A case series of dupilumab-treated allergic contact dermatitis patients

Atopic dermatitis is characterized by skin barrier abnormalities and immune dysregulation with increased T_H 2 signaling playing a central role. Investigations of allergic contact dermatitis suggest that certain allergens may also activate particular T cell signatures such as T_H 2-dominant responses to fragrance and rubber. We present a case series of patients with allergic contact dermatitis who were successfully treated with dupilumab, a biologic developed for atopic dermatitis that dampens T_H 2 signaling. In our cohort of three patients, two had extensive allergic contact dermatitis on their torso and extremities primarily due to textile and rubber allergens. The third was a hairdresser with severe hand dermatitis due to occupational allergens. Two of the three patients had no history of atopic dermatitis during childhood. Each patient experienced at least 90% improvement in body surface area involvement and continues to maintain their clinical response on dupilumab (range 6-13 months). Our hypothesis that dupilumab suppressed contact allergic reactions is supported by the identification of clinically relevant contact allergens on patch testing, acute onset and/or worsening of dermatitis in adulthood, and absence of childhood atopic dermatitis in two cases. Further, larger investigations to understand which factors affect responses of allergic contact dermatitis to dupilumab are warranted.