Dermatologists have identified dupilumab as a promising therapy for treatment-resistant keloids, after a patient saw a noticeable regression in keloid thickness and a reduction in pruritus within six weeks of treatment.
Specialists at Melbourne’s Western Health treated a 54-year old woman with a three-year history of pruritic keloids on her upper limbs with no prior trauma. They initiated dupilumab (at a 600mg loading dose then 300mg fortnightly) alongside continued steroid injections.
The patient in this case had previously tried a range of treatments, including antihistamines, topical corticosteroids, and intralesional triamcinolone administered every 6-8 weeks to bothersome lesions, but had found minimal relief.
Within six weeks of dupilumab treatment the patient reported “near-complete resolution of pruritus” and noticeable changes to the keloids, which became lighter and softer in texture.
The improvements were sustained at 12 months with no adverse events.
“This case highlights dupilumab as a promising adjunct for widespread, treatment-resistant keloids, demonstrating improvement in symptoms, lesion regression, and disease control by targeting IL-4/IL-13-driven fibrotic pathways,” the specialists said in Australasian Journal of Dermatology [link here].
“Emerging evidence further supports this T helper 2 (Th2) mechanistic pathway, where the persistent activation of IL-4 and IL-13 cytokines activate JAKSTAT6 signalling, upregulating collagen production and tissue growth factor-β (TGF-β) while impairing extracellular matrix degradation, promoting persistent scar tissue formation,” they wrote.
Recent findings had shown Th2-skewed inflammation in keloid disease, with elevated IL-13 and the Th2 chemokine CCL18 in both lesional and non-lesional skin, while increased expression of IL-4/IL-13 receptors has also been seen in keloid tissue, they noted.
“By targeting the Th2 cytokine signalling central to keloid pathogenesis, dupilumab represents a promising option for the management of widespread keloids,” the treatment team said.
The authors acknowledged the case study featured lesions across the arms, which differed from “typical spontaneous keloid sites” like the jawline, chest and shoulders.
This fact may influence the generalisability of the findings to other severe keloid cases, they stressed.
Despite this, the case suggested more research is warranted into dupilumab’s long-term efficacy for this patient group.
“Overall, it is important to highlight dupilumab as a potential evolving option within the broader management of this complex and challenging condition,” the authors said.