Effective Use of Dupilumab in Managing Systemic Allergic Contact Dermatitis

Abstract

Allergic contact dermatitis to metals has become increasingly recognized in patients with endovascular implants. The ACD can lead to in-stent restenosis as well as a prominent eczematous reaction overlying the implant, often necessitating its removal. We present a case of refractory allergic contact dermatitis to nickel in a 44-year-old man with numerous endovascular stents and vascular clips. He developed numerous adverse effects of systemic therapy to manage his symptoms including recurrent infections leading to frequent hospitalizations. He was effectively transitioned to dupilumab, a monoclonal antibody against the IL-4α subunit currently approved by the Food and Drug Administration in the management of atopic dermatitis, with an improvement in symptoms and a reduction in infection rate.

Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

“…These cytokines are thought to play a central role in the pathogenesis of AD. Dupilumab has been approved recently, after it was shown to be a successful treatment for AD in several phase III clinical trials . These trials showed improvement of disease severity, itch, sleep disturbance, anxiety, depression and quality of life with dupilumab as monotherapy or in combination with TCSs .…”

“…Dupilumab has been approved recently, after it was shown to be a successful treatment for AD in several phase III clinical trials. [11][12][13] These trials showed improvement of disease severity, itch, sleep disturbance, anxiety, depression and quality of life with dupilumab as monotherapy or in combination with TCSs. 3 The most frequently observed side-effects were conjunctivitis, herpes infections and injection-site reactions.…”

Systemic contact dermatitis caused by acupuncture: A neglected route of allergen entry

“…However, in a study of chromium‐induced contact dermatitis, chromium‐exposed workers with contact dermatitis had high T‐IgE levels and eosinophilic counts 11 . Eosinophilia and elevated T‐IgE levels are also reported in several cases of SCD 12,13 . Her eosinophil count returned to normal within 3 weeks after the pacemaker was removed.…”

Blocking type 2 inflammation by dupilumab does not control classic (type 1‐driven) allergic contact dermatitis in chronic hand eczema

“…She remained nearly clear while receiving dupilumab, and could continue her work. Joshi and Khan reported a case of refractory ACD caused by nickel in a patient after the placement of vascular stents because of an arterial popliteal thrombus . He had no personal or family history of AD.…”