ABSTRACT
Background/Objectives: The lip is a unique tissue type that acts as a "barrier" to the mouth and receives many external stimuli. It is also a common symptom in atopic dermatitis. Dupilumab was the first targeted biological drug approved for the treatment of moderate-to-severe atopic dermatitis (AD). There is no real-world clinical data on the use of dupilumab in patients with AD and cheilitis. This retrospective study compared the improvement in skin lesions in AD patients with cheilitis after dupilumab treatment and evaluated the improvement in cheilitis. Methods: This is a retrospective case series. We investigated patients with AD treated with dupilumab in our department from September 2020 to May 2022, including those with cheilitis. Demographic information such as age, sex, AD or other atopy history, and the anatomical site of dermatitis was collected. Disease severity was assessed using the eczema area and severity index score (EASI), body surface area (BSA), and severity assessment of cheilitis (the cheilitis symptom score) at baseline and after 16 weeks. Results: We reviewed 96 patients treated with dupilumab for AD, and including the 10 patients with cheilitis (10.4%). All patients demonstrated significant improvement in skin lesions, and lip symptoms improved in seven patients. Among AD patients with improved cheilitis, the average reduction in EASI was 35.0% for BSA (34.9%) and the cheilitis symptom score was 29.9% at week 8. At week 16, compared with the baseline score, the improvement in cheilitis symptom scores was 58.1%, EASI was 60.8%, and BSA was 56.2%, respectively. Conclusion: Effective treatment of both the skin and cheilitis was achieved with dupilumab. The improvement in cheilitis involvement was slower than that in skin lesions. This case series confirms that dupilumab could be a valuable approach for treating patients with atopic dermatitis-associated lip involvement.
ABSTRACT
INTRODUCTION: Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis (IH), is a rare variant of generalized pustular psoriasis (GPP) in pregnancy. It typically occurs in the third trimester and is a life-threatening condition for both the pregnant mother and the fetus if not diagnosed and treated promptly. Drug-induced PPP has been reported in sporadic case reports. Here we present a case of first-trimester PPP occurring after applying drugs including chloroquine, which we consider a possible culprit triggering the disease. CASE REPORT: A 29-year-old female was admitted to our department at 45 days gestation with sudden onset of fever and widespread erythematous pustules for 9 days. She had been on medications including hydroxychloroquine before onset. The eruptions and systemic symptoms were controlled with high-dose systemic steroids; however, she was detected to have a stillbirth, and underwent dilation and curettage of the uterine. At the latest follow-up about 2 years after her admission, she reported to have delivered a healthy baby about 1 month previously. CONCLUSIONS: Chloroquine has potential to lead to PPP in the first trimester of pregnancy. Further studies are warranted to investigate the etiology and treatment of PPP to facilitate early recognition and optimal management of this relatively rare dermatosis in pregnancy.
ABSTRACT
Chronic actinic dermatitis (CAD) is a rare chronic immunological photo-dermatosis resulting in pruritic eczematous eruption on sun-exposed skin to ultraviolet (UV) light. The disease mechanism may include a delay-type hypersensitivity reaction to an endogenous photo-induced antigen, postulated to be UVR-altered DNA, but the exact pathophysiology is unknown. Minimum erythema dosing and patch testing are diagnostic tools of CAD. There are limited safe and effective treatment options for CAD. Herein, a case series of three patients with severe recalcitrant CAD is presented after being treated with dupilumab off-label. The patients in this study had persistent severe disease and taken the first-line management plan, which consists of topical calcineurin inhibitors (TCI), topical corticosteroids (TCS), and strict photoprotection. However, the above treatment options were not able to control the symptoms. The patients were treated with dupilumab 600 mg first dose, 300 mg biweekly subcutaneously (SC), and hydroxychloroquine. Dupilumab showed excellent clinical benefits, including safe and well-tolerated in chronic actinic dermatitis. Further studies are required to be carried out before being applied in clinical practice.
