Dupilumab facial redness: Clinical characteristics and proposed treatment in a cohort

Abstract

In this case series, we report for the first time in the literature in a cohort, the positive response to oral or topical antifungals for atopic dermatitis patients treated with Dupilumab that developed Dupilumab facial redness, supporting the Malassezia hypersensitivity theory.adverse effects, atopic dermatitis, Dupilumab, facial redness, head and neck dermatitis, Malassezia Dupilumab has shown to be an effective treatment for moderate to severe atopic dermatitis (AD). 1 Adverse events (AE) that have been described in AD patients treated with Dupilumab include injection site reactions, cold sores, hypersensitivity, anaphylaxis, and eye problems mostly secondary to Dupilumab ocular surface disease (DOSD). 1 AD patients can also develop Dupilumab facial redness (DFR), an AE described after approval, with an unknown etiopathogenesis. 2 Four theories have been proposed to explain DFR: hypersensitivity reaction to Dupilumab, site-specific treatment failure, seborrheic dermatitis-like reaction to Malassezia spp., paradoxical flare of contact dermatitis, or a combination of these. 3

Dupilumab Alters Both the Bacterial and Fungal Skin Microbiomes of Patients with Atopic Dermatitis

“…In recent years, the administration of dupilumab has been shown to induce dupilumab-associated head and neck dermatitis (DAHND) (also called facial and neck erythema) [ 20 , 21 , 22 , 23 , 24 ]. Although the exact cause of DAHND remains uncertain, the appearance of specific anti- Malassezia IgE antibodies in patients, the improvement of DAHND symptoms, and the alteration of specific antibody levels after administering the antifungal medication itraconazole indicate that Malassezia could play a role in the development of DAHND [ 25 ].…”