Treating Alopecia Areata and Disco Lupus Erythematosus: New Approaches from a Dermatology Expert

At the 44th Annual Fall Clinical Dermatology Conference in Las Vegas, Eingun James Song, MD, associate chief medical officer and director of clinical research at Frontier Dermatology, shared valuable insights into treating two challenging dermatological conditions: alopecia areata and disco lupus erythematosus (DLE). Song presented his talk, ’20 Tips in 20 Minutes,’ highlighting four key clinical pearls. Let’s delve into two of these impactful tips.

Alopecia Areata: When JAK Inhibitors Aren’t Suitable

Song addressed a common scenario: a patient with alopecia areata who isn’t a candidate for oral Janus Kinase (JAK) inhibitors. He shared a case involving a patient with generalized vitiligo, meaning their entire body lacked pigmentation. Oral JAK therapy for alopecia could potentially lead to skin repigmentation, something the patient wasn’t interested in.

“So I warned a patient, if we put him on an oral JAK for his scalp, his color may re-pigment again, and that was not something he was interested in because he’s lived for years without having any color in his skin. We had to pivot and look for a different treatment option,” Song explained.

The alternative solution was diphenyl cyclopropane (DPCP), a form of contact immunotherapy.

“It’s an oldie, but a goodie, and it’s a form of contact immunotherapy, where we’re trying to trick or distract the immune system so it doesn’t pay attention to the scalp,” Song said. “It pays attention to the dermatitis that we’re causing by applying that product.”

Song starts patients with a low dose (0.01%) and gradually increases it every few weeks until a mild dermatitis develops. This, he says, has yielded excellent results for even the most stubborn cases, including those who didn’t respond to oral JAK inhibitors.

Disco Lupus Erythematosus: A Steroid-Sparing Solution

For patients with refractory disco lupus erythematosus (DLE), Song turned to deucravacitinib, an allosteric TYK2 inhibitor.

“We’ve tried traditional immunosuppressants on DLE, whether it’s methotrexate, mycophenolate, azathioprine, and these medicines have a lot of side effects and, quite frankly, they don’t work all that well either,” Song said. “So we’ve been using deucravacitinib, which is an allosteric TYK2-inhibitor, as kind of my treatment of choice now as a steroid-sparing agent in DLE.

Song explained that deucravacitinib blocks TYK2, a key enzyme involved in interferon type 1 signaling, which is often elevated in patients with lupus erythematosus.

For access to the full interview segment and more insights from the conference, visit the provided link above.

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