Background: The underlying mechanisms of residual facial dermatitis on dupilumab (RFDD) in patients dupilumab therapy for atopic dermatitis are poorly understood.Objective: We sought to determine the incidence of RFDD in patients receiving dupilumab and the rate of resolution of RFDD after expanded series patch testing (ESPT) and allergen avoidance.Methods: This is a retrospective chart review of 80 patients with atopic dermatitis who were evaluated for RFDD after treatment with dupilumab. Expanded series patch testing findings and response to allergen avoidance were assessed in the subset of patients with RFDD who subsequently underwent ESPT while continuing to receive dupilumab.Results: Forty-nine patients (61.3%) experienced facial dermatitis before initiating dupilumab. Thirty-five patients (43.8%) experienced RFDD after starting dupilumab. Of the 14 patients with RFDD who received ESPT, 92.9% had 1 or more relevant positive patch test results, with 50% of such patients being mostly to completely clear of facial dermatitis after allergen avoidance. Importantly, 50.6% of the positive reactions to allergens were not included on the North American Contact Dermatitis Group Core 80.Conclusions: Many patients with RFDD benefit from patch testing and subsequent allergen avoidance. Expanded series patch testing should be offered to patients who experience RFDD after beginning dupilumab therapy to ensure that such patients have eliminated any exogenous component of their dermatitis, such as concomitant allergic contact dermatitis.D upilumab, an anti-interleukin (IL)-4 receptor α human monoclonal antibody that inhibits T helper 2 pathway IL-4 and IL-13 signaling, is effective in treating moderate-to-severe atopic dermatitis (AD). 1 New-onset and recalcitrant facial dermatitis (FD) has been reported in patients receiving dupilumab therapy. [2][3][4][5][6][7][8][9][10][11] Although hypotheses regarding the etiology of paradoxical facial flaring on dupilumab include site-specific treatment failure, 9 hypersensitivity reaction to dupilumab, 9 hypersensitivity to facial Malassezia species, 4,7 new-onset rosacea, 5 and flaring of allergic contact dermatitis (ACD), 3,8 the underlying mechanisms responsible for residual FD on dupilumab (RFDD) in patients during dupilumab therapy are poorly understood. 12 Given the reports of patients experiencing significant improvement in RFDD 8 and ocular surface disease 13 after patch testing, we hypothesized that comprehensive patch testing of patients with RFDD using expanded series patch testing (ESPT) and subsequent allergen avoidance would increase the rate of FD resolution in such patients. Our study aimed to characterize the incidence of RFDD in patients receiving dupilumab for classic AD and determine the rate of resolution in patients who underwent patch testing and allergen avoidance.
METHODS
Study PopulationThis study involved retrospective data collection from medical records of patients who received 300-mg dupilumab every other week for the management of AD between May 2017 and...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.