Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition in children, with approximately 20% affected and many cases debuting before 6 months of age. Despite various treatment options, disease control remains challenging, and severe AD is a known risk factor for other Type 2 (T2) inflammatory diseases. This study aimed to evaluate the efficacy and safety of dupilumab, a targeted therapy, in children with moderate-to-severe AD and other allergic conditions.

The study included 15 children with moderate-to-severe AD, median age of 13.3 years (range: 5.1–15.9), 67% males. Disease severity was assessed using standard scales: SCORAD (Scoring Atopic Dermatitis) and EASI (Eczema Area and Severity Index). Quality of life was evaluated in patients aged over 4 years using the CDLQI (Children’s Dermatology Life Quality Index) before starting dupilumab therapy and at regular intervals (4, 8, 12 weeks). All patients had a multimorbid atopic phenotype, with two or more allergic diseases, such as allergic rhinitis, asthma, eosinophilic esophagitis and food allergy. Most patients (87%) had the onset of AD before 6 months of age.

SCORAD-75 was achieved by 20% of patients by the 4th week, 20% by the 8th week, and 27% by the 12th week. However, 33% of patients did not achieve a 75% reduction in SCORAD by the 12th week. EASI-75 was achieved by 73% of patients by the 4th week, 20% by the 8th week, and 7% by the 12th week. All patients experienced a 75% reduction in EASI during the follow-up period. A 75% improvement in quality of life was observed in 38.4% of patients at 4 weeks, 23.1% at 8 weeks, and 15.4% at 12 weeks. By the 12th week, 23.1% of patients did not achieve a 75% improvement in CDLQI. Significant improvement was also observed in concomitant allergic conditions. Injection site reactions were noted in 13% patients, 14% reporting pain at the injection site, and 7% - itching. Conjunctivitis was observed in 6.7% patients. Erythema and swelling at the injection site were not reported.

The study demonstrated that dupilumab therapy significantly improved both clinical outcomes and quality of life in children with moderate-to-severe atopic dermatitis, even in those with atopic multimorbidity. The therapy demonstrated a favorable safety profile, with few and mild adverse events. Further studies are needed to optimize treatment strategies and assess long-term outcomes in children.