A Case of Dupilumab-Induced Psoriatic Alopecia

A 29-year-old man with severe atopic dermatitis developed psoriatic alopecia 7 weeks after starting dupilumab, a monoclonal antibody targeting the IL-4 receptor. Histological analysis confirmed psoriatic alopecia, characterized by psoriasiform and spongiotic features with peribulbar inflammation. After stopping dupilumab and treating the scalp with steroids and ketoconazole shampoo, the patient switched to abrocitinib, resulting in full hair regrowth and well-controlled eczema within 6 months. This case highlights the rare occurrence of psoriatic alopecia as a paradoxical reaction to dupilumab, suggesting a shift from the Th2 to Th1/Th17 pathway, and underscores the importance of considering alternative therapies if such reactions occur.