We report two cases of recalcitrant dyshidrotic eczema which have been successfully treated with dupilumab. Dyshidrotic eczema is a distinct cutaneous condition often considered within the spectrum of eczematous dermatitis and is often associated with significant morbidity, and is frequently very challenging to manage.2,3 There are numerous reports in the literature of patients treated with a wide variety of modalities including topical corticosteroids or calcineurin inhibitors, photo/photochemotherapy, various systemic immunomodulators, anti-psoriasis biologics, intradermal botulinum toxin, and even radiotherapy.2,4-5 However, none of these treatments are specific for the treatment of dyshidrosis and are often associated with partial, inadequate and/or brief response, or intolerability. With the approval of dupilumab by the FDA, a novel therapy is now available to patients with atopic dermatitis not controlled by topical therapies. In the short time since its approval, dupilumab, in our hands, also has proven useful in the management of two patients with dyshidrotic eczema. Importantly, there are current efforts to establish the efficacy of dupilumab in the treatment of asthma, nasal polyposis, eosinophilic esophagitis, and pediatric patients with atopic dermatitis.6 Additionally, controlled clinical trials to study the efficacy of this IL-4/IL-13 biologic inhibitor in treatment of dyshidrotic eczema are also warranted.
Bruce Strober has received honoraria as a Consultant, Advisory Board Member, and/or Principal Investigator from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene Corporation, Dermira, Inc., Eli Lilly and Company, Janssen-Ortho, Inc., Leo Pharma Inc., Merck & Company, Inc., Maruho Company, Ltd., Novartis Pharmaceuticals Corporation, Pfizer, Inc., Sanofi/Regeneron, Sun Pharmaceutical Industries, Ltd, and UCB Pharma. He is a Scientific Director for the Corrona Psoriasis Registry. Drs Weston and Hooper have no conflict of interest to declare.
- FDA approves new eczema drug dupixent [homepage on the Internet]. U.S. Food & Drug Administration. 2017 March 29, 2017 [cited August 3, 2017]. Available from: https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm549078.htm.
- Gill J, Pratt M. A severe case of recalcitrant pompholyx. J Cutan Med Surg. 2015;19(5):494.
- Lofren SM, Warshaw EM. Dyshidrosis: Epidemiology, clinical characteristics, and therapy. Dermatitis. 2006;17(4):165.
- Swartling C, Naver H, Lindberg M, Anveden I. Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin. JAAD. 2002;47(5):667.
- Wollina U. Pompholyx: A review of clinical features, differential diagnosis, and management. Am J Clin Dermatol. 2010;11(5):305.
- [homepage on the Internet]. clinicaltrials.gov: U.S. National Institutes of Health. 2017 [cited August 6, 2017]. Available from: https://clinicaltrials.gov/ct2/results?cond=&term=dupilumab&cntry1=&state1=&recrs=a. https://clinicaltrials.gov/ct2/results?cond=&term=dupilumab&cntry1=&state1=&recrs=a
Gillian Weston MD firstname.lastname@example.org