Clinical Observations Of Alopecia Areata Associated with Ige -Dependent and Ige -Independent Atopic Dermatitis in the Dynamics of Anticytokine Therapy

Abstract

Depending on atopic sensitization, IgE -dependent and IgE -independent variants of atopic dermatitis are isolated, which also differ in their immunological profile and activation of cytokines belonging to different types of T-cell immune response. For the treatment of severe forms of atopic dermatitis, the drug dupilumab is used, which selectively blocks the main T2 type cytokines,  IL-4 and IL-13. Of particular clinical interest is the association between atopic dermatitis and alopecia areata. The article describes clinical observations of two patients treated with dupilumab who have IgE-dependent and IgE-independent atopic dermatitis and concomitant alopecia areata. In a patient with IgE-dependent atopic dermatitis and a universal form of alopecia areata, treatment with dupilumab showed a pronounced positive effect on not only on the clinical manifestations of atopic diseases, but also on alopecia areata in the form of regrowth of eyelashes, eyebrows and partial regrowth of hair on the head. In atopic dermatitis, which is regarded as IgE-independent, the therapeutic result of dupilumab is characterized by moderately positive dynamics of atopic rashes and negative dynamics of alopecia areata in the form of progression of the disease from subtotal to total form with partial hair loss on the body. The use of anti-cytokine therapy, given its impact on the immunological profile, in combined immune-mediated pathology, requires an assessment of the endotypes of associated heterogeneous diseases. This will make it possible to personalize pathogenetic treatment by targeting the general molecular mechanisms of pathological processes.