Clinical and histopathological characterization of paradoxical head and neck erythema in atopic dermatitis patients treated with dupilumab: a case series.

We report on 7 AD patients presenting with a paradoxical head-neck erythema which appeared 10 to 39 weeks after start of dupilumab treatment. Patients presented with a relatively sharp demarcated, patchy erythema in the head and neck area that showed no or less scaling compared to their usual eczema. Only 1 patient experienced symptoms of itch and burning, although this was notably different from his pre-existent facial AD. Except for a notable "red face", eczema on other body parts had greatly improved in 6 out of 7 patients with a mean NRS treatment satisfaction of 9/10 at time of biopsy. Treatment of the erythema with topical and systemic drugs was unsuccessful. Despite the presence of this erythema, none of our patients discontinued dupilumab treatment. Lesional skin biopsies showed an increased number of ectatic capillaries, and a perivascular lymphohistiocytic infiltration in all patients. In addition, epidermal hyperplasia with elongation of the rete ridges was observed in 4 patients, resembling a psoriasiform dermatitis. Additional immunohistochemical stainings revealed increased numbers of plasma cells, histiocytes and T-lymphocytes. Interestingly, spongiosis was largely absent in all biopsies. We report on AD patients treated with dupilumab developing a paradoxical erythema in a head-neck distribution. Both clinically and histopathologically we found a heterogeneous response, which was most suggestive of a drug-induced skin reaction. PMID: 31749159 [PubMed -...
Source: The British Journal of Dermatology - Category: Dermatology Authors: Tags: Br J Dermatol Source Type: research