The following is a summary of “Baseline skin cytokine profiles determined by RNA in situ hybridization correlate with response to dupilumab in patients with eczematous dermatitis,” published in the MAY 2023 issue of Dermatology by Singh, et al.

Dupilumab has significantly improved the treatment of atopic dermatitis; however, some patients do not respond adequately, potentially due to underlying molecular heterogeneity. Currently, no accessible and clinically useful methods exist to assess such heterogeneity. Therefore, for a study, researchers sought to investigate whether cytokine staining and histologic features are correlated with clinical response to dupilumab in patients with eczematous dermatitis.

A retrospective analysis of biopsies from 61 patients with eczematous dermatitis treated with dupilumab (90.2% meeting Hanifin-Rajka criteria for atopic dermatitis) was conducted. RNA in situ hybridization was used to measure markers of type 1 (interferon gamma), type 2 (interleukin [IL]4, IL13), and type 3 (IL17A, IL17F, IL22) inflammation, while histologic features were also assessed. Patterns were compared among complete (n = 16), partial (n = 37), and non-responders (n = 8) to dupilumab.

Increased IL13 expression was associated with optimal response to dupilumab, whereas non-responders expressed less IL13 and relatively greater levels of type 1 and 3 cytokines. Moreover, certain histologic features were also correlated with improved response to dupilumab.

Cytokine RNA in situ hybridization may be useful in aiding the selection of treatment for eczematous disorders, and personalized treatment selection for inflammatory skin diseases may be possible.

Reference: https://www.jaad.org/article/S0190-9622(23)00179-2/fulltext