\u201cThe results of this study further support that type 2 inflammation may play a pathogenic role in alopecia areata in at least some patients,\u201d Benjamin Ungar, MD,<\/b> assistant professor of dermatology and director of the Alopecia Center of Excellence and the Rosacea & Seborrheic Dermatitis Clinic at the Icahn School of Medicine at Mount Sinai, told Healio.<\/p>\n
\u201cIn atopic dermatitis patients with high risk for alopecia areata, treating with dupilumab seems to reduce that risk, which can be very meaningful for patients who might otherwise develop a disease associated with an enormous psychosocial burden,\u201d Ungar, who is also a member of Healio\u2019s Allergy\/Asthma Peer Perspective Board, said.<\/p>\n
In a multicenter, retrospective cohort study, Ungar and <\/b>colleagues assessed 3,282,639 patients with AD from the Epic Cosmos electronic health record database to determine if having a dupilumab vs. topical corticosteroid or prednisone prescription impacts the risk for alopecia areata development.<\/p>\n
\u201cOver the last several years, alopecia areata has been increasingly recognized as having a strong link with atopic disease,\u201d Ungar said. \u201cBy far the most common comorbidities of alopecia areata are atopic diseases, with AD being the common among those. Moreover, having AD is a risk factor for developing alopecia areata.<\/p>\n
\u201cRecent studies have shown that targeting type 2 inflammation can be a successful therapeutic approach in alopecia areata patients with atopy, which we are evaluating further in ongoing clinical trials for adults and children,\u201d he continued. \u201cHowever, studies have not yet evaluated if targeting type 2 inflammation can reduce the risk of alopecia areata in AD who have not yet developed it, so we set out to evaluate that question.\u201d<\/p>\n
This study population included 154,967 patients treated with dupilumab, 2,137,234 patients treated with topical corticosteroids and 970,438 patients treated with prednisone.<\/p>\n
\u201cMedication exposure served to differentiate cohorts by severity, with topical corticosteroids representing milder, systemic-untreated AD and prednisone representing more severe disease requiring short-term or intermittent systemic therapy but not chronic immunomodulatory treatment,\u201d Ungar and colleagues wrote.<\/p>\n
In the 24 to 20 months prior to receiving treatment, researchers found an increased risk for alopecia areata in the group that was going to be treated with dupilumab when compared with those to be treated with topical corticosteroids (incidence rate ratio [IRR] = 2.11) or prednisone (IRR = 1.76).<\/p>\n
This pattern held true in the 0 to 4 months of treatment, as the risk for alopecia areata was greater among those receiving dupilumab vs. topical corticosteroids (IRR = 2.12) or prednisone (IRR = 1.97).<\/p>\n
At 20 to 24 months of treatment, researchers observed decreases in these rates. The IRR among patients receiving dupilumab dropped to 1.73 vs. topical corticosteroids and 1.38 vs. prednisone.<\/p>\n
Compared with the topical corticosteroid group, the prednisone group had an elevated risk for alopecia areata that stayed the same at both 0 to 4 months of treatment (IRR = 1.25) and 20 to 24 months of treatment (IRR = 1.25).<\/p>\n
Researchers noted \u201cconsistent patterns\u201d in relation to those outlined above within subgroups based on sex, race, age, IgE levels and atopic comorbidities including asthma, allergic rhinitis and food allergy.<\/p>\n
This outcome continued to be found after the study excluded patients with asthma, prurigo nodularis, eosinophilic esophagitis, nasal polyps, COPD, chronic spontaneous urticaria, rheumatoid arthritis and psoriasis in a sensitivity analysis.<\/p>\n
\u201cOverall, the results of the study were in line with our hypothesis that since type 2 inflammation contributes to alopecia areata pathogenesis, at least in the patient subset with an atopic background, reducing that type of inflammation may decrease how often alopecia areata develops,\u201d Ungar told Healio.<\/p>\n
\u201cFuture studies will need to explore this link in more detail,\u201d Ungar added. \u201cIdeally, prospective studies with different systemic treatments for AD will be conducted to evaluate the effects of successful AD-directed therapies on the risk of alopecia areata.\u201d<\/p>\n
For more information:<\/h2>\n Benjamin Ungar, MD,<\/b> can be reached at benjamin.ungar@mountsinai.org. <\/p>\n\n
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Sources\/Disclosures<\/h3>\n Source: <\/h2>\n Levine J, et al. J <\/i>Allergy <\/i>Clin <\/i>Immunol<\/i> <\/i>Pract<\/i>. 2026;doi:10.1016\/j.jaip.2026.03.015.<\/p>\n\n
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