Dupilumab treatment restores epithelial barrier in nonlesional and lesional skin in children with atopic dermatitis

Background Skin barrier dysfunction and inflammation characterize both lesional and nonlesional skin in moderate-to-severe atopic dermatitis (AD) and are associated with relapses and atopic march progression. Objective To assess the effects of dupilumab treatment on skin barrier function and integrity using non-invasive methods in children aged 6–11 years with moderate-to-severe AD compared to matched healthy volunteers. Methods Patients received dupilumab for 16 weeks. Transepidermal water loss (TEWL) before (basal) and after skin tape-stripping (STS), and epidermal thickness (TE), measured by optical coherence tomography, were assessed through week 28. Results PELISTAD enrolled 23 patients and 18 healthy volunteers. Mean±SD basal TEWL was significantly higher in AD lesional/nonlesional skin at baseline (55.1 ± 5.5/28.0 ± 3.1 g × m−2 × h−1) than in healthy skin (14.0 ± 1.6) and decreased to 30.3 ± 3.1/22.0 ± 2.6 at week 16 and 29.7 ± 4.3/18.3 ± 2.1 at week 28; TEWL after 5/20 STS improved similarly. Baseline mean±SD TE in lesional/non-lesional skin (251.1 ± 25.8/166.1 ± 15.2 µm), significantly higher than in healthy skin (118.2 ± 5.1), decreased to 196.8 ± 18.4/141.9 ± 11.9 at week 16 and 160.4 ± 12.9/142.7 ± 15.6 at week 28. At weeks 16 and 28, there was no significant difference between TEWL or TE in AD lesional and nonlesional skin vs healthy skin. Conclusion Using non-invasive techniques to monitor epithelial function, dupilumab treatment restored skin barrier function in children with AD. Improvements achieved at week 16 were sustained to week 28.