BackgroundClinical trial data for dupilumab, a monoclonal antibody against the interleukin‐4 receptor (IL‐4Rα), have shown that it is safe and effective for the treatment of moderate to severe atopic dermatitis in patients whose disease is resistant to other therapies. However, little real‐world experience with dupilumab use has been reported thus far. The aim of this retrospective study was to assess overall outcomes in adult patients with atopic dermatitis (AD) treated with dupilumab.MethodsA retrospective review of electronic medical records was conducted for patients treated with dupilumab in the Department of Dermatology at the University of California, Irvine.ResultsWe analyzed the medical records of 77 AD patients who received dupilumab according to standard dosing and had at least one documented follow‐up visit. In 66 patients (86%), dupilumab improved clinical disease severity, with 23 patients (30%) experiencing complete clearance on dupilumab. Dupilumab was generally well‐tolerated and caused no serious adverse events. The most common side effects included dry eyes, conjunctivitis, and keratitis. The most common reason for discontinuation of treatment was lack of substantial clinical improvement or progression of disease severity, followed by ophthalmologic side effects.ConclusionsOverall, dupilumab was well‐tolerated and resulted in clinical improvement in our patient population. These results provide additional important information on the safety and utility of dupilumab treatment for moderate to severe atopic dermatitis in the real‐world clinical setting.

No abstract

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Introduction:Many mucocutaneous conditions affect the skin and oral cavity. Common conditions include lichen planus, pemphigus, and pemphigoid. This case report shows an atypical presentation of a mucocutaneous condition wherein histopathology was required for definitive diagnosis and treatment. Case Presentation:A 51-year-old African American male self-reported to a private periodontal practice with a chief complaint of sporadic painful oral lesions of about 2 months duration. The patient also reported painful throat lesions. He had been previously treated for a sore throat followed by unspecified inflammation of the epiglottis. Clinical examination revealed diffuse bilateral eye redness, numerous intraoral ulcerations on soft and hard palate and floor of the mouth with trouble swallowing. Oral and ocular presentation suggested a differential diagnosis of cicatricial pemphigoid. Pemphigoid and lichen planus were also considered. Ophthalmologic exam revealed only allergies and no other abnormality. Soft tissue biopsies showed intraepithelial separation between the spinous layer and basement membrane. Direct and indirect immunofluorescence showed strong immunoglobulin G and moderate C3 reactivity confirming a diagnosis of pemphigus vulgaris (PV). A rheumatologist initially treated the patient with a daily combination regimen of methylprednisolone and mycophenolate mofetil. Lesions improved after a few weeks on the regimen. Reduction of medications resulted in return of oral and throat lesions. Resumption of the regimen resulted in lesion remission. Azathioprine replaced the mycophenolate mofetil, and then was gradually stopped after methylprednisolone cessation. Lesions have not reappeared for 1 year. Conclusion:This case illustrates that early diagnosis of mucocutaneous lesions leads to proper treatment and possible remission. Clin Adv Periodontics 2018;8:145-150.