Dupilumab for alopecia areata treatment: A double-edged sword?

Alopecia areata (AA), which is a common and inflammatory hair loss and one of the most frequent dermatological conditions with higher incidence worldwide, the complex interplay involved multiple factors was contributed to the pathogenesis that consists of immune privilege losing and destruction with autoimmune-mediated in hair follicle also the abnormal regulation of inflammatory pathways was highlighted, although it was remained unclear to date.(J Am Acad Dermatol, 78, 2018, 1) Some treatment options for AA were proposed with great advances in recent years, but the options and efficacy were limited, such as platelet-rich plasma, JAK-STAT inhibitor, PDE4 inhibitor, and others, also the good response with regrow hair of cytokine-targeted therapy like dupilumab, ustekinumab was shown.(Clin Exp Med, 21, 2021, 215; Drugs, 80, 2020, 635) Here, we present a case with onset of AA following dupilumab treatment, the chronological relationship between the AA onset and dupilumab use should be known and emphasized.