Mycosis Fungoides Unmasked by Dupilumab Treatment in a Patient With a History of Atopic Dermatitis

Ayasse, Marissa; Nelson, Kamaria; Glass, Frank; Silverberg, Jonathan I.

doi:10.1097/der.0000000000000679

Cited by 20 publications

(39 citation statements)

References 4 publications

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“…Twelve studies (nine case studies, one case series, one case review, and one cross‐sectional retrospective cohort study), to include a total of 27 patients (15 males, 12 females, male–female incidence rate ratio [M/F IRR] = 1.25), were included. Mean patient age was 57 years, ranging from 27 to 77 years of age 7–18 . Out of the nine patients whose ethnicity was documented, six were white, 16 two were African American, 15,16 and one was Japanese 18 .…”

Section: Resultsmentioning

confidence: 99%

“…Impetiginization with staphylococcus aureus was also reported 9 . Of the studies that reported BSA involvement, 7/7 (100%) were found to have >50% BSA involvement 7,9,11,17 . Sites of involvement included scalp, face, neck, trunk, upper and lower extremities, hands, feet, buttock, and groin.…”

Section: Resultsmentioning

confidence: 99%

“…In recent years, several case studies have associated unmasking or progression of cutaneous T‐cell lymphomas (CTCL) with dupilumab treatment 7–18 . Dupilumab competitively inhibits IL‐4 and IL‐13 at the IL‐4 α1 subunit receptor, preventing downstream activation of tyrosine kinases promoting gene transcription related to both barrier dysfunction and Th2‐mediated inflammation 19 .…”

Section: Introductionmentioning

confidence: 99%

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Cutaneous T‐cell lymphoma following dupilumab use: a systematic review

et al. 2022

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In recent years, studies have associated dupilumab with unmasking or progression of cutaneous T‐cell lymphoma (CTCL). The objective of this study was to synthesize reported cases of CTCL in the setting of dupilumab use. Two independent reviewers conducted a systematic review using PubMed and Embase databases. Twelve studies, of 27 total patients, were included. Dupilumab‐associated CTCL was diagnosed on average 7.8 months following dupilumab initiation. Of reports that included body surface area (BSA), 100% had a BSA >50% prior to diagnosis, and the majority of patients were diagnosed at later stages of disease: stage III (4/18) or IV (6/18). Post‐dupilumab biopsies revealed a greater density of cells and a predominant lichenoid pattern, compared to various histologic patterns and less cell density in pre‐dupilumab biopsies. The majority of TCR gene rearrangement studies were equivocal (20%) or negative (60%), posing a potential diagnostic pitfall. Limitations included lack of standardized data collection and reporting and a small number of studies. We suggest that earlier biopsies, three to four months after initiation of dupilumab, may be helpful for earlier recognition of CTCL in patients who are not improving, progressing, or have morphologic changes on dupilumab.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cutaneous T‐cell lymphoma following dupilumab use: a systematic review

et al. 2022

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“…In recent years, several case studies have associated the unmasking or progression of CTCL with dupilumab treatment [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Dupilumab competitively inhibits IL-4 and IL-13 at the IL-4 α1 subunit receptor, preventing the downstream activation of tyrosine kinases promoting gene-transcription and related to both barrier dysfunction and Th2-mediated inflammation [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 2017, dupilumab was approved by the United States Food and Drug Administration (FDA) for the treatment of moderate-to-severe AD in adults uncontrolled with topical medications, becoming the first biologic agent available to treat AD [ 1 ]. Several case studies in recent years have associated unmasking or progression of cutaneous T-cell lymphomas (CTCL) with dupilumab treatment [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. To date, all cases that have reported a CD4:CD8 ratio have shown a greater proportion of CD4+ cells [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Dupilumab-Associated Mycosis Fungoides with a CD8+ Immunophenotype

et al. 2022

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Dupilumab is a humanized IgG4 monoclonal-antibody that is approved by the United States Food and Drug Administration (FDA) for the treatment of moderate-to-severe atopic dermatitis (AD) in patients aged 12 years and older. In recent years, several case studies have associated the unmasking or progression of cutaneous T-cell lymphomas (CTCL) with dupilumab treatment. To date, all reported cases of dupilumab-associated CTCL have shown a CD4+ T-helper-cell-predominant immunophenotype. Here, we report a case of a 72-year-old man who presented with a 2-year history of a diffuse, pruritic eruption, who was started on dupilumab for 9 weeks. He subsequently developed mycosis fungoides (MF) with a CD8+-predominant immunophenotype. Overall, cases of CD8+ mycosis fungoides are less common and relatively less understood than their CD4+ counterparts, with varied presentations and courses. We present a case of dupilumab-associated CD8+ MF to highlight this presentation for pathologists and providers.

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