Efficacy of Dupilumab in a Young Woman with Refractory Cutaneous Lichen Planus: A Case-Based Review

Abstract

Background: Cutaneous lichen planus (CLP) is a chronic inflammatory T cell-mediated disease driven by a mixed Th1 and Th2 lymphocyte population, for which many of the currently available treatments have poor efficacy. Aim: The aim of this study was to indicate the clinical success of dupilumab administration after two years of treatment in a case of longstanding CLP and to perform a review of the medical literature related to the use of dupilumab in different dermatologic settings and in CLP. Case presentation: One 26-year-old woman with a previous history of atopic dermatitis had a long-lasting skin condition, referred to as a suspected lichen, which started when she was 7 years old. Her disease exhibited a relapsing-remitting course with severe bouts of pruritus over a very long period. The final histological diagnosis of CLP was confirmed at the age of 26. Starting dupilumab (injected subcutaneously at a dose of 600 mg followed by a maintenance dose of 300 mg every two weeks) resolved the skin scenery of this patient, who is currently in full remission. Conclusions: The remarkable recovery from CLP obtained via treatment with dupilumab in this single-patient case study emphasizes the potential therapeutic implications of targeting the Th2 pathway in this skin disorder.

Keywords: atopic dermatitis; cutaneous lichen planus; dupilumab; innovative biotechnologies; personalized treatment; pruritus.

Figure 1

Pretreatment clinical assessment of the patient: erythematous scaly plaques with well-defined borders located on the soles of feet (A) and well-defined flaky plaques extending from the heel to the lateral region of foot (B).

Figure 2

Interface dermatitis showing a degeneration of the basal layer of the epidermis with vacuolopathy, spongiosis and hyperkeratosis, that focally blurs the dermal–epidermal junction, consistent with the diagnosis of cutaneous lichen planus; the inflammatory infiltrate is chiefly represented by lymphocytes and forms a band-like arrangement along the dermal–epidermal junction (hematoxylin and eosin staining 20×).

Figure 3

Post-treatment clinical assessment of the patient: resolution of the erythematous scaly plaques after twelve weeks of treatment with dupilumab.