Recalcitrant Nummular Eczema in Childhood Responsive to Dupilumab Treatment

Nummular eczema (NE) is a distinctive eczematous dermatitis characterized by an eruption of coin-shaped erythematous, edematous, vesicular, and crusted patches that tend to expand as papulovesicular satellite lesions appear at the periphery and fuse with the main plaque. This pruritic disorder classically affects the extensor aspect of the extremities, trunk, and buttocks. Patients generally report poor quality of life, demanding early and effective treatment. Although topical therapy is the mainstay of management, treatment escalation may be required in severe cases. Dupilumab, a human monoclonal antibody that targets both IL-4 and IL-13, has shown efficacy for moderate to severe atopic dermatitis and other immune-mediated disorders. Here, we report a six-year-old boy with severe and extremely pruritic NE unresponsive to topical and classic systemic treatments, showing complete and maintained remission of all skin signs and symptoms under dupilumab treatment.