Case Report: Dupilumab induced sustained complete remission in a child with severe alopecia areata and markedly elevated IgE.

Background: Severe alopecia areata in children is difficult to treat, and conventional therapies often show limited efficacy and substantial adverse effects. Dupilumab has shown potential in patients with alopecia areata and an atopic background, and baseline IgE has been proposed as a predictor of response. However, long-term outcomes and maintenance strategies in children with very high IgE levels remain insufficiently described. Case presentation: We report a 7-year-old girl with severe alopecia areata (SALT score 95) and a disease d uration of more than 2 years who had responded poorly to previous glucocorticoid therapy. She had a history of atopic dermatitis (AD), and her serum total IgE level was 2300 IU/mL. She received dupilumab 300 mg subcutaneously every 4 weeks in combination with topical corticosteroids and, later, topical minoxidil. Hair regrowth was observed after 8 weeks. The SALT score decreased to 5 at week 30, and complete remission was achieved at week 48 (SALT score 0). Serum total IgE decreased in parallel to 330 IU/mL. After near-complete response, the dosing interval was successfully extended to 6 weeks, and efficacy was maintained through week 48. The only adverse event was a transient mild allergic reaction after the first injection. Conclusion: A progressive reduction in serum total IgE levels was observed in parallel with the patient's clinical improvement. This case supports dupilumab as a potentially effective and well-tolerated option for severe pediatric alopecia areata in the setting of markedly elevated baseline IgE. It also suggests that dynamic monitoring of​ IgE levels may be clinically informative and that interval extension during maintenance therapy may be feasible after a robust response.