Case report: Dupilumab leads to an increased chance of head and neck Staphylococcus aureus infection in atopic dermatitis patients.

Dupilumab was the first biological medication licensed to treat atopic dermatitis (AD), and it has shown remarkable effectiveness and safety in the treatment of moderate-to-severe atopic dermatitis. There are limited drug-related adverse events associated with dupilumab in atopic dermatitis (AD) treatment. Here, we present two cases of local Staphylococcus aureus infection during the treatment of atopic dermatitis with dupilumab.

Dupilumab in the Treatment of Cheilitis in Atopic Dermatitis Patients.

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.

Case report: Clinical and histopathological characteristics of psoriasiform erythema and de novo IL-17A cytokines expression on lesioned skin in atopic dermatitis children treated with dupilumab.

Background: Atopic dermatitis (AD) is a chronic recurrent inflammatory disease, and dupilumab, a human monoclonal antibody, is the firstly approved biological drug for AD. Psoriasiform erythema (PE) during dupilumab treatment in adults has been reported. This study describes the risk of PE in children after initiation of dupilumab treatment. Objectives: To evaluate the de novo cytokines gene expression in the transition of atopic dermatitis symptoms to psoriasiform erythema during dupilumab treatment in children. Methods: Two 17-year-old teenage twin patients with AD were included in this study who developed psoriasiform erythema after initiation of dupilumab. The lesional skin biopsy specimens were obtained for the histopathological investigation and RNA Fluorescence In Situ Hybridization (RNA-FISH). Dermoscopy, cytometry (cytokine detection in the blood), and blood investigations were completed for the pedigree and the lesioned descriptions. Results: Two twin patients with AD presented with erythematic scaly plaques on the back, scalp, abdomen, and extensor extremities after 20 weeks of dupilumab treatment. The transitional change of AD to psoriasiform erythema treated with dupilumab was observed. Our subjects' dermoscopy showed pinpoint bleeding and white scales on pink background. Histopathology features showed psoriasiform hyperplasia, epidermal hyperplasia (acanthosis), ectatic capillaries, perivascular lymphocytes infiltration, and parakeratosis, with the absence of the granular cell layer. mRNA (RNA-FISH) cytokines gene expression showed a significantly high concentration of IL-17A. Blood investigation results showed a high concentration of (Immunoglobulin E) IgE and Eosinophils, and cytokines detection in blood showed IL-5,6 and IL-17 in one patient; however, only IL-5 in another patient. The dupilumab was discontinued and initiated with Baricitinib. Baricitinib showed a significant reduction in skin lesions. Conclusion: Psoriasiform erythema can appear during dupilumab treatment in atopic dermatitis children. Potently, by suppressing skewed Th2 activation in patients with AD, the balance might shift toward Th1/Th17 predominance, and psoriasis develops. Baricitinib is a potential drug for psoriasiform erythema with significant therapeutic effects.

Dupilumab-induced Acute Generalized Exanthematous Pustulosis in a 17-year-old Female Chinese Patient with Atopic Dermatitis.

is missing (Short communication).

Clearance of Chronic Actinic Dermatitis With Dupilumab Therapy in Chinese Patients: A Case Series.

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.