Background The development of dermatitis on face and neck, which was not described in phase 3 clinical trials, has been reported in the literature in patients treated with dupilumab. Little is known regarding the causes or defining features of the facial dermatitis. Objectives We conducted surveys of consecutive patients with AD on dupilumab to describe its clinical features, morphology and aetiology. Methods A multi‐centre prospective cohort study was conducted from 1 January 2020, to 31 December 31 2020. A total of 162 patients under dupilumab treatment were asked to complete a questionnaire and patients were evaluated by dermatologists. Results Of all 162 patients, 137 (84.6%) patients reported pre‐existing facial dermatitis prior to dupilumab therapy. One hundred and twenty‐one (88.3%) patients with pre‐existing facial dermatitis reported improvement of their facial dermatitis with dupilumab therapy, nine (6.6%) patients reported no change after the treatment and seven (4.3%) patients of them got worse after the treatment (exacerbation group). Of 25 patients who reported no pre‐existing active facial dermatitis, six (24%) patients reported new‐onset facial erythema after the starting dupilumab therapy (new‐onset group). A large proportion of the patients in both the exacerbation (86%) and new‐onset groups (67%) had a history of facial TCS use. Both groups showed similar clinical manifestations and distribution with few differences. Conclusions The vast majority of patients treated with dupilumab in academic institutions from Korea and the United States experienced improvement in their facial dermatitis with dupilumab therapy. A small proportion of patients had new onset and exacerbation. Although the mechanisms of this adverse event remain unclear, steroid withdrawal should be considered as a diagnosis of the erythema in some patients.

This is the first reported case of a patient with MFS without autonomic dysfunction and AACG. We believe that pupillary dysfunction or lid ptosis due to neurological disorders may increase the possibility of AACG.

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