Case and Research Letter
Atopic Dermatitis Patient With Hepatitis C Treated With Dupilumab—A Case Report
Paciente con dermatitis atópica y hepatitis C tratado con dupilumab – informe de un caso
F. Mota
Photobiology and Cutaneous Immunology Unit, Hospital Senhora da Oliveira, Guimarães, Portugal
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Mota" "autores" => array:1 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Mota" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024000632?idApp=UINPBA000044" "url" => "/00017310/0000011500000004/v2_202407100447/S0001731024000632/v2_202407100447/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0001731024000796" "issn" => "00017310" "doi" => "10.1016/j.ad.2022.07.052" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "3832" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2024;115:T417-T419" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and research letter</span>" "titulo" => " Is Follicular Porokeratosis a Distinct Clinical Variant?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T417" "paginaFinal" => "T419" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Poroqueratosis folicular ¿es una variedad clínica distinta?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 978 "Ancho" => 1305 "Tamanyo" => 404667 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A.</span> Clinical image of the dermatosis characterized by erythema and thin scale that coalesce in round-shaped plaques with discrete keratotic borders. <span class="elsevierStyleBold">B.</span> Dermatoscopic image: presence of erythema and follicular distribution of scales without a defined dermatoscopic pattern. <span class="elsevierStyleBold">C.</span> Hematoxylin and eosin (H&E) stain, ×10. Histopathology: the epidermis exhibits orthokeratotic hyperkeratosis and areas of moderate regular acanthosis. Within the dermal thickness, dilated follicular infundibula containing laminar keratin and columns of compact parakeratotic hyperkeratosis corresponding to cornoid lamellae can be seen, with such structures being connected to the follicular epithelium where there is an absence of the granular layer. <span class="elsevierStyleBold">D.</span> Hematoxylin and eosin (H&E) stain, ×4 and ×40. In other areas of the section, cystic structures containing cornoid lamellae can also be seen, leading to a diagnosis of follicular porokeratosis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. González González, S. Torres González, J.R. Trejo Acuña, S. Guzmán Herrera, T.R. Torres Victoria" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "González González" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Torres González" ] 2 => array:2 [ "nombre" => "J.R." "apellidos" => "Trejo Acuña" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Guzmán Herrera" ] 4 => array:2 [ "nombre" => "T.R." "apellidos" => "Torres Victoria" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024000796?idApp=UINPBA000044" "url" => "/00017310/0000011500000004/v2_202407100447/S0001731024000796/v2_202407100447/en/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0001731024000632" "issn" => "00017310" "doi" => "10.1016/j.ad.2024.02.003" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "3826" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2024;115:T420-T421" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => " Paciente con dermatitis atópica y hepatitis <span class="elsevierStyleSmallCaps">C</span> tratado con dupilumab – informe de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T420" "paginaFinal" => "T421" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Atopic Dermatitis Patient With Hepatitis C Treated With Dupilumab—A Case Report" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1543 "Ancho" => 1740 "Tamanyo" => 319919 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Paciente con dermatitis atópica al inicio (a–c), y transcurridos 6 meses del tratamiento con dupilumab (d–f).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Mota" "autores" => array:1 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Mota" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024000632?idApp=UINPBA000044" "url" => "/00017310/0000011500000004/v2_202407100447/S0001731024000632/v2_202407100447/es/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Atopic Dermatitis Patient With Hepatitis C Treated With Dupilumab—A Case Report" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "420" "paginaFinal" => "421" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "F. Mota" "autores" => array:1 [ 0 => array:3 [ "nombre" => "F." "apellidos" => "Mota" "email" => array:1 [ 0 => "fernandojrmota@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Photobiology and Cutaneous Immunology Unit, Hospital Senhora da Oliveira, Guimarães, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paciente con dermatitis atópica y hepatitis C tratado con dupilumab – informe de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1542 "Ancho" => 1740 "Tamanyo" => 304172 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient with atopic dermatitis at baseline (a–c), and after 6 months of treatment with dupilumab (d–f).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atopic dermatitis is a common chronic inflammatory cutaneous disease with a great impact on the quality of life. It affects nearly 10–30% of children and 2–10% of adults.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Dupilumab was the first approved biologic therapy for this disease and is now approved for different age groups, including children as young as 6 years old with severe AD. It is a fully human monoclonal antibody that targets the alpha subunit of the interleukin 4 receptor (IL-4Rα), thus modulating the signaling of both IL-4 and IL-13. This recent drug is considered as being immunomodulatory and not immunosuppressant because of its mechanism of action. In fact, the clinical trials with dupilumab, showed no evidence of an increase in overall infection rates and evidence of no increased risk of serious or opportunistic infections in dupilumab-treated patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Real world evidence of the safe use of dupilumab in atopic dermatitis patients with viral infections such as HIV and hepatitis B has emerged, but it is important to gather data in other infections such as hepatitis C infection.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–6</span></a> Despite the drug not being formally contraindicated for AD patients with HCV infection under anti-viral treatment, there's no data regarding the use of dupilumab in this special population from the clinical trials, because having an active chronic or acute infections including HIV and hepatitis B and C was an exclusion criteria.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> To date, no data has been published regarding the use of dupilumab in the treatment of atopic dermatitis patients with hepatitis C. The author reports a case of an atopic dermatitis patients with active hepatitis C, successfully and safely treated with dupilumab.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 47-years-old male patient was observed in our consultation due to severe atopic dermatitis since the age of 32. He had a prior medical history of active hepatitis C and was being monitored in the Gastroenterology department. Clinically, the patient presented with extensive and lichenified lesions, with a BSA of around 60% and an EASI score of 40.9 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a–c). He reported a DLQI score of 27 and a pruritus NRS of 9. The patient started treatment with dupilumab, with significant overall improvement of the atopic dermatitis, reaching an EASI-90 response by month 6, with a DLQI score of 3 and pruritus NRS of 0 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>d–f). During the treatment, there was no worsening of the hepatitis (no changes in liver enzymes or viral load), with the patient undergoing hepatitis C treatment with Sofosbuvir and Ledipasvir and achieving clinical remission (normalization of liver enzymes and viral load of 0).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In patients with systemic infections such as HIV/AIDS or hepatitis C, once topical treatments and phototherapy fail, systemic treatment options for these patients are extremely scarce. Dupilumab is an effective and safe treatment for atopic dermatitis. Due to the mechanism of action (inhibition of the T-helper 2 pathway), it preserves the ability of the immune system to effectively react to viral infections (through T-helper 1 cells), even decreasing the frequency of some such as herpetic infections. It is also worth to mention that some investigational works suggest that IL-4 is overexpressed in liver grafts in a context of severe recurrent hepatitis C, which may indicate that this interleukin has a potential role in the accelerated course of fibrogenesis during recurrent HCV infection.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Studies have also shown that Th2 cytokines have a role in tissue fibrosis involving other organs such as the lung and the skin. Some data suggest that these profibrotic actions of IL-4 (and IL-13) occur via transforming growth factor-beta (TGF-β) pathway and periostin production and secretion.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> So theoretically, dupilumab may be safely used in patients with systemic viral infections such as hepatitis C as we’ve seen with hepatitis B infection cases, and may have a beneficial effect in patients with a degree of liver fibrosis. Most importantly, there's a recent publication by the International Eczema Council (IEC) that ranked dupilumab as first-line in the preferred systemic treatments for adults with AD who have a chronic hepatitis B and/or C viral infection.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this case, not only did the hepatitis not worsen, but the patient was able to undergo treatment and cure the infection while under treatment with dupilumab. To the best of our knowledge, this is the first reported case of an atopic dermatitis patient with active hepatitis C infection treated with dupilumab. Given the experience of this case and knowing the results of the IEC survey, in which dupilumab was selected as first-choice for these situations, the decision to start dupilumab seems to be clearer and more obvious today. However, more data is required regarding the use of dupilumab for the treatment of atopic dermatitis patients with systemic infections.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">F. Mota has received honoraria for acting as a consultant and/or as a speaker for Galderma, Janssen, LEO Pharma, Lilly, Novartis, Pfizer and Sanofi Genzyme.</p><p id="par0030" class="elsevierStylePara elsevierViewall">He has also worked as a co-investigator in clinical trials supported by Amgen and Novartis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1542 "Ancho" => 1740 "Tamanyo" => 304172 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient with atopic dermatitis at baseline (a–c), and after 6 months of treatment with dupilumab (d–f).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines of care for the management of atopic dermatitis: section 1. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 14 | 25 |
| 2024 October | 146 | 82 | 228 |
| 2024 September | 127 | 45 | 172 |
| 2024 August | 168 | 73 | 241 |
| 2024 July | 132 | 71 | 203 |
| 2024 June | 128 | 62 | 190 |
| 2024 May | 191 | 91 | 282 |
| 2024 April | 285 | 82 | 367 |
| 2024 March | 182 | 79 | 261 |
| 2024 February | 105 | 60 | 165 |
| 2024 January | 185 | 80 | 265 |
| 2023 December | 131 | 75 | 206 |
| 2023 November | 148 | 62 | 210 |
| 2023 October | 179 | 88 | 267 |
| 2023 September | 112 | 67 | 179 |
| 2023 August | 112 | 47 | 159 |
| 2023 July | 166 | 96 | 262 |
| 2023 June | 71 | 101 | 172 |
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