Generalized Granuloma Annulare Associated With Dupilumab Therapy

Abstract

Atopic dermatitis is a condition characterized by xerotic and pruritic skin. While the onset of the disease is usually in childhood, it may persist into adulthood. First-line treatments include adequate moisturization, avoidance of irritants, and the application of topical corticosteroids. Dupilumab is a biologic therapy, approved for moderate-to-severe atopic dermatitis, that dampens the pruritus sensation by inhibiting the downstream effects of the T helper cell type 2 pathway by binding to the interleukin-4 receptor α subunit. The monoclonal antibody is typically well-tolerated.We present a novel case of the development of generalized granuloma annulare after treatment with dupilumab. A 71-year-old male with a history of hypertension, hyperlipidemia, chronic kidney disease, gout, and bipolar disorder presented to clinic with biopsy-proven severe atopic dermatitis. First-line treatments had been exhausted, and the patient was not an ideal candidate for traditional systemic options secondary to his poor renal function. Therapy with dupilumab was initiated and continued for two years until the patient developed biopsy-proven generalized granuloma annulare. At this time, dupilumab was discontinued and the pharmaceutical company was made aware of this side effect.

Causal relationships between atopic dermatitis and psychiatric disorders: a bidirectional two-sample Mendelian randomization study

“…Interestingly, our reverse MR analysis also yielded noteworthy results that BD and AN are causally associated with an elevated risk of developing AD. Subsequently, through an extensive review of the literature, we encountered several clinical cases reporting a history of comorbidity between bipolar disorder and severe AD [ 37 , 38 ]. Moreover, previous investigations have identified a connection between dietary alterations and disturbances in the skin barrier, leading to the development of atopic skin allergy [ 39 ].…”

Retrospective assessment of immunologic and histologic heterogeneity in granuloma annulare by cytokine staining

“…Studies evaluating dupilumab in granuloma annulare would be particularly informative. To date, the literature is mixed with scarce reports of both improvement in and development of GA with dupilumab 13–15 . Incorporating immune tissue biomarkers as a function of treatment will be key to better understanding this as novel therapeutics for GA such as Janus kinase inhibitors and dupilumab are further evaluated.…”

Granuloma Annulare: A Clinical Update

“…Infliximab, adalimumab, etanercept [27], dupilumab [28], allopurinol [29], topiramate [30], interferon-alfa [31], amlodipine [32], Other forms of treatment Phototherapy [33], gold therapy [34], injection of collagen [35], mesotherapy [36]…”

“…Although generally well-tolerated, possible side effects of dupilumab include: injection site responses, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, and dry eye [150•, 151]. A case of generalized GA following dupilumab therapy has also been reported, with enduring symptoms despite cessation of dupilumab [28].…”