Eczema Drug Dupilumab Regrows Hair for Alopecia Patient

A patient with complete hair loss of the scalp, caused by an autoimmune disorder known as Alopecia Totalis, has managed to regrow significant amounts of her hair due to a side effect of eczema medication.

The 13 year old, who was completely bald and had not grown any hair on her scalp since she was 2 years old, was having dupilumab injections to treat her atopic dermatitis.

What is dupilumab?

Dupilumab is currently FDA approved in the USA and, whilst not MHRA licensed for the UK specifically, it has been approved by the European Medicines Agency (EMA) for use throughout the European Union, for the treatment of moderate to severe atopic dermatitis (eczema) only. It is prescribed under the Regeneron brand name Dupixent and is administered via injection, delivered in pre-filled, single dose syringe form.

In the UK it can be utilised by the NHS, however, if patients see no response after 16 weeks of treatment, it must be stopped, as per guidance issued by the National Institute for Health and Care Excellence in June 2018.

Concerns have been raised regarding its pricing but, most importantly, its side effect profile, with a number of potential associated adverse reactions ranging from reactions at the sites of the injections, conjunctivitis, and dry eye to oral herpes and other herpes simplex virus infections.

According to a September 2017 press release issued by Dupixent's UK marketing team Sanofi, the drug inhibits 'overactive signaling of two key proteins, IL-4 and IL-13, which are believed to be major drivers of the persistent underlying inflammation in atopic dermatitis'.

Treating Alopecia Areata with dupilumab

Dupilumab appears to keep functioning of IL-4 and IL-13 in check; these are both interleukins - types of proteins involved in regulating the immune system. The key link here is that Alopecia Areata, Totalis and Universalis are all considered to be autoimmune diseases whereby their sudden onset patchy hair loss to total baldness is caused by a disruption to the hair growth cycle triggering the body to attack the follicles.

Areas affected by hair loss shown in blue

At least one of this pair of interleukins (IL-13) has previously been thought to play a role in Alopecia Areata, particularly its more severe forms, Alopecia Totalis (baldness of the scalp with facial hair loss, such as eyebrows and eyelashes, also possible) and Alopecia Universalis (complete hairlessness from head to toe). Doctors have considered that by inhibiting IL-13 - and potentially other interleukins - hair regrowth may occur in people with these types of hair loss.

This medication was previously identified in 2016 as being potentially beneficial to people with various forms of Alopecia Areata. Studies and clinical trials using dupilumab to treat autoimmune-related hairloss have been going on ever since, with a 2023 completion date currently estimated.

An observational article detailing the aforementioned teenager's 'success story' was published in the JAMA Dermatology medical journal on 10th October 2018. It was authored by Dr Maryanne Makredes Senna of the Massachusetts General Hospital in Boston, USA, and refers to the finding as 'the first known case of hair growth in a patient with alopecia totalis associated with the use of dupilumab'.

The teen started this treatment in July 2017 and has now seen moderate to extensive - though not full - hair regrowth. As a result, further trials into using this form of subcutaneous treatment for severe alopecia - which currently has limited options with low success rates, unlike scalp-only Alopecia Areata Treatment - are expected.