Dupilumab in the Treatment of Cheilitis in Atopic Dermatitis Patients

BACKGROUND/OBJECTIVES: The lip is a unique tissue type that acts as a “barrier” to the mouth and receives many external stimuli. It is also a common symptom in atopic dermatitis. Dupilumab was the first targeted biological drug approved for the treatment of moderate-to-severe atopic dermatitis (AD). There is no real-world clinical data on the use of dupilumab in patients with AD and cheilitis. This retrospective study compared the improvement in skin lesions in AD patients with cheilitis after dupilumab treatment and evaluated the improvement in cheilitis. METHODS: This is a retrospective case series. We investigated patients with AD treated with dupilumab in our department from September 2020 to May 2022, including those with cheilitis. Demographic information such as age, sex, AD or other atopy history, and the anatomical site of dermatitis was collected. Disease severity was assessed using the eczema area and severity index score (EASI), body surface area (BSA), and severity assessment of cheilitis (the cheilitis symptom score) at baseline and after 16 weeks. RESULTS: We reviewed 96 patients treated with dupilumab for AD, and including the 10 patients with cheilitis (10.4%). All patients demonstrated significant improvement in skin lesions, and lip symptoms improved in seven patients. Among AD patients with improved cheilitis, the average reduction in EASI was 35.0% for BSA (34.9%) and the cheilitis symptom score was 29.9% at week 8. At week 16, compared with the baseline score, the improvement in cheilitis symptom scores was 58.1%, EASI was 60.8%, and BSA was 56.2%, respectively. CONCLUSION: Effective treatment of both the skin and cheilitis was achieved with dupilumab. The improvement in cheilitis involvement was slower than that in skin lesions. This case series confirms that dupilumab could be a valuable approach for treating patients with atopic dermatitis-associated lip involvement.