Clinical Psoriasiform Dermatitis Following Dupilumab Use for Autoeczematization Secondary to Chronic Stasis Dermatitis

Schrom, Kory P; Kobs, Alison; Nedorost, Susan

doi:10.7759/cureus.7831

Cited by 9 publications

(12 citation statements)

References 19 publications

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“…We discuss these topics in the next chapter. Furthermore, psoriasiform reaction during dupilumab treatment has been reported ( Fowler et al., 2019 ; Napolitano et al., 2019 ; Schrom et al., 2020 ) with increased expression of IL-23A in the lesional skin ( Napolitano et al., 2021 ). Arthritis and enthesitis during dupilumab treatment have also been reported ( Bridgewood et al., 2021 ; de Wijs et al., 2020c ; Ishibashi et al., 2020 ; Komaki et al., 2021 ; Willsmore et al., 2019 ).…”

Section: Effectiveness and Safety Of Dupilumab For Ad In The Real Worldmentioning

confidence: 99%

A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis

Kamata

Tada

2021

JID Innovations

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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.

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Section: Effectiveness and Safety Of Dupilumab For Ad In The Real Worldmentioning

confidence: 99%

A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis

Kamata

Tada

2021

JID Innovations

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“…Furthermore, one record of a patient with EE associated with a common variable immunodeficiency (CVID) demonstrated complete resolution of skin manifestations within 8 weeks [ 83 ]. Secondary generalized eczematization in a patient with underlying chronic venous stasis dermatitis was treated with dupilumab which led to significant improvement of itch; however, new psoriasiform lesions developed subsequently and dupilumab was discontinued [ 84 ].…”

Section: Resultsmentioning

confidence: 99%

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

et al. 2023

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Dupilumab was first approved for the treatment of atopic dermatitis (AD) and blocks the signaling of interleukin (IL)-4 and -13. Several other chronic skin conditions share mechanistic overlaps with AD in their pathophysiology, i.e., are linked to type 2 inflammation. Most recently, dupilumab was approved by the U.S. Food and Drug Administration for prurigo nodularis (PN). Given its relatively good safety profile, effective off-label use of dupilumab has been reported for a multitude of dermatologic diseases and several clinical trials for dermatologic skin conditions are currently ongoing. We conducted a systematic review of applications of dupilumab in dermatology other than AD and PN by searching the databases PubMed/Medline, Scopus, Web of Science and Cochrane Library as well as the clinical trial registry ClinicalTrials.gov. We found several reports for effective treatment of bullous autoimmune diseases, eczema, prurigo, alopecia areata, chronic spontaneous urticaria, Netherton syndrome and a variety of other chronic inflammatory skin diseases.

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“…Patients with chronic stasis dermatitis are at a 37% lifetime risk of developing autoeczematization later in the course of the disease when compared to the general population [ 4 , 6 ]. We postulate that stasis dermatitis causes a reaction involving T cells in the absence of interferon signaling, an autoeczematization reaction.…”

Section: Discussionmentioning

confidence: 99%

“…Identification of T cell-mediated processes as the pathology underlying autoeczematization has helped tailor treatment. A study on dupilumab, a monoclonal antibody inhibitor of IL-4 receptor, as a treatment for autoeczematization found that this treatment shifted the T cell-mediated reaction towards Th1 dominance, rather than Th2, causing a subsequent resolution of the autoeczematous rash and development of a psoriatiform rash that was different from the initial autoeczematous rash [ 6 ]. This finding guides the choice of methotrexate as a treatment.…”

Section: Discussionmentioning

confidence: 99%

A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis

Bhagat¹,

Otles²,

Salmon³

et al. 2022

Cureus

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Autoeczematization, the dissemination of a local eczematous reaction to a distal site, is closely associated with lower extremity edema. Our patient is a 50-year-old man with a past medical history of drug-induced lupus to hydralazine and recent bilateral cellulitis in his lower extremities. He was presented with complaints of vesicles on his palms and soles and a scaling rash that had spread over his torso, arms, and trunk. Laboratory studies found no evidence of an active rheumatological condition with complement C3 and C4 levels being normal and no anti-dsDNA, anti-histone, anti-Smith, anti-ribonucleoprotein (anti-RNP), anti-centromere, anti-neutrophil cytoplasmic antibodies (ANCA), anti-Ro, or anti-La antibodies present. Moreover, syphilis, HIV, gonorrhea, chlamydia, rickettsia antibody, and Borrelia burgdorferi antibody testing was negative suggesting a non-infectious etiology of the rash. Hypothesizing a dermatologic origin of the rash, a skin biopsy was performed that revealed intermittent foci of moderate hyperparakeratosis and mild hypergranulosis indicative of eczematous dermatitis. Unfortunately, treatment of the disseminated rash with 10 mg of daily oral prednisone and topical triamcinolone acetonide 0.1% ointment proved inefficient, and methotrexate therapy was advised. We posit that cellulitis, a soft tissue infection under the skin, is a potential cause of disruption of the skin barrier that leads to activation of autosensitized T cells. These activated T cells circulate to distal areas of the skin and may lead to autoeczematization. The treatment of these id reactions with corticosteroids - both topical and oral - may be insufficient at reducing dermatitis and require the application of systemic methotrexate or cyclosporine. Through this case, we demonstrate the importance of treating id reactions by stepping up the intensity of treatment due to the severity of autosensitization-driven eczema.

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Clinical Psoriasiform Dermatitis Following Dupilumab Use for Autoeczematization Secondary to Chronic Stasis Dermatitis

Cited by 9 publications

References 19 publications

A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis

A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis

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