Resumen
Objetivo: Presentar un reporte de caso de una médica con eccema de manos (EM) refractario al tratamiento convencional, destacando los desafíos diagnósticos y terapéuticos, así como la evolución clínica tras el uso de dupilumab y su impacto en la calidad de vida. Detalles del caso: Médica de 29 años, con antecedentes de dermatitis atópica y asma, desarrolló EM. Inicialmente, las lesiones eran superficiales y respondían parcialmente a corticoides tópicos. Posteriormente, se produjo un agravamiento con fisuras, dolor, edema y prurito intenso, lo que comprometió actividades diarias y profesionales, afectando su salud mental y calidad de vida. El tratamiento convencional, incluidos los corticoides tópicos y orales, mostró respuesta limitada. Se inició el uso de dupilumab, con remisión significativa de las lesiones en cuatro semanas y mejoría consistente en los puntajes SCORAD, ADCT y DLQI tras 3,5 meses. Consideraciones finales: Se evidencia la complejidad diagnóstica y terapéutica del EM, especialmente en profesionales de la salud expuestos a factores de riesgo ocupacionales. El dupilumab mostró eficacia clínica e impacto positivo en la calidad de vida, reforzando la importancia de enfoques terapéuticos innovadores, personalizados e integrados, que consideren no solo el control de las lesiones cutáneas, sino también los aspectos funcionales y psicosociales de la enfermedad.
Referencias
ASAMOAH N, et al. Efficacy and safety of dupilumab in chronic hand eczema: a systematic review. Archives of Dermatological Research, 2025; 317(1): 441.
DRISLANE C, IRVINE AD. The role of filaggrin in atopic dermatitis and allergic disease. Annals of Allergy, Asthma & Immunology, 2020; 124(1): 36–43.
EDWARDS TM, et al. Allergic Contact Dermatitis. Cutis, 2023; 112(4): 195–197.
HOWE W, et al. Overview of eczematous dermatitides. UpToDate, 2025; UpToDate, 2025; agosto. Disponível em: https://www.uptodate.com/contents/overview-of-dermatitis-eczematous-dermatoses. Acesso em: 10 de setembro de 2025.
JORGE MFS, et al. Dimensionality and psychometric analysis of DLQI in a Brazilian population. Health Qual Life Outcomes, 2020; 18(1): 268.
JUCÁ NBH, CAPRARA A. Manifestações cutâneas em profissionais de saúde da linha de frente à COVID-19. Revista Eletrônica Acervo Saúde, 2023; 23(3): e12110.
KOSKELO M, et al. Risk factors of hand eczema: A population-based study among 900 subjects. Contact Dermatitis, 2022; 87(6): 485–491.
LI Y, et al. Quick treatment of very severe refractory hand and foot eczema with dupilumab: a case report and literature review. Journal of Asthma and Allergy, 2023; 16: 1–8.
MARIANO IA, et al. Dermatite atópica na infância-uma revisão abrangente sobre a epidemiologia, fisiopatogênese, fatores de risco, diagnóstico, abordagem medicamentosa, cuidados com a pele, complicações, prognóstico e qualidade de vida. Brazilian Journal of Health Review, 2024; 7(2): e67848.
NIJSTEN T. Dermatology life quality index: time to move forward. J Invest Dermatol., 2012; 132: 11–3.
OLBRICH H, et al. Dupilumab in inflammatory skin diseases: a systematic review. Biomolecules, 2023; 13(4): 634.
PALLER AS, et al. Treatment of atopic dermatitis (eczema). UpToDate, 2025; agosto. Disponível em: https://www.uptodate.com/contents/treatment-of-atopic-dermatitis-eczema. Acesso em: 10 de setembro de 2025.
PATEL K, NIXON R. Irritant Contact Dermatitis – a Review. Current Dermatology Reports, 2022; 11(2): 41–51.
RADEMAKER M, et al. Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. The Australasian Journal of Dermatology, 2021; 62(1): 17–26.
RENCZ F, et al. Questionnaire modifications and alternative scoring methods of the Dermatology Life Quality Index: a systematic review. Value in Health, 2021; 24(8): 1158–1171.
SACHAN S, et al. A randomized controlled trial comparing methotrexate iontophoresis and oral methotrexate for the treatment of hyperkeratotic palmoplantar eczema. Cureus, 2025; 17(5): e83684.
SANOFI; REGENERON PHARMACEUTICALS INC. ADCT – Ferramenta de Controlo da Dermatite Atópica. ADCT Patient Form – Portugal/Portuguese. Version 1, 27 nov. 2018. Aprovado em nov. 2021. Version of 23 Feb 2022 – ICON. MAT-GLB-2105147 V1.0.
SILVERBERG JI, et al. Atopic dermatitis (eczema): pathogenesis, clinical manifestations, and diagnosis. UpToDate, 2025; agosto. Disponível em: https://www.uptodate.com/contents/atopic-dermatitis-eczema-pathogenesis-clinical-manifestations-and-diagnosis. Acesso em: 10 de setembro de 2025.
SIMPSON E, et al. Validation of the Atopic Dermatitis Control Tool (ADCT©) using a longitudinal survey of biologic-treated patients with atopic dermatitis. BMC Dermatology, 2019; 19(1): 15.
SIMPSON EL, et al. Dupilumab treatment improves signs, symptoms, quality of life, and work productivity in patients with atopic hand and foot dermatitis: Results from a phase 3, randomized, double-blind, placebo-controlled trial. Journal of the American Academy of Dermatology, 2024; 90(6): 1190–1199.
SOUZA TR, et al. Os principais tipos de dermatites eczematosas: uma revisão narrativa de literatura. Revista Ibero-Americana de Humanidades, Ciências e Educação, 2023; 9(9): 880–886.
STADLER JF. Severity scoring of atopic dermatitis. The SCORAD index. Consensus Report of the European Task Force on Atopic dermatitis. Dermatology, 1993; 186: 23–31.
STÄNDER S. Atopic Dermatitis. The New England Journal of Medicine, 2021; 384(12): 1136–1143.
TEO HG, et al. Prevalence of occupational hand eczema among healthcare workers and its associated risk factors in a tertiary hospital in Sarawak during Covid-19 pandemic. Indian Journal of Dermatology, 2023; 68(1): 121.
THYSSEN JP, et al. The epidemiology of hand eczema in the general population–prevalence and main findings. Contact Dermatitis, 2010; 62(2): 75–87.
VYAS J, et al. The Dermatology Life Quality Index (DLQI) used as the benchmark in validation of 101 quality-of-life instruments: A systematic review. Journal of the European Academy of Dermatology and Venereology, 2025; 39(3): 631–679.
WEIDINGER S, NOVAK N. Hand eczema. Lancet, 2024; 404(10470): 2476–2486.
WOLLENBERG A, et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. Journal of the European Academy of Dermatology and Venereology, 2020; 34(12): 2717–2744.
