Reactivation of Alopecia Areata After Dupilumab Therapy for Atopic Dermatitis

In the document, a case is presented where a 42-year-old woman with a history of severe atopic dermatitis (AD) and alopecia areata (AA) experienced a reactivation of AA after starting treatment with dupilumab, a medication targeting interleukin-4 receptor alpha and modulating IL-4/13 signaling. Despite a significant improvement in her AD, the patient developed rapidly progressive hair loss 4 months into the treatment, resulting in a 70% reduction of scalp hair density by the 7th month. However, after receiving intramuscular triamcinolone for the presumed AA reactivation, she experienced near-complete hair regrowth within 2 months while continuing dupilumab therapy. This case, along with six other reported cases of alopecia following dupilumab initiation, suggests a potential adverse effect of the drug, although the exact mechanism remains unclear. It is hypothesized that dupilumab may activate alternative immune pathways that contribute to alopecia induction. The authors recommend that the possibility of AA-like phenomena should be discussed with patients considering dupilumab therapy, especially those with a history of AA, and further investigation is needed to understand the relationship between AD and AA in the context of dupilumab treatment.