Complete hair regrowth in a young male with severe atopic dermatitis and alopecia areata after dupilumab: probably more than a coincidence

We report the case of a 29-year-old male patient who has suffered from severe atopic dermatitis (AD) since early childhood and presented with a 6-month evolution of patchy hair loss in the temporal and occipital regions, clinically suggestive of alopecia areata (AA), which was confirmed by scalp biopsy. The patient started therapy for atopic dermatitis with the monoclonal antibody dupilumab, with a substantial response regarding atopic dermatitis, and with renewed hair growth on the scalp. Dupilumab blocks the α-subunit of the interleukin 4 receptor, interrupting the signaling cascade of IL-4 and IL-13 and thus leading to a reduced Th2 immune response. Some controversy exists regarding dupilumab and AA, with some reports describing improvement after starting this drug while others showing patients with dupilumab-induced alopecia. The patient demonstrated dramatic improvement in both AD and AA early on and tolerated the drug without significant side effects. His quality of life was significantly improved. Patient selection could play a crucial role in the future, and the predictors of a good response are currently being identified so the responders with severe atopic dermatitis and alopecia areata could benefit from dupilumab.