Alcohol-induced facial flushing in a patient with atopic dermatitis treated with dupilumab

Igelman, Sean; Na, Chanho; Simpson, Eric L.

doi:10.1016/j.jdcr.2019.12.002

Cited by 14 publications

(10 citation statements)

References 8 publications

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“…Furthermore, this percentage is lower than that reported by in both clinical trials (range 5–28%) 12,22,23 and real‐life studies (range 8–62%) 10,26,28 . It should be noted that a quite frequently (10/276; 3.6%) reported AE was flushing, which is only rarely described in literature 2 as occurring in association with alcohol intake, due to a possible competitive inhibition of cytochrome P450 2E1 by dupilumab and ethanol 29 . In our study, the association between flushing and alcohol intake was reported by two of the 10 patients reporting this AE; therefore, in the remaining 8, the reaction is currently unexplainable; it could also be assumed that these patients did not pay attention to correlating alcohol intake with the onset of flushing.…”

Section: Discussionmentioning

confidence: 65%

Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real‐life study

Patruno

Napolitano

Argenziano

et al. 2021

Acad Dermatol Venereol

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Background Treatment of moderate‐to‐severe atopic dermatitis (AD) in the elderly may be challenging, due to side‐effects of traditional anti‐inflammatory drugs and to comorbidities often found in this age group. Furthermore, efficacy and safety of innovative drugs such as dupilumab are not yet well known. Objectives A multicentre retrospective, observational, real‐life study on the efficacy and safety of dupilumab was conducted in a group of patients aged ≥65 years and affected by severe AD. Their main clinical features were also examined. Methods Data of elderly patients with severe (EASI ≥24) AD treated with dupilumab at label dosage for 16 weeks were retrospectively collected. Treatment outcome was assessed by comparing objective (EASI) and subjective (P‐NRS, S‐NRS and DLQI) scores at baseline and after 16 weeks of treatment. Results Two hundred and seventy‐six patients were enrolled in the study. They represented 11.37% of all patients with severe AD. Flexural eczema was the most frequent clinical phenotype, followed by prurigo nodularis. The coexistence of more than one phenotype was found in 63/276 (22.82%) subjects. Data on the 16‐week treatment with dupilumab were available for 253 (91.67%) patients. Efficacy of dupilumab was demonstrated by a significant reduction of all the scores. No statistically significant difference regarding efficacy was found in elderly patients when compared to the group of our AD patients aged 18–64 years, treated with dupilumab over the same period. Furthermore, only 18 (6.52%) patients discontinued the drug due to inefficacy. Sixty‐one (22.51%) patients reported adverse events, conjunctivitis and flushing being the most frequent. One (0.36%) patient only discontinued dupilumab due to an adverse event. Conclusions Therapy with dupilumab led to a significant improvement of AD over a 16‐week treatment period, with a good safety profile. Therefore, dupilumab could be considered as an efficacious and safe treatment for AD also in the elderly.

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Section: Discussionmentioning

confidence: 65%

Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real‐life study

Patruno

Napolitano

Argenziano

et al. 2021

Acad Dermatol Venereol

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“…Facial AD lesions may have a higher impact on a patient's quality of life than AD lesions in other anatomic regions [32], as it is a highly visible and an aesthetically important site. Recent studies have described new-onset or acute worsening of facial rash and posited various etiologies-many of which are presumably unrelated to dupilumab treatment-including rosacea, allergic contact dermatitis, Malassezia colonization involving the face and neck, photosensitivity, and steroid withdrawal [18][19][20][21][22][23][24][25][26][27][28]. The face is a common site for exacerbation by irritants and/or allergic contact dermatitis [33].…”

Section: Discussionmentioning

confidence: 99%

“…Although no safety signal was detected during randomized clinical trials of dupilumab in AD, a number of individual case reports and limited case series describe a new-onset or acute worsening of facial rash associated with dupilumab treatment [18][19][20][21][22][23][24][25][26][27][28]. Reported clinical signs and symptoms include erythema, edema, flushing, papulopustules, pruritus, scaling, and a burning sensation in the centrofacial area [26,28].…”

Section: Introductionmentioning

confidence: 99%

Dupilumab with Topical Corticosteroids Provides Rapid and Sustained Improvement in Adults with Moderate-to-Severe Atopic Dermatitis Across Anatomic Regions Over 52 Weeks

Blauvelt

Bruin‐Weller

Simpson

et al. 2021

Dermatol Ther (Heidelb)

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Introduction In a 52-week, phase 3 clinical trial (LIBERTY AD CHRONOS) in adult patients with moderate-to-severe atopic dermatitis (AD), dupilumab in combination with topical corticosteroids (TCS) resulted in a significant improvement in overall Eczema Area and Severity Index (EASI) compared with placebo plus TCS. In a post hoc analysis, dupilumab significantly improved the overall extent and severity of AD across four anatomic regions (head and neck, trunk, upper extremities, lower extremities) over 16 weeks. However, as AD severity and presentation may vary by body region, this analysis sought to determine whether there are regional variations in dupilumab efficacy. Methods Using data from the LIBERTY AD CHRONOS study, we performed a post hoc analysis of the mean percentage change in individual EASI signs (erythema, infiltration/papulation, excoriation, lichenification) from baseline through week 52 across four anatomic regions (head and neck, trunk, upper extremities, lower extremities). Results Dupilumab plus TCS, compared with placebo plus TCS, significantly improved the severity of all individual AD signs to a similar extent across the four anatomic regions. Significant improvements in each sign were seen early, within the first 2–4 weeks of treatment, and were sustained through week 52 across all regions. Conclusions In adult patients with moderate-to-severe AD, treatment with dupilumab resulted in rapid and sustained improvement in the signs of AD across all anatomic regions. Trial registration LIBERTY AD CHRONOS (NCT02260986).

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“…Recalcitrant head and neck dermatitis (HND), commonly reported as facial erythema, is a common phenotype of AD and has also been observed in real-world patients treated with dupilumab [105]. While not identified as an adverse event in dupilumab clinical trials [80], retrospective analyses and registries suggest frequency ranging from 3 to 10% [84,106,107]. Simpson and Ahn [108] investigated the prevalence of facial erythema from 162 patients on dupilumab for AD and detected that most patients presented with facial erythema before dupilumab initiation, and signs resolved or improved on dupilumab.…”

Section: Management Of Conjunctivitis In Admentioning

confidence: 99%

Practical Management of Patients with Atopic Dermatitis on Dupilumab

Papp

Hong

Lansang

et al. 2021

Dermatol Ther (Heidelb)

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Introduction Dupilumab is approved to treat moderate-to-severe atopic dermatitis (AD) in several countries in patients as young as 6 years of age. Since its approval, practical issues related to the use of dupilumab for AD have arisen, with particular interest in transitioning from current therapies and managing medication overlap, considerations for special populations of patients with AD, and management of potential adverse events. Methods This article aims to review the literature addressing several practical management issues related to dupilumab use for AD and to provide a framework for clinical decision-making in these circumstances and sub-populations. Each statement was reviewed, revised and voted on by authors to provide their level of agreement and degree of uncertainty for each statement. Results An agreement level > 80% was achieved for all of the statements. Conclusion The expert panel provides statements considering the practical management of patients with AD taking dupilumab to inform clinical decision-making in specific but frequently encountered clinical situations. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00586-w.

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Alcohol-induced facial flushing in a patient with atopic dermatitis treated with dupilumab

Cited by 14 publications

References 8 publications

Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real‐life study

Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real‐life study

Dupilumab with Topical Corticosteroids Provides Rapid and Sustained Improvement in Adults with Moderate-to-Severe Atopic Dermatitis Across Anatomic Regions Over 52 Weeks

Practical Management of Patients with Atopic Dermatitis on Dupilumab

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