DUPILUMAB EFFICACY IN THE TREATMENT OF SEVERE ATOPIC DERMATITIS WITH COMORBID TREATMENT-RESISTANT DEPRESSION (A CLINICAL CASE PRESENTATION)
Keywords:
atopic dermatitis, major depressive disorder, treatment-resistant depression, cytokines, interleukin-4, dupilumab, neuroinflammationAbstract
Introduction. Atopic dermatitis (AD) is a chronic inflammatory skin disease. It is characterized by skin itching and skin soreness, which usually increase at night, and dry skin with its increased sensitivity to various mechanical and chemical irritations.
Case description. Presented a clinical case of a young man with severe atopic dermatitis and comorbid treatment-resistant depression. By both dermatologist and allergy-immunology specialist he was prescribed topical glucocorticoids, oral antihistamines, montelukast, ketotifen, and tacrolimus — but with insufficient effect. For his depression, he tried more than 10 different psychopharmacotherapy combinations, without any significant effect at all. Taking into account both the severity of atopic dermatitis and the lack of any appreciable therapeutic effect on his depression from psychopharmacotherapy, the young man got recommendation to try to obtain a federal quota for the use of dupilumab. Then, 1,5 months after switching from tacrolimus to dupilumab, he got a significant improvement in the course of his atopic dermatitis. His itching and rashes stopped, and the dryness of his skin greatly decreased. In parallel with this, the patient’s mental state fully normalized. His depression, anxiety, and sleep disturbances were all relieved. Dupilumab potentially can be effective not just in the treatment of allergic and atopic diseases, such as atopic dermatitis and asthma, but also in the relief of comorbid depressive and anxiety conditions.
Conclusion. Taking into account the role of interleukin-4 in the pathogenesis of depressive states, it is an interesting question if dupilumab could be effectively used also in cases of treatment-resistant depression without any allergic or atopic comorbidity. Some other anti-cytokine drugs — for example, tumor necrosis factor-alpha antagonists (infliximab, etanercept), interleukin-1 antagonists (anakinra) — already have a successful history of such use.
