. Methods/Results: We report the case of a Caucasian boy as young as 21 months of age with severe recalcitrant atopic dermatitis that markedly impacted the quality of life of both the patient and family. His case was complicated by multiple infective exacerbations of atopic dermatitis characterised by disseminated viral, bacterial and fungal infections. He had inadequate response to various topical therapies (emollients, corticosteroids, calcineurin inhibitors and crisaborole), wet wraps and bleach baths. He was subsequently commenced on dupilumab 4-weekly at a dose of 200 mg subcutaneously and achieved remarkable clinical improvement. After 12 months of therapy, his EASI, PGA and DLQI scores had all substantially improved. Conclusions: To our knowledge, this is the youngest reported case of a paediatric patient with severe atopic dermatitis successfully treated with dupilumab. Our case supports the use of this novel biologic as an effective alternative to other immunosuppressants when faced with treatment-refractory atopic dermatitis in young children. Aims/introduction: Atopic dermatitis is a common skin disease that may result in significant morbidity and impaired quality of life in the paediatric population. In severe and treatment-refractory cases, more efficacious therapies with a favourable.L6381498472022-06-08 <br />