Abstract: 【Abstract】 Objective To investigate the efficacy and safety of dupilumab in the treatment of elderly patients （≥ 60 years old） with atopic dermatitis （AD）, with particular attention paid to rare adverse reactions. Methods A single-center retrospective analysis was conducted on data collected from 281 elderly AD patients who received the standard regimen of dupilumab at the Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to May 2024. Clinical characteristics such as gender, disease duration, skin lesion manifestations, and itch severity were analyzed. Changes in skin lesions and itch severity, as well as related adverse events were recorded during the follow-up period of 0 - 16 weeks. The efficacy and safety of dupilumab in the treatment of elderly AD patients were evaluated. Results Among the 281 elderly AD patients, 214 were males （76.16%） and 67 were females （23.84%）, with the age being 71.13 ± 7.91 years and the age at onset being 59.92 ± 15.72 years. The disease duration （M［IQR］） was 5.00 （13.00） years. After standard-regimen dupilumab treatment, the improvement rates of clinical outcome indicators SCORing Atopic Dermatitis （SCORAD） and pruritus numerical rating scale （NRS）scores gradually increased. At week 16, the improvement rates of SCORAD and NRS scores （M［IQR］） reached the maxima of 72.37% （23.89%） and 75.00% （29.72%）, respectively. The overall incidence of adverse events was relatively low, with only 16 patients （6.05%） reporting adverse events. Common adverse reactions such as conjunctivitis （2 cases, 0.71%） and facial erythema （1 case, 0.36%） were mild and well-tolerated. Phenotype switching occurred in 10 cases （3.56%）. Conclusion Dupilumab was an effective and safe treatment for elderly AD, but phenotype switching may occur.

Key words: Dermatitis, atopic, Aged, Biological factors, Treatment outcome, Drug-related side effects and adverse reactions, Th1-Th2 balance, Dupilumab