Dupilumab use in dermatologic conditions beyond atopic dermatitis–a systematic review

Importance: While dupilumab has emerged as an effective treatment for moderate-to-severe atopic dermatitis (AD) since its approval in 2017, interleukin-4 and 13 blockade has also demonstrated efficacy in off-label chronic dermatologic conditions. Objective: To identify chronic dermatologic conditions in which dupilumab has demonstrated efficacy. Findings: Thirty-three reports of dupilumab use in non-AD dermatologic conditions were identified through systematic literature review. Effective use of dupilumab has been reported in case reports and case series in the treatment of chronic pruritus, prurigo nodularis, eczematous eruption of aging, allergic contact dermatitis, chronic hand eczema, alopecia areata, urticaria, eosinophilic annular erythema, bullous pemphigoid and papuloerythroderma of Ofuji. Clinical trials are underway evaluating the efficacy of dupilumab in allergic contact dermatitis, chronic hand eczema, alopecia areata, chronic spontaneous urticaria and cholinergic urticaria. Conclusions and relevance: Overlap in immune signaling pathways between AD and chronic pruritus, eczematous eruption of aging, allergic contact dermatitis, chronic hand eczema, alopecia areata, urticaria, eosinophilic annular erythema, bullous pemphigoid and papuloerythroderma of Ofuji make these conditions candidates for dupilumab therapy when standard treatments have failed or are contraindicated. While promising as a therapeutic option, off-label prescribing of dupilumab requires consideration of challenges in insurance authorization and out-of-pocket cost to the patient.