Psoriatic Plaques After Initiation of Dupilumab Therapy

Development of a clinical algorithm to predict phenotypic switches between atopic dermatitis and psoriasis (the “Flip‐Flop” phenomenon)

“…Active skin lesions are usually consistent with clinicopathologic findings of AD and PV 10 . In addition to the co‐occurrence of both diseases in the same patient at the same time, few cases also report sudden phenotypic switches (AD ↔ PV) in the course of disease, either with or without biological treatment (so‐called paradoxical reactions 16–52 ; hereinafter referred to as “Flip‐Flop” (FF) patients). The possibly underestimated incidence of a switch from AD towards PV under dupilumab treatment is 1.7% 17 .…”

“…The possibly underestimated incidence of a switch from AD towards PV under dupilumab treatment is 1.7% 17 . The switch has usually been described to occur 2–18 months after the initiation of dupilumab 17,20,21 and in patients with AD onset in infancy or early childhood 22–25,47 . Switches from PV to AD have mainly been described for the inhibition of IL‐17 signaling (secukinumab, ixekizumab 36,37,47 ), IL‐12/−23 signaling (ustekinumab) 42,47 and IL‐23 signaling (guselkumab, 49 tildrakizumab 44 ) after a treatment of 5 weeks to 22 months 37,44,47 .…”

“…Switches from PV to AD have mainly been described for the inhibition of IL‐17 signaling (secukinumab, ixekizumab 36,37,47 ), IL‐12/−23 signaling (ustekinumab) 42,47 and IL‐23 signaling (guselkumab, 49 tildrakizumab 44 ) after a treatment of 5 weeks to 22 months 37,44,47 . FF patients often report severe pruritus and atopic diseases 20,22–24,36,37,42,44,48,49 . So far, an approach is lacking to identify FF patients.…”

Dupilumab-Induced Palmoplantar Psoriasis: Is It True Psoriasis?

“…Recently, several cases of newly developed psoriatic lesions have been reported, including dupilumab-induced psoriasis, psoriasiform eruption, and psoriasiform dermatitis. [1][2][3] The pathogenesis of psoriasiform dermatitis, however, remains unclear. Although a shift of the T-helper (Th) 1/Th17 phenotype from Th2 is plausible, it is currently burdensome to examine various T-cell cytokines and receptor profiles for each patient in real-world practices.…”

“…Dupilumab, a monoclonal antibody that binds and inhibits interleukin (IL)-4 and IL-13 receptor subunit α, is a novel therapy for moderate to severe AD. Recently, several cases of newly developed psoriatic lesions have been reported, including dupilumab-induced psoriasis, psoriasiform eruption, and psoriasiform dermatitis 1–3 . The pathogenesis of psoriasiform dermatitis, however, remains unclear.…”