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Dupilumab: Breaking Boundaries beyond the Barriers of Atopy

Sara A. Altandi, Maella Severino-Freire, Juliette Mazereeuw-Hautier

Dupilumab is a monoclonal antibody that blocks the effects of interleukin-4 and interleukin-13 thereby inhibiting Th2-mediated inflammation. It is approved for moderate-to-severe atopic dermatitis requiring systemic treatment. It was expanded to off-label treatment of numerous dermatological conditions. We provide an update on the increasing scope of uses of dupilumab in rare and common dermatological diseases refractory to frontline therapy. PubMed/MEDLINE database were searched for articles mentioning the term 'dupilumab', excluding the terms “atopic dermatitis”, “asthma” and “nasal polyps”, then manually reviewed to identify published data on the off-label dermatologic uses of dupilumab that were not mentioned in previous reviews. Dupilumab appears to be an effective treatment for several dermatologic conditions including congenital ichthyosis, dermatitis related to immunodeficiency disorders, non-immune bullous diseases and acantholytic disorders. In the context of atopic dermatitis, it seems to reduce associated bacterial and viral infections. Dupilumab was successfully used as an off-label treatment in many recalcitrant skin diseases. However, more studies are required to support the preliminary evidence provided by case reports and case series.