Effectiveness and safety of tacrolimus ointment combined with dupilumab for patients with atopic dermatitis in real‐world clinical practice

Abstract

Atopic dermatitis (AD) is the most common inflammatory skin disease affecting people of all age groups worldwide. To our knowledge, there are currently no studies estimating the effectiveness of tacrolimus ointment and dupilumab as a combination therapy for AD. Thus, here we describe the effectiveness and safety of tacrolimus ointment in combination with dupilumab for facial rashes in patients with AD. Overall, we included 109 patients who newly received dupilumab from April 2018 to July 2020 in the Dermatology Department of Hyogo College of Medicine Hospital. Of them, 60 patients were treated with tacrolimus ointment. Specifically, of the 60 patients, 40 were treated with dupilumab in combination with tacrolimus ointment and topical steroids, whereas the remaining 20 were prescribed tacrolimus ointment alone and were further analyzed. The analysis showed that the combination does not cause serious side‐effects at high frequency. The patients showed rapid improvement of facial dermatitis along with systemic dermatitis, and the rate of improvement of head/neck Eczema Area and Severity Index (EASI) score significantly correlated with the rate of improvement of overall EASI score. In addition, there was no complication of herpes simplex observed in these 20 patients. Thus, tacrolimus ointment combined with dupilumab is an effective and safe treatment option for facial AD.

Effectiveness of tacrolimus ointment for dupilumab‐resistant facial erythema

“…This fact supports the hypothesis that DRFE and pre‐existing facial AD have different pathomechanisms and that tacrolimus ointment might be a suitable option for the treatment of DRFE. While our observation is based on a single case, a previous study demonstrated combined effectiveness of tacrolimus ointment and dupilumab in clinical practice 2 . Malassezia hypersensitivity has been proposed to explain the pathomechanism of DRFE as well as that of AD, especially of the head and neck 2 .…”

“…While our observation is based on a single case, a previous study demonstrated combined effectiveness of tacrolimus ointment and dupilumab in clinical practice. 2 Malassezia hypersensitivity has been proposed to explain the pathomechanism of DRFE as well as that of AD, especially of the head and neck. 2 Actually, our patient's serum Malasseziaspecific IgE level was high.…”

“…2 Malassezia hypersensitivity has been proposed to explain the pathomechanism of DRFE as well as that of AD, especially of the head and neck. 2 Actually, our patient's serum Malasseziaspecific IgE level was high. We hypothesize that the high serum Malassezia-specific IgE level may be a potential biomarker of risk factors of DRFE.…”

“…Treatment with dupilumab was started, and after 6 months of treatment his condition had improved, with overall eczema and area severity index (EASI) score changing from 32.7 at baseline to 9.85 points. 2 However, a worsening scaly erythema with itching and lichenification developed on his face (Figure 1). The head/neck EASI score increased from 3.15 at baseline to 6 after dupilumab therapy.…”

“…Treatement with dupilumab for atopic dermatitis (AD) is ineffective or causes exacerbation of facial erythema in approximately 10% of patients. [1][2][3][4][5] Treating dupilumabresistant facial erythema (DRFE) is challenging because its pathomechanisms are unclear. 1,[3][4][5] Here, we report the case of a 21-year-old male patient with DRFE who was successfully treated with tacrolimus ointment but was resistant to other ointments (topical corticosteroids and delgocitinib).…”