P158 Efficacy of dupilumab in the treatment of atopic dermatitis in the head and neck region: a systematic review

Abstract

Dupilumab is a biologic therapy that is increasingly used for atopic dermatitis (AD) unresponsive to topical treatments. It has demonstrated efficacy in treating AD across both paediatric and adult populations. However, an increasing number of reports describe paradoxical worsening or persistence of AD in the head and neck (H&N) region with dupilumab use. This systematic review aimed to synthesize existing evidence on the efficacy of dupilumab in treating H&N-specific AD. Through this review, we aim to clarify regional treatment responses, inform clinical decision making and guide future research priorities. We conducted a PRISMA-guided systematic review in accordance with the Cochrane Handbook. Major databases were searched from inception to 26 May 2025. Human studies evaluating dupilumab for H&N AD in patients aged ≥ 6 months were included. Data were extracted from eligible studies and synthesized narratively. Thirteen studies involving 3715 participants were included, of whom 1751 received dupilumab. Among seven studies reporting percentage reduction in Eczema Area and Severity Index (EASI) scores, all demonstrated > 50% improvement in H&N EASI by week 16. Three randomized controlled trials showed significant reductions in least-squares-mean change in H&N EASI domain scores (week 16, P ≤ 0.001). Real-world observational studies reported comparable improvements, with EASI reductions ranging from 50.8% to 84.9% by week 16. Moreover, improvements were also observed in global disease severity and quality-of-life measures. Comparative analyses across anatomical sites revealed differential regional responses. Overall, dupilumab demonstrates consistent efficacy in improving H&N AD across study designs and populations. Nevertheless, H&N involvement may represent a distinct therapeutic phenotype, as evidenced by comparatively attenuated responses relative to other anatomical sites and persistent disease in a subset of patients up to 104 weeks. Collectively, these findings suggest that H&N involvement may present distinct treatment challenges, potentially related to local microbial, vascular or immunological factors.