Full scalp hair regrowth in a 4-year-old girl with alopecia
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A 4-year-old otherwise healthy female presented with AD resistant to topical steroids, calcineurin inhibitors, oral antihistamines, and emollients since infancy. She also had clinically diagnosed AA of the scalp, eyelashes and eyebrows since age 2.5 years that was similarly resistant to topical and intralesional steroids. She had no history of asthma or other atopic conditions and had no other relevant family history.

Physical examination revealed total non-scarring alopecia of the eyelashes and eyebrows as well as of the scalp,with sparse hair on the vertex scalp. Scattered hyperpigmented, lichenified, scaly plaques were present on the trunk, buttocks, and all extremities. Dupilumab was chosen to treat this patient’s AD for several reasons :
- prior treatment failures
- potential for adverse effects of systemic immunomodulators,
- demonstrated efficacy in adults
- minimal side effect profile in older children.

Dupilumab was initiated at a dose of 200mg subcutaneously every two weeks. Two weeks after the first dose, the patient’s AD improved substantially, and her family reported improvement in her hair growth. After two months of treatment, the patient reported minimal pruritus and continued improvement of her AD. On exam, dramatic scalp hair regrowth (but minimal regrowth on her eyelashes and eyebrows) was noted. After four months, her AD remains well-controlled with minimal need for topicals. The patient’s scalp hair is fully regrown without the use of additional therapy.

source: https://www.jaadcasereports.org/article/S2352-5126(20)30735-9/fulltext?rss=yes