Dupilumab-resistant facial erythema - Dermoscopic, histological and clinical findings of three patients

One-Year Effectiveness and Safety of Dupilumab Treatment for Moderate-to-Severe Atopic Dermatitis in Korean Patients: A Real-World Retrospective Analysis

“…Paradoxical facial and neck erythema, which has been reported in the literature, 7 was rare in our Korean study group with its presentation in only one patient. In addition, while persistent facial redness resistant to dupilumab has been previously reported, 8 this case was not found in our study, and 27 of the 28 (96.4%) patients with severe face eczema at baseline reached an IGA score of 0 or 1 at the last follow-up. Notably, most patients with severe hand eczema at baseline also showed excellent responses to dupilumab treatment (9 of the 10 patients, 90%).…”

A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis

“…Real-world evidence raised the issue of facial redness that developed in some patients after initiation of dupilumab, although facial redness was not focused on as an adverse event in the clinical trials. To date, some case series of facial redness in dupilumab-treated patients with AD have been reported ( Albader et al., 2019 ; de Beer et al., 2019 ; de Wijs et al., 2020b ; Heibel et al., 2021 ; Herz et al., 2019 ; Igelman et al., 2020 ; Nakanishi et al., 2021 ; Okiyama et al., 2020 ; Quint et al., 2020 ; Seok et al., 2020 ; Soria et al., 2019 ; Stout and Silverberg, 2019 ; Suresh and Murase, 2018 ; Waldman et al., 2020 ; Yamane et al., 2019 ; Zhu et al., 2019 ).…”

A case of facial redness in atopic dermatitis occurring during dupilumab treatment successfully treated with topical delgocitinib ointment

“…[1][2][3] In other patients, facial redness was resistant to dupilumab therapy. 4,5 Although this adverse event was not reported in the phase 3 clinical trial investigating the efficacy and safety of dupilumab, a recent multicenter retrospective medical review in USA and a single-center retrospective study in Korea revealed that DFR or facial erythema developed in about 10% of dupilumab-treated patients. 6,7 The mechanism of DFR has not been elucidated yet and there are several hypotheses to explain DFR, such as a hypersensitivity reaction to dupilumab, a seborrheic dermatitis-like reaction to facial Malassezia species, a rosacea-like reaction associated with demodex, and concomitant allergic contact dermatitis.…”

“…3,5 Many reported cases are resistant to topical corticosteroids, topical tacrolimus, emollients, or combination of them. 2,5 Oral minocycline in combination with topical tacrolimus and/or brimonidine tartrate 0.33% topical gel was reported to improve facial redness on the average within 23 weeks in one case series. 3 In other reports, oral itraconazole administration or allergen avoidance resulted in significant improvement of facial redness.…”

“…1,2,6 The cause of DFR may differ depending on individual cases, because histopathologic findings were varied: spongiotic dermatitis with parakeratosis and neutrophilic infiltraton, 1 psoriasiform dermatitis without spongiosis, 2 and perifollicular inflammatory infiltrates or granulomas with dilated vessels. 3,5 Many reported cases are resistant to topical corticosteroids, topical tacrolimus, emollients, or combination of them. 2,5 Oral minocycline in combination with topical tacrolimus and/or brimonidine tartrate 0.33% topical gel was reported to improve facial redness on the average within 23 weeks in one case series.…”