The atopic dermatitis (AD) treatment dupilumab (Dupixent, Sanofi) could offer a therapeutic option for keloids, according to data reported in the Journal of European Academy of Dermatology and Venereology that demonstrated a patient given the drug for severe disease also experienced a dramatic reduction in the size of their keloids.
Atopic dermatitis is an independent risk factor for keloids, which are benign growths that appear as result of abnormal collagen proliferation due to disrupted wound healing. These growths can greatly impact quality of life and are most likely to occur in African American and Asian populations.
The patient in this particular case report was a 53-year-old African American man with severe atopic dermatitis (Body Surface Area/ BSA 70%; SCORing of AD/SCORAD, 50; Eczema Area and Severity Index/EASI, 33) who also presented with two keloids: one a large prominent exophytic nodule with raised borders, the other a smaller nodule on the right popliteal fossa that had been present for more than two years. The patient had previously received more than six intralesional triamcinolone injections to treat the keloids, but these injections had little impact on the size of the keloids.
In August 2018, he began a course of dupilumab 300mg subcutaneous injections every two weeks for his atopic dermatitis, and seven months later his condition had improved significantly (BSA 8%; SCORAD, 16; EASI, 10). It was also apparent there had been significant improvement in his keloids: the amount of fibrotic plaque had approximately halved, the large keloid had shrunk with flattening of the surrounding borders and the smaller keloid had completely disappeared.
Current treatments for keloids including intralesional steroids, bleomycin and surgical excision, are of limited benefit. Keloids that resolve frequently reoccur, and there is a need for new treatment approaches.