Dupilumab‐induced psoriasiform dermatitis in two pediatric cardiac transplant patients

Abstract

Dupilumab is an interleukin‐4 receptor antagonist important in the treatment of refractory atopic dermatitis (AD), particularly among pediatric patients. Two boys with a history of AD and cardiac transplant who developed psoriasiform dermatitis in response to dupilumab therapy are reported. These patients paradoxically developed an immune‐mediated adverse drug reaction despite taking systemic immunosuppressive agents. While the literature suggests possible pathomechanisms for psoriasiform dermatitis despite immunosuppression, further research is necessary to better characterize this unique and unexpected phenomenon.

Case report: Treatment of psoriasiform dermatitis in patients with malignancy

“…Consequently, distinguishing between psoriasis and AD, especially when clinical and histological findings overlap, can be challenging (2). In such cases, the term "psoriasiform dermatitis" is employed to describe variable eczema-like histopathological changes with a psoriasiform appearance (3)(4)(5). Histologic features overlapping with psoriasis include edema of the papillary dermis and the presence of Munro microabscesses, while ADassociated features encompass neutrophil and plasma exudation in parakeratosis, lymphocytic exocytosis in the epidermis, fullthickness spongiosis, or spongiotic vesicle formation.…”