Alopecia Areata Associated with Dupilumab: National Database Study

Background: Alopecia areata (AA), an autoimmune condition causing non-scarring hair loss, often coexists with atopic dermatitis (AD) due to shared T-helper cell type 2 (Th2)-mediated pathways. Dupilumab, a monoclonal antibody inhibiting IL-4 and IL-13 signaling, is a cornerstone treatment for AD but...

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Published inDiagnostics (Basel) Vol. 15; no. 14; p. 1828
Main Authors Sontam, Tarun, Nfn, Humaira, Li, Jodi Yanking, Nadeem, Sehar, Beier, Katie, Jairath, Neil K., Ramachandran, Vignesh
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 21.07.2025
MDPI
Subjects
adverse effect
Alopecia
alopecia areata
Atopic dermatitis
Baldness
Case reports
Cytokines
Dermatitis
Dermatology
Development and progression
Drug therapy
dupilumab
Hair loss
Inflammation
Kinases
Patients
Risk factors
Th2
United States
atopic dermatitis
adverse effect
alopecia areata
Th2
dupilumab
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Summary:Background: Alopecia areata (AA), an autoimmune condition causing non-scarring hair loss, often coexists with atopic dermatitis (AD) due to shared T-helper cell type 2 (Th2)-mediated pathways. Dupilumab, a monoclonal antibody inhibiting IL-4 and IL-13 signaling, is a cornerstone treatment for AD but has conflicting reports regarding its impact on AA, with some suggesting therapeutic benefits and others indicating AA induction. Methods: This retrospective study, utilizing the TriNetX Research Network’s de-identified data from over 300 million patient records, investigates the association between dupilumab use and AA risk in AD patients. Results: After propensity score matching, 23,782 dupilumab users were compared with an equal number of controls. Results revealed a statistically significant increased AA risk in dupilumab users (odds ratio: 1.436, 95% CI: 1.066–1.935, p = 0.0167) after 16 weeks. Cases occurring within 16 weeks were excluded. Conclusions: Potential mechanisms include immune rebalancing, with Th2 suppression possibly upregulating Th1/Th17 pathways or unmasking latent AA in predisposed individuals. These findings challenge dupilumab’s potential as an AA treatment and highlight the need for vigilant monitoring, including routine scalp examinations and patient education. Future research should focus on mechanistic pathways, risk stratification, and comparative studies with other biologics to optimize personalized treatment strategies for AD and AA.
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These authors contributed equally to this work.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics15141828