Successful treatment with upadacitinib for tumour necrosis factor-alpha inhibitor-induced palmoplantar pustulosis following infliximab therapy for ulcerative colitis

BackgroundAlopecia areata can be accompanied by atopic dermatitis. Alopecia areata accompanied by atopic dermatitis shows more severe symptoms and responds limitedly to dupilumab monotherapy. Topical immunotherapy often fails due to atopic dermatitis flares.ObjectivesTo report the usefulness of dupilumab combined with topical immunotherapy in alopecia areata patients with atopic dermatitis.Materials & MethodsEleven cases of alopecia areata with atopic dermatitis, all with Severity of Alopecia Tool (SALT) scores ≥70 and Eczema Area and Severity Index (EASI) scores ≥16, received dupilumab for atopic dermatitis and topical immunotherapy for alopecia areata. A representative treatment began with sensitization using squaric acid dibutyl ester or diphenylcyclopropenone, followed by dupilumab monotherapy to control atopic dermatitis. After topical immunotherapy titration, concurrent dupilumab and topical immunotherapy were administered. SALT scores were evaluated at week 28.ResultsAll patients completed the combination therapy without atopic dermatitis flares. At week 28, 64% achieved SALT ≤20, including those with alopecia areata duration ≤seven years. Patients with IgE ≥200 IU/mL tended towards higher efficacy. No serious adverse events were reported, including in paediatric or oncology cases. Notably, 75% of patients who had previously failed topical immunotherapy tolerated concentrations up to 100-fold higher.ConclusionDupilumab combined with topical immunotherapy demonstrated favourable effects in alopecia areata patients with atopic dermatitis, offering a safer and effective option, especially for paediatric or oncology cases.