Dupilumab Shows Promise as Novel Treatment for Necrobiosis Lipoidica: Case Report

NL typically presents as red-brown plaques, most commonly on the lower legs, and has long posed a therapeutic challenge due to its unclear etiology and resistance to conventional treatments. While it is often associated with diabetes mellitus, NL can occur independently of it, as highlighted in the current report.

The case involved a 71-year-old woman who sought medical attention for painful, red plaques on her legs. A skin biopsy confirmed the diagnosis of NL. Initial management with topical agents, including tacrolimus and betamethasone dipropionate, failed to improve significantly. Given her age and potential side effects, systemic steroids were avoided.

As her condition persisted, clinicians opted to explore dupilumab as an alternative approach. Known for targeting interleukin (IL)-4 and IL-13 pathways, dupilumab has shown benefit in other inflammatory skin disorders. In this instance, a 600 mg subcutaneous dose was administered, followed by 300 mg every two weeks.

Remarkably, within just two weeks of initiating dupilumab therapy, the patient demonstrated notable improvement. The inflammatory plaques began to resolve, evolving into post-inflammatory hyperpigmentation, and the symptoms of burning and irritation significantly subsided. With continued therapy over four months, the patient maintained disease control with no reported adverse effects.

As the skin lesions improved, the patient gradually discontinued the use of topical agents, resorting to them only for minor flare-ups around the ankles. The substantial reduction in inflammation and overall symptom relief highlighted dupilumab's potential in altering the course of NL, even in cases unresponsive to traditional therapy.

The case not only reinforces the safety profile of dupilumab but also underscores its therapeutic versatility. The authors noted that the rapid clinical response points toward a possible role of IL-4 and IL-13 in the underlying pathogenesis of NL—cytokines directly targeted by dupilumab. Whether one or both pathways are responsible remains to be clarified in future studies.

By presenting this case, Jennifer Sato, University of Hawaii John A. Burn School of Medicine, University of Hawaii Medical Student, Honolulu, United States, and colleagues aim to encourage further exploration of dupilumab in managing necrobiosis lipoidica. Given its positive impact on this patient and its favorable safety record, dupilumab could represent a viable treatment avenue for other patients suffering from recalcitrant NL.

"While broader clinical trials are needed to confirm these findings, our report adds to the growing body of evidence supporting the expanding role of biologics in dermatology beyond their initially approved indications," the authors concluded.

Reference:

DOI: 10.2174/0118743722350879241209044938