Figure - available from: Frontiers in Medicine
This content is subject to copyright.
Eczematous, scaly, and excoriated plaques on the face of Patient 2 before treatment (a). Nearly clearance of lesions after dupilumab treatment (b).
Source publication
Chronic actinic dermatitis (CAD) is a rare chronic immunological photo-dermatosis resulting in pruritic eczematous eruption on sun-exposed skin to ultraviolet (UV) light. The disease mechanism may include a delay-type hypersensitivity reaction to an endogenous photo-induced antigen, postulated to be UVR-altered DNA, but the exact pathophysiology is...
Citations
... 3 Some hypotheses suggest that the disease mechanism may involve a delayed-type hypersensitivity reaction to an endogenous photoinduced antigen, postulated as UV-altered DNA. 9,10 It is believed that the recognition of UV-induced neoantigens by lymphocytes in the skin may underlie this process. 7 While CAD affects individuals of any sex and age, it primarily develops in men over 50 years of age, 11,12 particularly those with fair skin, 13 often engaging in outdoor activities. ...
... 7 While CAD affects individuals of any sex and age, it primarily develops in men over 50 years of age, 11,12 particularly those with fair skin, 13 often engaging in outdoor activities. 10 These sex and age patterns appear to be more pronounced in Asian populations. 3,14 CAD follows a relapsing and remitting course, which significantly compromises the affected individual's quality of life. ...
... 15 The management of CAD includes strict sun protection, photoprotective clothing, and the use of UVA and UVB sunscreens. 10 Currently, no curative treatment for CAD. 5 Topical calcineurin inhibitors (TCIs) and topical and systemic corticosteroids are first-line pharmacological management options. In severe cases, indicated systemic immunosuppression usually involves cyclosporine, methotrexate, mycophenolate mofetil, and azathioprine. ...
We present the case of a 58-year-old male patient who presented with pruritic skin plaques and papules on the scalp, face, back, and back of the hands for over a year. The symptoms worsened upon exposure to sunlight and improved on cloudy days. Despite previous attempts at treatment with glucocorticoid ointment and antihistamine drugs, the patient experienced progressive aggravation of symptoms. Physical examination revealed hypertrophic and infiltrating nodules, with significant scratches and local exudation. Skin biopsy confirmed the diagnosis of sun-induced dermatosis. The patient was initiated on tofacitinib, an oral Janus Kinase inhibitor, along with a halometasone ointment, oral ebastine tablets, and strict sun protection. Over the course of four revisits spanning four months, the patient experienced a significant improvement in symptoms, with the rash almost disappearing and pruritus subsiding. The treatment was well tolerated and no adverse effects were observed. Follow-up for six months post-treatment showed no recurrence of symptoms. This case highlights the efficacy of tofacitinib in managing sun-induced pruritic plaques and suggests it as a potential therapeutic option in similar cases.
... Dupilumab has proved to be safe and effective in several real-life studies both on clinical and psychological aspects of AD. [4][5][6][7] CAD is an immune-mediated photodermatosis and has been reported to have a similar Th2-mediated inflammatory pathogenesis to AD. According to previous reports, [8][9][10][11][12][13] dupilumab prescribed for CAD has shown promising results in the disease. However, the evidence supporting its efficacy in patients with CAD comes from small case series and case reports. ...
... Previous studies have reported that patients experienced significant improvement in their signs and symptoms within 4 weeks of initiating dupilumab treatment. 8,12 However, in this retrospective investigation, noteworthy improvement of CSS-CAD, DLQI, and NRS was observed as early as week 4, while ADCT exhibited slightly delayed response. Additionally, at week 4, only a solitary patient achieved a good response; but with continuous treatment, the number of patients showing goodto-excellent responses significantly increased by week 8. ...
... Dupilumab is an IL-4 receptor alpha antagonist that blocks Th2 proinflammatory cytokines IL-4 and IL-13. Although previous reports [8][9][10][11][12][13] and this study have found that dupilumab showed surprising efficacy in the treatment of CAD, it is challenging to speculate on the exact mechanism of dupilumab to improve the disease severity in patients with CAD. Ko et al found the role of Th1/Th2 misbalance in patients suffering severe CAD. 15 Besides, UV irradiation may inhibit antigen presentation to Th1 cells but increase that to Th2 cells. ...
Background
Although dupilumab is an effective treatment approach for chronic actinic dermatitis (CAD) in some cases, its effectiveness and safety in CAD have not been sufficiently assessed.
Purpose
Evaluation of the effectiveness and safety of dupilumab in patients with recalcitrant CAD was performed.
Methods
We retrospectively reviewed the medical records of CAD patients treated with dupilumab. Data regarding demographics were collected, and disease severity scores were assessed using the following: Clinical Severity Score of CAD (CSS-CAD), Atopic Dermatitis Control Tool (ADCT), Dermatology Life Quality Index (DLQI), and Numeric Rating Scale (NRS)-itch scores.
Results
After 12 weeks of treatment, there was a significant decrease in disease severity scores of 16 CAD patients. Only one patient achieved a good response and most of the patients (62.5%, 10/16) had no significant symptom improvement after 4 weeks of treatment. However, after 12 weeks of treatment, 43.75% (7/16) of the patients reached excellent response (>75% improvement of CSS-CAD), 31.25% (5/16) good response (50%–75% improvement of CSS-CAD), 6.25% (1/16) partial response (25%–50% improvement of CSS-CAD), and only 18.75% (3/16) no response (<25% improvement of CSS-CAD). One patient complained of injection site reaction at the first injection.
Conclusion
This study supports dupilumab as an effective and safe treatment option for patients with recalcitrant CAD. Patients may require at least 4 weeks of treatment before the partial response is noted.
... Improved methods of delivering drugs to the patient can lead to better outcomes. Topical administration of many drugs has been widely explored for the past decade using nano-based formulations for skin disease therapy [18][19][20]. Using nanoencapsulation, the dosages needed to achieve biological activity are reduced, side effects are minimized because of targeted administration, and novel compounds may now be employed pharmacologically. ...
Recurrent eczematous lesions and acute itching describe chronic actinic dermatitis (CAD). Continuous use of corticosteroids might result in a dermal adverse effect. Chitosan (CS)-coated PLGA nanoparticles encapsulated prednisolone (PDS) and co-encapsulated to poloxamer hydrogel to enhance anti-inflammatory action and reduce side effects. The PDS@NPs were synthesized using the solvent-emulsification evaporation method, and their physical and chemical properties were analysed. Ex vivo drug absorption experiment was conducted utilizing the Franz diffusion cells in vitro. Toxic effects on human fibroblasts and keratinocytes were not observed in the nanoparticle formulations. Nanoparticles and hydrogels altered PDS’s release kinetics, but not by the non-encapsulated PDS (NE@PDS). Nanoparticles could not penetrate the stratum corneum of removed the skin, which shows the nano-encapsulation of PDS improved skin absorptions. Pseudoplastic and non-Newtonian behaviour was seen in all hydrogels. The nanoformulations appear to be a promising option for glucocorticoid delivery to individuals with chronic actinic dermatitis (CAD).
... Chronic photodermatoses including chronic actinic dermatosis (CAD) and actinic prurigo are induced by exposure to UV-radiation and can resemble photosensitive AD. Reports showed efficacy of dupilumab in 16 cases of CAD (Table 8) [252][253][254][255][256][257][258] as well as in a pediatric patient with actinic prurigo [259], leading to higher minimal erythema doses in repeated UV-phototesting in some cases. ...
Dupilumab was first approved for the treatment of atopic dermatitis (AD) and blocks the signaling of interleukin (IL)-4 and -13. Several other chronic skin conditions share mechanistic overlaps with AD in their pathophysiology, i.e., are linked to type 2 inflammation. Most recently, dupilumab was approved by the U.S. Food and Drug Administration for prurigo nodularis (PN). Given its relatively good safety profile, effective off-label use of dupilumab has been reported for a multitude of dermatologic diseases and several clinical trials for dermatologic skin conditions are currently ongoing. We conducted a systematic review of applications of dupilumab in dermatology other than AD and PN by searching the databases PubMed/Medline, Scopus, Web of Science and Cochrane Library as well as the clinical trial registry ClinicalTrials.gov. We found several reports for effective treatment of bullous autoimmune diseases, eczema, prurigo, alopecia areata, chronic spontaneous urticaria, Netherton syndrome and a variety of other chronic inflammatory skin diseases.
... 4 Notably, there have been case series and case reports outlining improvement of Chronic Actinic Dermatitis treatment with Dupilumab: A Case Report and Review of the Literature Journal of Integrative Dermatology CAD after dupilumab, particularly in the Chinese population. 7,8 We add this report to the literature. CONCLUSION CAD can be a debilitating disorder; this patient had to leave his job and take disability due to the outdoor nature of his job. ...
... Dupilumab represents a novel treatment that shows promise in treating CAD. 7,8 More large-scale studies are needed to evaluate the full effect of dupilumab in treating CAD, both in terms of safety and efficacy, but clearly there is potential for this approach. Chronic Actinic Dermatitis treatment with Dupilumab: A Case Report and Review of the Literature ...
Chronic actinic dermatitis (CAD) is a chronic immune-mediated photo-dermatosis causing pruritic eczematous lesions, infiltrated lichenified papules,and plaques on sunexposed skin. It commonly affects elderly males who are chronically exposed to sunlight. The photosensitivity is mostly to ultraviolet (UV) B wavelengths and less frequently to ultraviolet (UV)A and visible light. In this article, the pathogenesis, clinical features, investigations, and treatment of CAD will be discussed.
The photodermatoses comprise of a miscellaneous set of photosensitive disorders with abnormal cutaneous response to sunlight. The diagnosis is mostly clinical and is augmented by methods such as phototesting, photoprovocation testing, and photopatch testing, which are discussed below. Treatment includes photoprotection, prophylactic phototherapy, as well as topical and systemic immunosuppression to varying extents. Various newer modalities for photoprotection as well as treatment are being explored.
We report a retrospective case series from two UK photobiology units of twelve patients with concomitant Atopic Dermatitis and Chronic Actinic Dermatitis treated with dupilumab as a systemic monotherapy. Whilst dupilumab is an effective therapy for moderate-severe AD, our results suggest that it may be less effective for the photosensitivity of CAD. In 11 of 12 patients with CAD, dupilumab was associated with improvement in dermatitis, but only half of patients noted improvement in photosensitivity.
The photodermatoses are a diverse group of conditions in which abnormal responses to light exposure are the hallmark. Photodiagnostic investigations through a specialist unit may be essential to ensure accurate diagnosis and management, and this chapter explores the nature of the photodermatoses and the photodiagnostic techniques that can be applied. Management approaches include early diagnosis, prevention and disease suppression, and awareness of the significant adverse impact on well‐being and psychological health that can occur with photosensitivity. Photoprotection is a mainstay approach for the photodermatoses but is often not sufficient alone for disease control. Desensitisation through natural hardening or light‐based therapies may be feasible, although systemic immunosuppressants and immunomodulators may be required. Awareness of the possibility of vitamin D deficiency is also necessary. This chapter will cover these approaches in detail.
