Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(3):5420 1 The Effect of Dupilumab on Growth Parameters in Pediatric Atopic Dermatitis Patients Vincenzo Piccolo1, Teresa Russo1, Julia Nowowiejska2, Giuseppe Argenziano1, Carlo Mazzatenta3, Andrea Bassi3 1 Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy 2 Department of Dermatology and Venereology, Medical University of Bialystok, Bialystok, Poland 3 Division of Dermatology, Azienda USL Toscana Nord Ovest, Lucca, Italy Key words: Atopic dermatitis, Eczema, Dupilumab, Growth, Height Citation: Piccolo V, Russo T, Nowowiejska J, et al. The Effect of Dupilumab on Growth Parameters in Pediatric Atopic Dermatitis Patients. Dermatol Pract Concept. 2025;15(3):5420. DOI: https://doi.org/10.5826/dpc.1503a5420 Accepted: April 31, 2025; Published: July 2025 Copyright: ©2025 Piccolo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Assist. Prof. Julia Nowowiejska MD, PhD, Department of Dermatology and Venereology, Medical University of Bialystok, 14 Zurawia St, 15-540 Bialystok, Poland. ORCID 0000-0002-6870-1167. E-mail: julia.nowowiejska@umb.edu.pl Introduction No data have been previously published about the relation- ship between dupilumab and growth charts in children [1-3], but the treatment result in our patient was so impressive that we considered it important to share it. Case Presentation The patient was referred to us when he was 4 years old, affected by a severe form of atopic dermatitis (AD), with EASI 24, NRS 10, cDLQI 18 (Figure 1A). The child was oth- erwise healthy, apart from the AD and the high counts of blood eosinophils and serum IgE. AD had appeared in the first months of life, and it progressively worsened with child- hood. At the time of consultation, the patient’s weight was lower than the 3rd percentile, and height was at the 10-25 percentile. The parents were concerned about that, but it was attributed to a constitutional reason. The patient was initially prescribed potent topical steroid and topical calcineurin inhibitors, with transient, partial re- sponse. At the age of five, the patient was prescribed oral cyclosporine (4 mg/kg/day), but the parents refused treat- ment because of concerns about side effects. Finally, at the age of six, the patient started treatment with dupilumab 200 mg, with a high impact on disease severity, itch, sleep distur- bance, and quality of life (after 48 weeks, EASI 2, NRS 1, cDLQI 1) (Figure 1B). Apart from the expected results of the treatment, the patient incredibly started gaining weight (10-25 percentile) and height (25-50 percentile), thus ap- pearing as generally healthy. Conclusion A recent paper showed how a twin affected by AD was significantly shorter than her healthy sister [4]. A more recent study investigated the impact of moderate-to- severe AD on growth in patients younger than 12 years, 2 Research Letter | Dermatol Pract Concept. 2025;15(3):5420 showing a higher mean weight and BMI and lower mean height in AD patients than in the reference healthy pop- ulation [5]. Different explanations may be advanced: 1. Severe AD is definitely a systemic disease that may po- tentially affect growth in children. Proper treatment may interfere with this effect. 2. Sleep disturbance secondary to AD could reduce growth hormone (GH) production and impact child’s growth. Treatment ameliorates quality of sleep, thus impact- ing proper production of GH, thus positively impact- ing growth. 3. Psychological impact of AD can modify eating habits in children, which may be without appetite. Improving disease may be significant for a regular and adequate nutrition. 4. Dupilumab has been associated with a significant activity of alkaline phosphatase in children, a marker of bone mineralization, thus meaning that it indirectly favors growth [6]. All the above reasons may contribute to the effects of dupi- lumab on growth charts in children. We hope that this observation, although limited to a sin- gle patient, can be a useful spark to induce other clinicians to investigate the impact of dupilumab on growth charts in children, once again confirming the importance of an early systemic treatment in children with severe AD. References 1. Paller AS, Siegfried EC, Thaçi D, et al. Efficacy and safety of dupilumab with concomitant topical corticosteroids in chil- dren 6 to 11  years old with severe atopic dermatitis: A ran- domized, double-blinded, placebo-controlled phase 3 trial. J Am Acad Dermatol. 2020;83(5):1282-1293. PMID: 32574587, DOI: 10.1016/j.jaad.2020.06.054. 2. Patruno C, Fabbrocini G, Lauletta G, et al. A 52-week multi- center retrospective real-world study on effectiveness and safety of dupilumab in children with atopic dermatitis aged from 6 to 11 years. J Dermatolog Treat. 2023;34(1):2246602. PMID: 37580895 DOI: 10.1080/09546634.2023.2246602. 3. Napolitano M, Fabbrocini G, Neri I, et al. Dupilumab Treat- ment in Children Aged 6-11 Years With Atopic Dermatitis: A Multicentre, Real-Life Study. Paediatr Drugs. 2022;24(6): 671-678. PMID: 36028611 PMCID: PMC9417930 DOI: 10.1007 /s40272-022-00531-0. 4. Zhang M, He M, Tang T. The effect of atopic dermatitis in pediatric patients on height: Reflections triggered by a real-life case report. Medicine (Baltimore). 2023;102(47):e36150.  PMID: 38013381 PMCID: PMC10681620 DOI: 10.1097/MD.0000000000036150. 5. Paller AS, Geng B, Irvine A, et al. Growth Analysis in Children Aged Less Than 12 Years with Moderate-to-Severe Atopic Der- matitis. Paper presented: American Academy of Dermatology (AAD) 2024 Annual Meeting. March 8 – 12, 2024. San Diego, CA. https://aad-eposters.s3.amazonaws.com/AM2024/poster/51363/ Growth+Analysis+in+Children+Aged+Less+Than+12+Years+w ith+Moderate-to-Severe+Atopic+Dermatitis.pdf. Accessed Decem- ber 16, 2024. 6. Irvine A, Paller A, Horowitz J, et al. Dupilumab Treatment of Chil- dren With Atopic Dermatitis Increases Bone Alkaline Phosphatase, Regardless Of Asthma Comorbidity. Ann Allergy, Asthma Immu- nol. 2023; 131 (5-Suppl 1): S11. DOI: 10.1016/j.anai.2023.08.048 Figure 1. (A) The patient at the age of five with a severe form of atopic dermatitis (B) The same patients 48 weeks after starting dupilumab.