Dupilumab for Off-Label Treatment of Moderate to Severe Childhood Atopic Dermatitis

Atopic dermatitis (AD) is a complex chronic pruritic skin disease in which helper T cell (T(H)2)-type cytokines IL-4 and IL-13 are key contributors in the inflammatory response. Debate still exists as to whether disease initiation is due to immune responses or barrier dysregulation. The disease course is divided into infantile, childhood, and adolescent/adult stages and exhibits an extensive clinical spectrum. Topical agents have been the mainstay of treatment in childhood AD. Phototherapy has been successful but is not always available. Although they are not approved by the US Food and Drug Administration (FDA), some systemic immunomodulating agents are used for recalcitrant AD, but patients must be monitored closely for side effects. A considerable number of biologics currently are under investigation, as no FDA-approved treatments for moderate to severe childhood AD with responses appreciable to those of topical therapies currently exist. In 2017, dupilumab was approved by the FDA for treatment of moderate to severe AD in patients aged 18 years and older. We report the case of a 7-year-old boy who was treated with dupilumab off label for 17 weeks.