Effectiveness of Dupilumab on Special Sites in Atopic Dermatitis

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Atopic dermatitis (AD) frequently affects the hands, impacting approximately 60% of patients with this chronic inflammatory condition.¹ As hands are constantly exposed to environmental and chemical stressors, such as allergens, low temperatures, UV radiation, and irritants, their skin barrier is especially susceptible to damage. This damage can lead to inflammation flare-ups, making AD on the hands particularly challenging to treat.² Additionally, the hands' central role in daily activities means that AD in this area has a significant impact on patients’ quality of life (QoL), affecting both functional abilities and social interactions.³ Although dupilumab, a monoclonal antibody targeting the interleukin-4 and interleukin-13 pathways, is known to be highly effective in treating AD, researchers behind a recent study noted its specific efficacy for hand AD has been under-researched.⁴

Study Design and Methods

The study, a retrospective, single-center investigation, focused on assessing the efficacy of dupilumab for severe hand AD in a cohort of 485 patients. Each participant was treated with an initial dupilumab loading dose of 600 mg, followed by 300 mg subcutaneously every 2 weeks. The cohort included 255 male patients (52.5%), with an average age of 38 years (range: 13 to 88 years). Patients with suspected allergic contact dermatitis were excluded from the study after undergoing patch testing, thus isolating the AD-specific response to treatment.⁵

To evaluate the clinical progress of hand AD, researchers utilized multiple assessment tools: the Eczema Area and Severity Index (EASI), Pruritus Numerical Rating Scale, Atopic Dermatitis Control Tool (ADCT), and Dermatology Life Quality Index (DLQI). Measurements were recorded at baseline and subsequently every 4 months. Complete remission (CR) was defined as achieving an EASI and Pruritus NRS score of 0, with no use of topical corticosteroids or calcineurin inhibitors in the 4 months preceding the evaluation. Patients could use emollient creams as supportive care throughout the study. 

Study Findings

The study findings indicated substantial efficacy of dupilumab in treating hand AD. After 4 months of treatment, researchers reported 62.7% of patients achieving CR. This response rate continued to improve over time, with 76.5% of patients in CR at the 1-year mark and 85.6% at 3 years. Researchers stated these findings support the long-term effectiveness of dupilumab for managing hand AD, with increasing benefits observed with prolonged treatment.

Moreover, the study reported that non-responder patients consistently had higher DLQI and ADCT scores than responders, underscoring the importance of hand AD management for improving general QoL and symptom control. Although the DLQI score comparison at 4 months did not show a significant difference between responders and non-responders, researchers stated subsequent evaluations showed a clear correlation between symptom control and QoL improvements. 

Clinical Implications

This study highlights dupilumab’s role in treating hand AD, a site historically known to be difficult to manage. Notably, 85% of patients achieved CR with extended treatment. For clinicians, the study stated that these findings underscore the potential of dupilumab to control hand AD symptoms effectively, even in patients who initially show resistance. Researchers noted that prolonged treatment may thus benefit some unresponsive patients by increasing their chances of CR and transforming persistent AD into an intermittent condition. They wrote that this suggests discontinuing dupilumab prematurely in favor of alternative therapies may not be advisable without a sufficient trial period, especially in cases involving the hands. 

Conclusion

Researchers stated that this large-scale study confirms the high efficacy of dupilumab for treating hand AD, with prolonged treatment yielding favorable results in a majority of patients. These findings provide insights for clinicians managing patients with AD involving the hands, supporting dupilumab as an effective long-term treatment option for this challenging and impactful condition. As dupilumab shows promise for managing hand AD, researchers stated clinicians may consider its extended use to optimize symptom control and improve patients’ QoL, particularly for those experiencing chronic or severe hand AD symptoms.

References

1. Simpson EL, Thompson MM, Hanifin JM. Prevalence and morphology of hand eczema in patients with atopic dermatitis. Dermatitis. 2006;17(3):123-127. doi:10.2310/6620.2006.06005
2. Fartasch M, Taeger D, Broding HC, et al. Evidence of increased skin irritation after wet work: impact of water exposure and occlusion. Contact Dermatitis. 2012;67(4):217-228. doi:10.1111/j.1600-0536.2012.02063.x
3. Silverberg JI, Simpson B, Abuabara K, et al. Prevalence and burden of atopic dermatitis involving the head, neck, face, and hand: A cross sectional study from the TARGET-DERM AD cohort. J Am Acad Dermatol. 2023;89(3):519-528. doi:10.1016/j.jaad.2023.04.052
4. Vittrup I, Krogh NS, Larsen HHP, et al. A nationwide 104 weeks real-world study of dupilumab in adults with atopic dermatitis: Ineffectiveness in head-and-neck dermatitis. J Eur Acad Dermatol Venereol. 2023;37(5):1046-1055. doi:10.1111/jdv.18849
5. Perego G, Aromolo IF, Barei F, et al. Special sites in atopic dermatitis: Effectiveness of dupilumab on the hands in a single-centre study on 485 patients. Australas J Dermatol. 2024. doi: 10.1111/ajd.14372