Atopic dermatitis (AD) is typically a big issue during early childhood. But it also afflicts up to 5% of adults. Mild cases, which are virtually always managed in primary care, are usually successfully treated with a combination of topical emollients, corticosteroids, and calcineurin inhibitors (tacrolimus, pimecrolimus). In 2016, a new agent entered the armamentarium when the US Food and Drug Administration (FDA) approved a novel topical phosphodiesterase-4 inhibitor (crisaborole) for use in patients ≥ 2 years of age.
In contrast to the anticipated success of this approach for relatively mild disease, these topical agents are not as effective for moderate to severe AD. They are cumbersome to apply to large body surface areas and seldom result in prolonged disease remission.
Along comes dupilumab, the first biologic agent to receive FDA approval for the treatment of moderate to severe AD in patients > 12 years of age. The drug is a monoclonal antibody that blocks the proinflammatory signaling pathway that is overactive in atopic disease.[1] Approval followed three pivotal clinical trials, which all demonstrated consistent improvements measured by a range of objective tools.[2,3] Adverse effects were generally mild and included injection-site reactions, headache, nasopharyngitis, and conjunctivitis.[2,3,4] Interestingly, dupilumabhad been reported to both improve and induce alopecia areata.
