How Long Does Dupixent Take To Work
How Long Does Dupixent Take To Work – Two reasons, presented by JDD authors Ryan A. Gall, MD, John D. Peters, MD, and Allison J. Brinker, MD, are that patients with refractory dyshidrotic eczema and those without It adds to the growing body of literature supporting the use of dupilumab in therapy. . Dyshirotic intractable cancer. Contact allergy.
Dyshidrotic eczema, also known as dyshidrosis or hidridosis when larger blisters are involved, is a chronic disease of receding palmoplantar dermatosis characterized by severe itching and persistent pain. Often compared to tapioca pudding, these vesicles appear on the sides of your fingers and last for several weeks before drying and falling off.
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Dyshidrotic acne is not an isolated disease, but is often considered a symptom of other skin diseases such as allergic dermatitis, contact dermatitis (allergic and irritant) dermatitis.
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Basic treatment strategies for all patients with dyshidrotic acne include avoidance of irritants, gentle skin care to reduce irritation, and use of topical agents to restore barrier function.
Mild to moderate cases can be treated with topical steroids, calcineurin inhibitors, and ultraviolet light (UV-B and UVA1). Treatment failure with first-line drugs is common, including very potent corticosteroids in prophylaxis, systemic corticosteroids, psoralen ultraviolet A (PUVA) therapy, methotrexate, mycophenolate mofetil, and cyclosporine. , effective treatments such as systemic immunosuppressants such as azathioprine are used. However, dyshidrotic acne is often incurable, and many treatments have been attempted, resulting in significant morbidity. In this series, we report his two cases of refractory dyshidrotic eczema that improved after treatment with dupilumab.
A 38-year-old chief petty officer in the U.S. Navy visited a dermatology clinic five years ago complaining of severe tingling in his hands and feet. He had previously been treated with keratolytics, topical clobetasol, PUVA, and acitretin, but there was no significant improvement in his symptoms. Palmar biopsy showed spongiform dermatitis and intraepidermal vesicle formation supporting the diagnosis of dyshidrotic acne. Patch tests showed reactions to benzocaine, nickel sulfate, methylisothiazolinone, iodoproponyl butylcarbamate, cocamidopropyl betaine, and formaldehyde. Despite avoiding and adhering to a low-nickel diet, my symptoms improved slightly. He went on to say something similar, “Keep playing Legos.” Symptoms resolved with triamcinolone 60 mg intramuscularly, but they recurred within 1 month. He was started on dupilumab his 600 mg subcutaneously (SQ), followed by weekly doses of 300 mg SQ and clobetasol as needed. At follow-up, he saw rapid and significant improvement starting within a week of the first dose. After 6 months, improvement can be achieved without the use of clobetasol.
Figure 1. (Left) Patient 1’s arm before starting dupilumab. (Right) Patient 1 at 6-week follow-up.
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A 38-year-old male nutritionist in the United States Navy was seen at a dermatology clinic because of a several-year history of dyshidrotic eczema on the hands and feet. Early signs are mild and can only be controlled with topical moisturization. But over the course of a year, his symptoms began to worsen, and he was unable to cook and had difficulty walking. As his symptoms worsened, he became unresponsive to corticosteroids. She had some improvement on oral prednisone and her symptoms returned.
After the end. Patch testing and the North American Standard Series did not identify any contact allergens. The patient was treated with apremilast for 1 month, but there was no significant improvement and treatment was limited by the onset of depression. He started Dupilumab on his 600mg SQ and then for 2 weeks he received 300mg SQ once. At the same time, he started treatment with his UVB narrowband 2-3 times a week and clobetasol as a prophylaxis if needed at this time. At a 6-week follow-up, they reported 80-90% improvement and complete resolution of their plantar symptoms. Physical examination revealed fine scales on his fair feet and both palms. Narrowband UVB was discontinued and improved three months later.
Figure 2. (Left) The patient’s two legs before starting dupilumab. (Right) Patient 2 at 6-week follow-up.
In this article, we report two cases of his with refractory dyshidrotic eczema that were successfully treated with dupilumab. Dupilumab is an interleukin-4 receptor alpha antagonist that inhibits the activity of IL-4 and IL-13, thereby inhibiting his two important cytokines against Th2 inflammation.
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Dupilumab is FDA-approved for atopic dermatitis in adults that is not controlled by topical therapy. Other studies of dupilumab’s efficacy include treating eosinophilic esophagitis, childhood peanut allergy, alopecia areata, and chronic urticaria.
Dyshidrotic acne is a distinct entity considered to be on the clinical spectrum with allergic reactions. It is difficult to control and may recur when the drug is stopped. Currently, there are only a few randomized controlled trials for the treatment of dyshidrotic eczema, and there are no FDA-approved treatments. Current treatment options for resistant cases are limited by low efficacy and significant side effects. Systemic corticosteroids are often effective, but usually not long-term. Immunosuppressants have limitations because they have serious side effects and the possibility of relapse after discontinuation.
Side effects of dupilumab are generally mild, with the most common side effects being conjunctivitis, injection site reactions, and local herpes simplex.
These two cases add new evidence that dupilumab can be used as a highly effective treatment for patients with uncontrolled dyshidrotic cancer of the palms or feet. So far, four cases of successful treatment of dyshidrotic eczema with dupilumab have been reported in the literature, with deep and durable responses.
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This case series adds to the literature supporting the use of dupilumab in the treatment of patients with refractory dyshidrotic eczema, with or without allergic disease.
The authors of this publication have no disclosures, relevant financial relationships, patents, or conflicts of interest to report. Disclaimer: The opinions expressed in this article are those of the author and do not necessarily reflect the authority of any government agency, Department of the Navy, Department of Defense, or the United States Government.
4. Lodi A, Betti R, Chiarelli G, Urbani CE, Crosti C. Epidemiological, clinical, and epidemiological findings regarding sweat blisters.
6. Guillet MH, Wierzbicka E, Guillet S, Dagregorio G, Guillet G. Her three-year study of sweat blisters in 120 patients.
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7. De Boer EM, Bruinsel DP, van Ketel WG. Dyshidrotic eczema as an occupational dermatitis in metalworkers.
16. Weston GK, Hooper J, Strober BE. Dupilumab in the treatment of dyshidrosis: report of two cases.
17. Nanda S, Nagrani N, MacQuhae F, Nichols A. Complete resolution of large cell dyshidrotic carcinoma treated with dupilumab.
18. Weins AB, Biedermann T, Eyerich K, Moeckel S, Schnopp C. Successful treatment of refractory dyshidrotic eczema with dupilumab in children.
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Gall, R. A., Peters, J. D., and Brinker, A. J. His two cases of refractory dyshidrotic eczema treated with dupilumab. Journal of Drugs in Dermatology: JDD, 20 (5), 558-559.
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This article is part of the Pemphigus and Pemphigoid Disease Research Project: In memory of Detlef Zillikens View all his 35 articles
Background: Bullous pemphigoid (BP) is an inflammatory skin disease. Systemic corticosteroids remain the first-line treatment for mild to severe hypertension with serious side effects. Dupilumab has emerged as an alternative option for patients with BP.
Objective: We evaluated the efficacy and safety of dupilumab in the treatment of BP and investigated the drug’s mechanism of action in detail.
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Methods and Results: A multicenter retrospective cohort of 20 patients with BP who received dupilumab with or without systemic corticosteroids in the dupilumab group and 20 patients with BP who received corticosteroids alone in the culture group. Serum samples were collected from 20 patients (10 from the dupilumab group and 10 from the conventional group) at baseline and week 4. Compared with systemic corticosteroids alone, dupilumab with or without systemic corticosteroids was equally effective in clinical remission at 4 weeks (remission, complete remission, and partial remission). : 100%) and week 24 (complete and partial remission: 100%), but it is possible to significantly reduce the cumulative dose of corticosteroids with minimal side effects. However, dupilumab did not reduce BP180 antibodies despite clinical improvement. performed a comparative analysis of plasma proteomics before and after treatment in three of his BP patients.
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