Dupilumab in patients with bullous pemphigoid and concomitant atopy

Katerina Jobst¹Stephan R. Künzel^2,3Stefan Beissert¹Susanne Abraham^1*

• ¹Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
• ²Institute for Transfusion Medicine, Faculty of Medicine Carl Gustav Carus, Dresden, Germany, Dresden, Germany
• ³DRK Blutspendedienst Nord-Ost gGmbH, Dresden, Germany, Dresden, Germany

Background: Bullous pemphigoid (BP) and atopic dermatitis (AD) are chronic inflammatory skin diseases that may share overlapping immunopathogenic mechanisms, particularly a type 2 immune response. Emerging evidence suggests that dupilumab, an IL-4Rα antagonist, may be effective in treating both conditions. Methods: In this retrospective case series, twelve patients (mean age: 78.6 years; range: 67–93 years) with moderate to severe BP and a history of AD were included. All patients received dupilumab and were monitored over 12 weeks. Clinical activity was assessed using BPDAI scores, pruritus NRS, and DLQI. Results: At week 12, complete remission of bullous skin lesions was observed in all patients (100%), with 83.3% already achieving this by week 4. Pruritus improved significantly (p < 0.0001), with 58.3% achieving complete resolution (NRS 0/10) at week 12. Notably, two patients had previously received tralokinumab without clinical improvement, underscoring the distinct efficacy of dupilumab in this setting. Patient satisfaction was uniformly high (score 5/5). No adverse events were reported. Dupilumab was well tolerated, even in elderly, multimorbid patients. Conclusion: Dupilumab appears to be a safe and highly effective treatment for patients with concurrent BP and AD, leading to rapid and sustained symptom control, resolution of skin lesions, and high patient satisfaction.