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BackgroundThe mechanisms underlying eye-related complications with dupilumab are poorly understood.ObjectiveThis study aimed to determine the incidence and characteristics of ocular complications with dupilumab and the prevalence of comorbid allergic contact dermatitis in the same subpopulation.MethodsThis is a retrospective chart review of 48 patients with atopic dermatitis who received dupilumab. For patients with eye involvement at first follow-up, we discuss the presence of eyelid dermatitis, blepharitis, or conjunctivitis and analyze available patch test findings in patients with ocular complications while treated with dupilumab.ResultsA total of 14 patients (29.2%) showed eye involvement while on dupilumab, all of whom experienced eye involvement prior to dupilumab. The results of the patch test were most commonly positive for emulsifier/surfactants (42.5%) and fragrances (30.4%). Nine patients experienced improvement with allergen avoidance subsequent to patch testing, and four of nine patients’ conditions cleared almost entirely. This is a non-randomized study in a small cohort of patients. Only 18 patients had their disease confirmed by an ophthalmologist.ConclusionAll patients with eye involvement while on dupilumab had a history of eye involvement prior to dupilumab, suggest that dupilumab may encourage rather than cause ocular surface inflammation. Significant improvement after patch testing in nearly half of patients suggests that allergic contact dermatitis contributes to some cases of dupilumab-associated eye complications.

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laris. In this case series of 3 patients with generalized prurigo nodularis treated with dupilumab, all 3 patients experienced reduction of pruritus symptoms and subsequent improvement in prurigo lesions within 12 weeks of treatment.Dupilumab is a fully human monoclonal antibody to the α chain of the IL-4 receptor that blocks the biologic effects of cytokines IL-4 and IL-13. 4 The mechanism by which dupilumab may work on prurigo nodularis is unknown. One possibility is that dupilumab interrupts aberrant neuroimmune interactions in the skin, driving the chronic itch-scratch cycle in prurigo nodularis. Chronic itch depends on neuronal signaling of the IL-4 receptor α, the target of dupilumab. 5 Evidence of a type 2 immunologic signature in prurigo nodule skin biopsy specimens suggests that IL-4 and IL-13 may play a principle role in prurigo nodularis pathogenesis. 6 It is also possible that dupilumab was effective because prurigo nodularis was the clinical manifestation of underlying atopy, with approximately half of cases associated with an atopic diathesis. 1 Our case series has limitations, including a small sample size and short follow-up period. We were also unable to control for the concurrent therapies that each patient continued. However, given the lack of improvement during the months that patients continued their previous regimens, we propose that it is unlikely that clinical improvement would have occurred without the addition of dupilumab.

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