Head and Neck Dermatitis Can Develop or Worsen With Dupilumab Treatment

By Reuters Staff

September 09, 2019

NEW YORK (Reuters Health) - Patients treated for atopic dermatitis with dupilumab can develop or experience worsening of head and neck dermatitis, according to a retrospective study.

Studies on the effects of dupilumab, a humanized monoclonal antibody targeting the alpha subunit of the interleukin-4 and interleukin-13 receptors, have yielded inconsistent results, with one showing consistent improvement of atopic dermatitis across anatomic regions and another reporting new regional dermatoses during treatment.

Dr. Angele Soria from Hopital Tenon, APHP, in Paris, and colleagues in the GREAT Research Group evaluated the development or exacerbation of head and neck dermatitis in patients treated for atopic dermatitis with dupilumab.

Among 1,000 adult patients treated for atopic dermatitis with dupilumab, they identified 42 patients (4.2%) from 29 centers with head and neck dermatitis, including 32 with exacerbation (more than 50% worsening) and 10 with de novo occurrences, the researchers report in JAMA Dermatology, online September 4.

These cases occurred a mean 65.4 days (range, 5-365 days) after initiation of dupilumab therapy. Nearly half the patients (20/42, 48%) had concomitant ocular adverse effects (mainly conjunctivitis).

Treatments included topical tacrolimus, steroids and antifungal agents, and four cases received systemic antifungal agents. With treatment, 22 patients experienced improvement of head and neck dermatitis, eight worsened and five had persistent dermatitis.

Dupilumab therapy had to be discontinued as a result of head and neck dermatitis severity in four cases and as a result of concomitant ocular and head and neck dermatitis involvement in one case.

Possible explanations for this phenomenon, the authors suggest, include a flare of atopic dermatitis resulting from topical steroid withdrawal during dupilumab therapy; modulation of T helper cell signaling due to interleukin-4 receptor alpha blockade, unmasking an allergic contact dermatitis; and activation of the TH17 pathway, leading to a proliferation of Malassezia fungus, which is predominantly localized in the sebaceous head and neck area.

Dr. Soria did not respond to a request for comments.

SOURCE: https://bit.ly/2kxNRXj

JAMA Dermatol 2019.