Observation of the clinical features of dupilumab-associated facial erythema

INTRODUCTION: Dupilumab is the first biologic agent used to clinically treat moderate and severe atopic dermatitis (AD) and is currently the only biologic agent used for this condition.

Many studies have reported that moderate-to-severe AD was significantly improved after dupilumab injection, although head/neck dermatitis occurred with itching, flushing, and scaling.

Moreover, because all the symptoms occur after dupilumab treatment, they are called “dupilumab facial redness (DFR)”.

AIM: To retrospectively analyse the clinical characteristics and treatment of facial erythema in patients with atopic dermatitis treated with dupilumab.

MATERIAL AND METHODS: The clinical data of patients with moderate-to-severe atopic dermatitis treated with dupilumab (600 mg for the first time, 300 mg every 2 weeks thereafter) in the department of dermatology from July 2020 to May 2022 were obtained.

We described their characteristics and analysed their symptomatic treatment measures and efficacy.

RESULTS: Twenty-one patients with DFR were included.

Most clinical manifestations were erythema and pruritus, which differed from the symptoms of typical moderate-to-severe AD.

After treatment, drug withdrawal, and dressing change, the symptoms of 17 patients were effectively controlled or completely improved, while these of 4 did not improve.

CONCLUSIONS: Although the mechanism of DFR is still unclear, symptomatic treatment is partially effective, and medication discontinuation and switching to Janus kinase inhibitors are acceptable for some patients.