A paradoxical head and neck erythema: an adverse event due to dupilumab in adult patients with atopic dermatitis

Russo, Filomena; Rizzo, Arianna; Santi, Francesco; Lamberti, Arianna; Lazzeri, Laura; Flori, Maria Laura; Rubegni, Pietro

doi:10.1111/ijd.15871

Cited by 11 publications

(9 citation statements)

References 6 publications

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“…In our study, the higher frequency of head and neck dermatitis could be attributed to the observation of this being a specific side effect of dupilumab than previously known 14–16 . Conjunctivitis was found to be mild and transient in the majority of patients (14/20, 70%) and persistent in patients who had a history of prior allergic conjunctivitis (3/6, 50%).…”

Section: Discussionsupporting

confidence: 45%

“…This side effect was noted to be transient, occurring after the loading dose or within the first 6 months in the majority of patients. Waldman et al observed an incidence of 9.9% of dupilumab facial redness in their 111 patients on dupilumab for AD 16 . Theories proposed by the authors for this side effect include hypersensitivity reaction to dupilumab, site‐specific treatment failure, a seborrheic dermatitis‐like reaction to facial Malassezia species, paradoxical flaring of allergic contact dermatitis, or a combination of these 18 …”

Section: Discussionmentioning

confidence: 99%

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Long‐term real‐world experience of the side effects of dupilumab in 128 patients with atopic dermatitis and related conditions aged 6 years and above: Retrospective chart analysis from a single tertiary care center

Parmar

Abdula

Falasi

et al. 2022

Dermatologic Therapy

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Dupilumab is a monoclonal antibody against interleukins 4 and 13 currently FDA approved for the treatment of moderate to severe atopic dermatitis (AD) in adults and adolescents and severe AD in children aged 6–11 years. It is reported to be safe with the most common side effects described from clinical trials being conjunctivitis, nasopharyngitis and injection site reactions. Outside the clinical trial setting, there is insufficient data on the side effects of dupilumab in adults with AD, and much less among children and adolescents. The aim of this study was to analyze the spectrum of side effects in all patients receiving dupilumab for the treatment of AD and related conditions in a real‐world setting at a single tertiary referral center, and correlate any risk factors for the development of these side effects. A retrospective review of electronic medical records was conducted for all patients who had received dupilumab for a minimum of 2 months for the treatment of AD and related conditions in the department of dermatology at Rashid hospital, Dubai from February 2018 to November 2021. We analyzed the medical records of 128 patients who received dupilumab according to standard age‐related dosing. This included 78 adults (age range 18–81 years) and 50 children and adolescents (aged 6–17 years). There were 73 males and 55 females. The mean duration of dupilumab treatment was 14.9 months. The most common side effects encountered during dupilumab therapy were head and neck dermatitis in 25 (19.5%), conjunctivitis in 20 (15.6%), erythema, pruritus and peeling of skin in 14 (10.9%) and dryness of eyes in 10 (7.8%) patients, respectively. Overall, dupilumab was well‐tolerated in our patient population. Most of the side effects were mild and did not require discontinuation of dupilumab. These findings would enable dermatologists understand the side effects of dupilumab better, resulting in improved treatment plan decisions in clinical practice.

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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Long‐term real‐world experience of the side effects of dupilumab in 128 patients with atopic dermatitis and related conditions aged 6 years and above: Retrospective chart analysis from a single tertiary care center

Parmar

Abdula

Falasi

et al. 2022

Dermatologic Therapy

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“…Biologics related to paradoxical eczematous reactions have been observed in all categories: tumor necrosis factor-alpha inhibitor (TNF-ai), IL-12/23i, IL-17i, IL-23i, and IL-4/13i, but there is some difference among them [ 81 ]. A broad spectrum of clinical features, including facial eczema, dyshidrotic eczema, or generalized AD-like dermatitis, were recorded during biologics treatment for PSO (TNF-ai, IL-12/23i, IL-17i, IL-23i), while most commonly presented signs of dupilumab (IL-4/13i) were localized to the face and neck, so-called paradoxical face and neck erythema [ 81 , 82 , 83 ].…”

Section: Phenotypes Of Overlapping Psoriasis and Atopic Dermatitismentioning

confidence: 99%

“…Histologically, psoriasiform dermatitis was found, but spongiosis, which was the main change of AD, was absent. Besides, this special drug-induced facial dermatitis showed no response to systemic itraconazole, oral and topical corticosteroids, topical calcineurin inhibitors, and emollients [ 82 , 83 ]. Although the incidence rate of paradoxical reaction was not low (estimated approximately 19%), most patients kept dupilumab without switch or discontinuation [ 81 ].…”

Section: Phenotypes Of Overlapping Psoriasis and Atopic Dermatitismentioning

confidence: 99%

Overlapping Features of Psoriasis and Atopic Dermatitis: From Genetics to Immunopathogenesis to Phenotypes

Tsai

2022

IJMS

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Psoriasis (PSO) and atopic dermatitis (AD) were once considered to be mutually exclusive diseases, but gradually regarded as a spectrum of disease. Shared genetic loci of both diseases were noted in some populations, including Chinese. Shared immunopathogenesis involving Th17, Th1, Th22 cells, or even IL-13 was found in certain stages or phenotypes. This review discusses the overlapping genetic susceptibility, shared cytokines, immune-mediated comorbidities, and clinical presentations. Overlapping conditions could be classified into mainly PSO lesions with AD features or vice versa, concomitant PSO and AD, or disease transformation as a result of biologics treatment.

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“…1,2 However, it was not always effective as expected and adverse events such as facial erythema also occurred. 3 In that cases, previous studies introduced the combination therapy of dupilumab and systemic immunosuppressants to improve efficacy and mitigate the side effects. 4 However, there have been many cases where patients who are using dupilumab had side effects on immunosuppressants when they used it before.…”

mentioning

confidence: 99%

The effect of baricitinib add‐on therapy in atopic dermatitis patients treated with dupilumab

Kook

Hong

Lee

et al. 2022

Dermatologic Therapy

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A paradoxical head and neck erythema: an adverse event due to dupilumab in adult patients with atopic dermatitis

Cited by 11 publications

References 6 publications

Long‐term real‐world experience of the side effects of dupilumab in 128 patients with atopic dermatitis and related conditions aged 6 years and above: Retrospective chart analysis from a single tertiary care center

Long‐term real‐world experience of the side effects of dupilumab in 128 patients with atopic dermatitis and related conditions aged 6 years and above: Retrospective chart analysis from a single tertiary care center

Overlapping Features of Psoriasis and Atopic Dermatitis: From Genetics to Immunopathogenesis to Phenotypes

The effect of baricitinib add‐on therapy in atopic dermatitis patients treated with dupilumab

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