Dyshidrotic eczema (dyshidrosis) primarily appears on the palms and soles and is often difficult to treat. In this Journal of Drugs in Dermatology (JDD) case report, we look at two successfully treated unique cases of recalcitrant dyshidrotic eczema (dyshidrosis). This article was written by Gillian K. Weston MD, Jette Hooper, Bruce E. Strober MD PhD and published in March 2018. Citation: J Drugs Dermatol. 2018;17(3):355-356.
ABSTRACT
Dupilumab (Dupixent, Regeneron Pharmaceuticals and Sanofi Genzyme) is a novel biologic medication recently approved by the FDA for the treatment of moderate-to-severe atopic dermatitis in adults who have not achieved adequate control with topical medications. Dyshidrotic eczema is a distinct entity, often considered on the spectrum of atopic dermatitis, that primarily effects the palms and soles; it is often associated with considerable morbidity yet is frequently challenging to treat. We report two cases of recalcitrant dyshidrotic eczema treated successfully with dupilumab at standard dosing. Further studies to establish the efficacy of dupilumab in the treatment of dyshidrosis are warranted.
INTRODUCTION
Dupilumab (Dupixent, Regeneron Pharmaceuticals and Sanofi Genzyme) is a novel agent approved by the FDA in March 2017 for the treatment of adults with moderate-to-severe atopic dermatitis (AD) not adequately controlled by topical medications. Through its action as a monoclonal antibody targeting the alpha subunit of the interleukin-4 receptor (IL-4Ra), it inhibits the biologic effects of both interleukin-4 (IL-4) and interleukin-13 (IL-13), which contribute to the inflammation seen in patients with atopic dermatitis. Dyshidrotic eczema is a distinct entity, alternatively called hand eczema, dyshidrosis or pompholyx, which often affects the hands and feet and is characterized by recurrent pruritic and painful erythematous papules and vesicles followed by peeling, scaling, and fissuring of the skin. Moderate-to-severe disease is debilitating, and treatment is often challenging. We report two cases of recalcitrant dyshidrotic eczema managed successfully with dupilumab.
CASE #1
A 63-year-old male presented with severe hand dermatitis. His past medical history was significant for asthma, seasonal allergies, osteoarthritis, and hypertension, although he denied a history of childhood atopic dermatitis. He worked as a mechanic and his dermatitis was a significant professional hindrance. Between 2006 and 2017, he was treated with minimal success using high potency topical corticosteroids, emollients, narrow band ultraviolet B phototherapy, psoralen-ultraviolet A therapy (PUVA), excimer laser, multiple courses of systemic
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