From Bald to Bold: Reversal of Alopecia Totalis in an Adolescent Using Dupilumab Monotherapy

Alopecia areata (AA) is an autoimmune condition marked by non-scarring, patchy hair loss of the scalp which progresses in <10% of cases to alopecia totalis (AT), which is marked by complete hair loss from the scalp, eyebrows, and eyelashes. AA is prevalent in pediatric patients and is associated with atopic dermatitis (AD). The interleukin (IL)-4 and IL-13 antagonist dupilumab is approved for use in both pediatric and adult patients with AD and asthma. However, in some cases, dupilumab has shown promising results in regrowing hair in patients with concurrent AA.

We report a 13-year-old male patient with a past medical history of AD and food atopy, who presented with AA to the scalp. The patient's hormonal lab work-up was within normal limits, and he was treated and failed typical therapies for AA. Within nine months of treatment, the hair loss progressed to AT of the scalp and eyebrows. Dupilumab was then initiated as monotherapy for the patient's AD and AT, leading to regrowth of hair on the scalp and eyebrows within several months and sustained complete hair regeneration after 17 months post dupilumab initiation.

This case demonstrates the potential use of dupilumab, which has a well-established safety profile, for pediatric patients with AA and its ability to initiate and sustain hair growth for the long term. Dermatologists may consider dupilumab for patients with AA and comorbid AD that have failed a variety of treatments from several drug classes.  .