Eczematous reactions to psoriasis biologics treated with dupilumab: A case series

Koschitzky, Merav; Tan, Kathryn; Encarnacion, Maria Rosa Noliza; Rivera-Oyola, Ryan; Khattri, Saakshi

doi:10.1016/j.jdcr.2021.03.006

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…In the majority of the previous cases, clinicians withdrew psoriasis biologics after minimal response to topical and systemic steroids. [ 4 , 8 ] In our case, the patient showed almost no improvement with various eczematous dermatitis treatments and gradually new lesions were induced. Generalized eczematous dermatitis presented a good response to CsA and systemic steroids after the discontinuation of secukinumab.…”

Section: Discussionmentioning

confidence: 62%

“…However, several paradoxical cutaneous adverse effects have been demonstrated during the biological treatment for psoriasis and eczema. [ 4 , 7 , 8 ] For instance, dupilumab, targeting the IL-4 receptor alpha subunit, inhibits the IL-4 and IL-13 signaling cascades, thereby inducing the Th1 or Th17 immune-associated cutaneous diseases during in treatment of AD. [ 9 ] Similarly, Th2 immune-associated cutaneous disorders have been reported in biogical treatement of psoriasis.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of paradoxical eczematous eruption in psoriasis treated with secukinumab: A case report

Peng

Mao

et al. 2023

Medicine

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Rationale: Eczematous eruption is an increasingly recognized form of drug-related eruption, typically reported in association with interleukin 17 (IL-17)A inhibitors. However, severe paradoxical eczematous eruption due to IL-17A inhibitors has been rarely reported. Herein, we reported a case of a man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. Patient concerns: We reported a case of a 20-year-old man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. A skin biopsy was performed. It revealed spongiotic dermatitis consistent with eczematous reaction. Direct and indirect immunofluorescence assays were negative. Diagnoses: He was diagnosed with eczematous eruption. Interventions: Discontinuation of secukinumab and administration of cyclosporine and prednisone were considered. Outcomes: Significant improvement was observed, with no adverse events. Conclusion: Our case shows that eczematous eruption can paradoxically occur in patients on IL-17A inhibitors and this report is expected to increase awareness of the rising number of cutaneous eruptions related to biological agents.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Treatment of paradoxical eczematous eruption in psoriasis treated with secukinumab: A case report

Peng

Mao

et al. 2023

Medicine

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“…Localized or generalized eczema can develop in response to drugs in the form of drug-induced eczematous eruption (EE) typically described for TNFα-inhibitors. Dupilumab treatment of EE induced by anti-IL-17 or -23 agents (tildrakizumab, brodalumab, ixekizumab and ustekinumab) given for underlying psoriasis or Crohn’s disease led to complete clearance within months in all 4 reported patients [ 79 , 80 ]. EE of aging is an exclusion diagnosis and was treated with dupilumab leading to sustained improvement of skin lesions and itch in a total of 16 patients without a history of AD or atopic diathesis ( Table 1 ) [ 81 , 82 ].…”

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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“…More examples of the importance of type 17 and type 2 immune pathway interactions after targeted therapy are now being recognized. IL-17A therapy-induced eczema-like rashes occur in patients with psoriasis (10), with a recent report of successful use of dupilumab in this syndrome (11). In contrast, patients with AD treated with dupilumab have been reported to develop psoriaform-like skin changes (12), with a skin biopsy study in this condition reporting significant increases of IL-23A messenger RNA levels in skin lesions from patients treated with dupilumab who developed drug-induced skin psoriasis compared to those in skin lesions from other patients with AD or psoriasis (13).…”

Section: Discussionmentioning

confidence: 99%

Characterization of a Musculoskeletal Syndrome of Enthesitis and Arthritis in Patients With Atopic Dermatitis Treated With Dupilumab, an Interleukin‐4/13 Inhibitor

Hughes

Nathan

Mathew

et al. 2023

Arthritis & Rheumatology

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ObjectiveTo characterize the presentation and outcomes of patients with atopic dermatitis (AD) who developed musculoskeletal symptoms after treatment with dupilumab, a human IgG4 monoclonal antibody that blocks the functions of interleukin‐4 (IL‐4) and IL‐13, key pathologic pathways in AD.MethodsThis article reports an observational cohort of patients receiving dupilumab who developed new‐onset musculoskeletal symptoms after dupilumab therapy at our center. All patients had a comprehensive rheumatologic history and examination, with imaging by ultrasonography (US) or magnetic resonance imaging (MRI) in most patients.ResultsBetween October 2018 and February 2021, we recorded 470 patients with AD commencing dupilumab treatment from routine clinical care records. Of 36 patients referred for rheumatologic assessment, we identified 26 patients (14 male, 12 female) with a musculoskeletal syndrome of inflammatory enthesitis, arthritis, and/or tenosynovitis. Clinical findings were confirmed by US and MRI. All patients had very good response to dupilumab treatment, and no specific predictors of musculoskeletal syndrome were noted. Symptoms were mild in 16 patients, moderate in 6 patients, and severe in 4 patients. Receipt of nonsteroidal antiinflammatory drugs or cyclooxygenase 2 inhibitors, reduction of dupilumab dose/frequency, and cessation of dupilumab therapy led to improvement, but moderate or severe symptoms persisted for many months.ConclusionWe report a new musculoskeletal syndrome of inflammatory enthesitis/arthritis/tenosynovitis in some patients receiving the IL‐4 receptor antagonist dupilumab. This response to a cytokine‐targeting therapy provides key insights into the pathogenesis of enthesitis.

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Eczematous reactions to psoriasis biologics treated with dupilumab: A case series

Cited by 6 publications

References 9 publications

Treatment of paradoxical eczematous eruption in psoriasis treated with secukinumab: A case report

Treatment of paradoxical eczematous eruption in psoriasis treated with secukinumab: A case report

Dupilumab in Inflammatory Skin Diseases: A Systematic Review

Characterization of a Musculoskeletal Syndrome of Enthesitis and Arthritis in Patients With Atopic Dermatitis Treated With Dupilumab, an Interleukin‐4/13 Inhibitor

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