Dupilumab for Adult and Pediatric Ophiasis-Pattern Alopecia Areata: A Narrative Review of Published Cases

ABSTRACT

Ophiasis-pattern alopecia areata (AA) is a band-like, margin-predominant variant with poorer prognosis and relative treatment resistance than patch-type AA. Type 2–skewed inflammation, especially in atopic patients, provides a rationale for off-label dupilumab (interleukin 4 receptor alpha blockade). The objective of the study is to synthesize published adult and pediatric cases of dupilumab-treated ophiasis AA and describe clinical characteristics, treatment regimens, responses, durability, and safety. We conducted a narrative review of PubMed/MEDLINE, Embase, and other major databases through November 11, 2025, using combinations of “ophiasis,” “alopecia areata,” and “dupilumab.” Reports were included when an ophiasis phenotype, dupilumab exposure (alone or adjunctive), and clinical outcomes were clearly documented. Demographic and treatment variables were extracted and summarized descriptively. Four publications met criteria: Two adult single-patient reports, one pediatric case and one adult adjunctive case. Atopy was present in two patients, absent in one, and unreported in one. Adult regrowth occurred between 2 weeks and 3 months. In the pediatric case, regrowth progressed from absent at 3 months to near-complete by month 4, with SALT 0 6 months after dupilumab reinitiation. In the adjunctive case, adding dupilumab to baricitinib plus oral minoxidil converted a partial response to near-complete regrowth within 2 months. One adult and the pediatric patient relapsed after discontinuation, but both re-responded to retreatment. No adverse events were reported. Although limited to case-level data, available evidence suggests clinically meaningful and durable regrowth with dupilumab in ophiasis AA, including successful re-challenge and apparent synergy with Janus kinase inhibition. Prospective studies and registries are warranted. Level of evidence: IV.