Lichenoid-granulomatous drug reactions to dupilumab: A report of 2 cases

Perforating lichen nitidus in the setting of atopic dermatitis

“…The differential diagnosis in our patient may also include drug‐induced lichenoid and granulomatous dermatitis from dupilumab injections. However, in considering these differentials, authors also report interstitial and sarcoidal granulomas in the deeper dermis, which were not identified in our case 16 . Literature review of drug reactions to dupilumab include lichenoid‐granulomatous and psoriasiform patterns 16–18 .…”

“…However, in considering these differentials, authors also report interstitial and sarcoidal granulomas in the deeper dermis, which were not identified in our case. 16 Literature review of drug reactions to dupilumab include lichenoid-granulomatous and psoriasiform patterns. [16][17][18] In our case, the presence of eosinophils in the inflammatory infiltrate was not appreciated, which further supports the diagnosis of perforating lichen nitidus.…”

“…16 Literature review of drug reactions to dupilumab include lichenoid-granulomatous and psoriasiform patterns. [16][17][18] In our case, the presence of eosinophils in the inflammatory infiltrate was not appreciated, which further supports the diagnosis of perforating lichen nitidus.…”

“…Rare cases of lichenoid eruptions following dupilumab treatment in patients with a history of atopic dermatitis have been reported. 16,18 Dupilumab is an interleukin-4 receptor alpha antagonist that inhibits IL-4 and IL-13 cytokine-induced responses, including the release of proinflammatory cytokines, chemokines, and immunoglobulin E. It is hypothesized that the blockade of Th2 response by dupilumab may activate Th1 mediated hyper immune responses. 18 However, a case of acquired perforating dermatosis (reactive perforating collagenosis) has been reported as being successfully treated with dupilumab monotherapy.…”

“…Our patient had been managing his atopic dermatitis with dupilumab injections, 300 mg every 2 weeks. Rare cases of lichenoid eruptions following dupilumab treatment in patients with a history of atopic dermatitis have been reported 16,18 . Dupilumab is an interleukin‐4 receptor alpha antagonist that inhibits IL‐4 and IL‐13 cytokine‐induced responses, including the release of proinflammatory cytokines, chemokines, and immunoglobulin E. It is hypothesized that the blockade of Th2 response by dupilumab may activate Th1 mediated hyper immune responses 18 .…”