Dupixent Shows Promise for Treating Atopic Dermatitis with Alopecia and Vitiligo

Dupixent (dupilumab) could serve as a promising treatment option for patients with atopic dermatitis (AD) who also have alopecia areata (AA) and/or vitiligo, as these conditions share immune pathways targeted by the drug, according to an analysis recently published in the Journal of the American Academy of Dermatology case reports.

Dupixent is a targeted biologic therapy that blocks the inflammatory signals of interleukin (IL)-4 and IL-13, key drivers of immune overactivity in several chronic diseases. The drug is FDA-approved for many conditions, including moderate-to-severe atopic dermatitis, certain types of asthma, chronic rhinosinusitis with nasal polyps and eosinophilic esophagitis.

Dupixent shows potential as a treatment for atopic dermatitis, alopecia and vitiligo, targeting shared immune pathways for improved skin health.

According to researchers, there is growing interest in the drug’s potential use for other immune-mediated skin disorders, including vitiligo and AA.

Dupixent’s ability to target critical immune pathways involved in inflammation makes it versatile for a variety of chronic conditions. In addition to AD, Dupixent is approved for prurigo nodularis, chronic obstructive pulmonary disease (COPD) with high eosinophils, chronic spontaneous urticaria and bullous pemphigoid.

It can be administered alone or alongside other therapies, often reducing the need for oral corticosteroids.

Vitiligo affects about 1% to 2% of people and occurs when the immune system attacks the cells that give skin its color. It can be triggered by the Koebner phenomenon, where skin injury such as scratching from AD causes new patches.

AA leads to patchy hair loss and is also connected to AD.

While Dupixent shows promise for patients with AD and overlapping AA or vitiligo, rare cases of the drug-induced vitiligo have been reported, according to a study in Frontiers in Immunology. Researchers suggest this may occur because blocking IL-4 and IL-13 shifts the immune balance from CD4+ T cells, Th2 toward Th1/Th17 activity, which can trigger type 1 inflammation and melanocyte destruction.

To explore these mechanisms, researchers conducted an IRB-exempt review of patient charts, focusing on folks with AD who also had vitiligo or AA and received Dupixent therapy. The case series included six patients with AD and alopecia universalis (AU) and one patient with AD, vitiligo and AA.

The AU group ranged in age from a 5-year-old Asian girl to a 78-year-old Hispanic woman. Most showed significant hair regrowth on Dupixent, though responses varied. The youngest patient regrew hair for four months but lost it after discontinuing therapy due to insurance issues, while a 12-year-old with long-standing AU showed no regrowth.

A 14-year-old male experienced steady hair regrowth, including eyelashes, but developed brief conjunctivitis. Two women, aged 24 and 78, had rapid hair regrowth, and a 15-year-old female initially achieved full regrowth but later required Litfulo (ritlecitinib), an AA medication, after shedding occurred. All AU patients with AD reached an Eczema Area and Severity Index (EASI)-75 at six months.

The single patient with vitiligo/AA, a 61-year-old woman, experienced rapid stabilization within two months and substantial repigmentation—90% on the face and 70% on the extremities—after one year of Dupixent combined with topical cream Jakafi (ruxolitinib). Her 40% scalp hair loss fully resolved alongside the repigmentation, with improvements plateauing at 12 months.

This case series highlights Dupixent’s potential in patients with AD who also have AU, AA or vitiligo, although individual responses varied. Most AU patients experienced decdent hair regrowth, and all reached EASI-75 by six months.

The strongest outcomes were observed in patients with rapid or steady regrowth, with some regaining eyelashes. Side effects were minimal, limited to brief conjunctivitis in one patient.

Limitations of the study include the small sample size, varied ages, differing disease durations and adjunctive therapies in some cases, which make it difficult to isolate Dupixent’s effect.

The authors recommend larger, controlled studies to identify which patients are most likely to respond, particularly children and those with multiple overlapping conditions.