Mount Sinai Researchers have discovered that dupilumab (Dupixent, Sanofi) may represent a therapeutic option for keloids as during a recent study a patient using the drug for severe disease experienced a great reduction in the size of their keloids.
Recently reported on in the Journal of European Academy of Dermatology and Venerology and picked up by Dermatology Times, lead investigator Emma Guttman-Yassky, MD, with the department of dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, reports excitement about the potential, noting: “the potential of changing the way we treat keloids, a painful and debilitating condition that, up to now, was primarily treated with surgery and radiation (as gold standard).”
What are Keloids?
Knowns as keloid disorder and keloidal scar, they involve the formation of a type of scar which, depending on its maturity, is comprised mainly of either type III (early) or type I (late) collagen. See example from Mayo Clinic. The result of overgrowth of granulation tissue (collagen type 3) at the site of a healed skin injury, it is slowly replaced by collagen type 1. Firm and rubbery lesions or shiny, fibrous nodules, they can vary in color from pink to the color of the patient’s skin. They are benign and not contagious but can be accompanied by severe itchiness and pain. They can change in texture. Severe cases can actually involve movement of skin. They are experienced 15 times more frequently in people of sub-Saharan African descent than people of European descent, according to some reports. In another report from Henry Ford Hospital in Detroit, African Americans are 7 times more likely to experience them.
Dermatology Times reports that the current treatment for keloids can involve intralesional steroids, bleomycin and surgical excision but all are of limited benefit and the keloids can often reoccur leading to the conclusion that there is a need for new treatment approaches.
This research centered on one African American patient—a 53-year old man with severe atopic dermatitis but also presented with two keloids. By August 2018, Mount Sinai started him on a treatment of dupilumab 300mg subcutaneous injections every two weeks for the atopic dermatitis. Several months later, not only was his severe atopic dermatitis in much better shape but so were his keloids.
Dr. Guttman-Yassky, noting the potential of this finding, commented: “This study has the potential to revolutionize the way we are thinking of the pathogenesis of keloids, which were primarily thought of as abnormal wound healing response and not as having an immune-based etiology.”
Marketed as Dupixent, the monoclonal antibody is used for allergic diseases, such as atopic dermatitis (eczema) and nasal polyps, which result in chronic sinusitis. The drug was developed by Regeneron Pharmaceuticals and Sanofi (Genzyme). It received FDA approval for moderate-to-severe atopic dermatitis in 2017. As of 2019, its costs were about $37,000 per year.
Emma Guttman-Yassky, MD with the department of dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai
Call to Action: The New York-based team, led by Dr. Guttman-Yassky, will now conduct a study into the effectiveness of dupilumab and other immune-based treatments in patients with keloids.