P100 Critically Appraised Topic: Is Dupilumab a Cause or a Treatment for Alopecia Areata? A Case Series and Literature Review to Guide Discussions in Clinical Practice

This study explores the complex relationship between dupilumab, a treatment for atopic dermatitis, and alopecia areata (AA). Among 156 patients treated with dupilumab, five developed AA, with a mean onset of 15.5 weeks. Despite this, most patients experienced hair regrowth while continuing dupilumab. A literature review identified 61 relevant papers, revealing 20 adult cases of AA after starting dupilumab, with 13 showing hair regrowth during treatment. The study highlights a paradoxical effect where dupilumab may both induce and treat AA, with a notable number of patients experiencing regrowth despite ongoing treatment. The findings suggest a complex interaction between Th1 and Th2 pathways, with dupilumab potentially downregulating Th2 and inadvertently promoting AA through Th1. The study calls for further investigation into the association and potential under-reporting of cases.