An elderly recalcitrant eosinophilic annular erythema (EAE) patient was successfully treated with benralizumab, a monoclonal antibody, suggesting that antibodies targeting the IL-5 signaling pathway may be effective therapy for EAE patients.¹

This condition is benign, and there are approximately 60 cases that are reported to be in the available literature and no treatment guidelines.

The case described here was authored by Fernando Moro-Bolado, MD, from the Dermatology Department at Ciudad Real University General Hospital in Spain. The case’s investigators wrote that drugs targeting T-helper 2 (Th2)-type cytokines have been seen as possible first-line therapies for patients with EAE.

They also added that there are 2 prior case reports that found achievement of complete response with dupilumab, a dual IL-13 and IL-4 inhibitor.

“Given the few cases reported in the literature, to our knowledge there are no clear treatment recommendations,” Moro-Bolado and colleagues wrote. “In this article, we describe a case of EAE in an elderly woman who was successfully treated with benralizumab, a monoclonal antibody directed against the α chain of the interleukin (IL)–5 receptor (IL-5Rα).”

Background and Findings

The research team wrote that the 83-year-old female patient had presented since around 2006 with a generalized pruritic eruption, describing the eruption as annular and polycyclic plaques appearing on the woman’s neck, face, trunk, and extremities with an appearance that changed.

The EAE patient was assessed and began receiving care at the Ciudad Real University General Hospital in Spain, beginning in the year 2014.

The investigators note that benralizumab is an antibody directed at the α chain of IL-5Rα. IL-5 is produced by Th2 lymphocytes, natural killer cells, mast cells, and eosinophils, promoting—alongside Th2 cell-derived cytokines IL-13 and IL-4—activation of eosinophils as well as tissue recruitment.

The elderly patient had been diagnosed with eosinophilic annular erythema (EAE) following laboratory and imaging studies that ruled out infections, autoimmune disorders, or internal cancers.

They wrote that her biopsy results showed inflammation with numerous eosinophils. The team found that treatment with oral prednisone achieved total remission for the patient, but tapering led to a relapse of her lesions.

They also initiated dapsone treatment, which was found to reduce the number of plaques and pruritus. The patient discontinued it due to mild hemolytic anemia.

The investigators ended up proposing treatment with benralizumab, administering it every 4 weeks for the first 3 doses, and then every 8 weeks after that. The treatment was found to result in complete resolution of the cutaneous lesions during the induction phase of therapy and minimal relapse during the maintenance phase.

Biopsy results showed a decrease in eosinophils compared to the prior biopsy. The researchers continued to treat the patient without the appearance of pruritus, and limited lesions appeared when the next dose came about.

“While further research is needed, antibodies targeting the IL-5 signaling pathway could be an effective therapy for patients with recalcitrant EAE,” the investigators wrote.

References

1. ^{Moro-Bolado F, Martínez-Montalvo L, Al-Wattar-Ceballos O, Galindo-Bonilla PÁ, García-Arpa M. Treatment of Eosinophilic Annular Erythema With Benralizumab. JAMA Dermatol. Published online April 05, 2023. doi:10.1001/jamadermatol.2023.0314.}