Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2023; 11(10): 2301-2307
Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2301
Dupilumab for treatment of severe atopic dermatitis accompanied by lichenoid amyloidosis in adults: Two case reports
Xue-Qi Zhao, Wen-Jing Zhu, Yan Mou, Meng Xu, Jian-Xin Xia
Xue-Qi Zhao, Wen-Jing Zhu, Yan Mou, Meng Xu, Jian-Xin Xia, Department of Dermatology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Author contributions: Zhao XQ and Xia JX contributed to study conception and design, and data collection and analysis; Zhu WJ contributed to study conception and design, and data collection; Mou Y and Xu M contributed to data collection and analysis; all authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81803160; and Scientific Development Program of Jilin Province, No. 20200801078GH.
Informed consent statement: Informed consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Xin Xia, MD, PhD, Professor, Department of Dermatology, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun 130041, Jilin Province, China. 911469806@qq.com
Received: December 4, 2022
Peer-review started: December 4, 2022
First decision: February 7, 2023
Revised: February 18, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: April 6, 2023
Processing time: 115 Days and 22.7 Hours
Abstract
BACKGROUND

Lichenoid amyloidosis (LA) is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules, usually on the lower leg, back, forearm, or thigh. LA may be associated with several skin diseases, including atopic dermatitis (AD). The treatment of LA is considered to be difficult. However, as there is some overlap in the etiopathogenesis of LA and AD, AD treatment may also be effective for LA.

CASE SUMMARY

Case 1: A 70-year-old man was diagnosed with severe AD with LA based on large dark erythema and papules on the trunk and buttocks and dense hemispherical millet-shaped papules with pruritus on the extensor side of the lower limbs. He had a long history of the disease (8 years), with repeated and polymorphic skin lesions. Given the poor efficacy of traditional treatments, this patient was recommended to receive dupilumab treatment. At the initial stage, 300 mg was injected subcutaneously every 2 wk. After 28 wk, the drug interval was extended to 1 mo due to the pandemic. Follow-up observations revealed that the patient reached an Eczema Area Severity Index of 90 (skin lesions improved by 90% compared with the baseline) by the end of the study. Moreover, Investigator's Global Assessment score was 1, and scoring atopic dermatitis index and numeric rating scale improved by 97.7% and 87.5% compared with the baseline, respectively, with LA skin lesions having largely subsided. Case 2: A 30-year-old woman was diagnosed with severe AD with LA, due to dense and substantial papules on the dorsal hands similar to changes in cutaneous amyloidosis, and erythema and papules scattered on limbs and trunk with pruritus, present for 25 years. After 16 wk of dupilumab treatment, she stopped, and skin lesions completely subsided, without recurrence since the last follow-up.

CONCLUSION

Dupilumab shows rational efficacy and safety in the treatment of severe AD with LA, in addition to benefits in the quality of life of the patients.

Keywords: Atopic dermatitis; Lichenoid amyloidosis; Dupilumab; Treatment; Case report

Core Tip: Although cases of atopic dermatitis (AD) with lichenoid amyloidosis (LA) are not uncommon, there are few reports on the use of AD treatment for LA. In this paper, two adult patients with severe AD and LA are described. Treatment with dupilumab significantly improved the AD and LA skin lesions with no adverse reactions, confirming the efficacy and safety of dupilumab in the treatment of AD with LA, and providing a reference for clinically similar diseases.