Explore the vast range of titles available.

Biologic therapies have transformed the management of atopic dermatitis (AD) and prurigo nodularis (PN), yet paradoxical adverse events such as dupilumab‐induced psoriasiform eruption (DPE) are increasingly recognized. We report a 48‐year‐old Japanese man with long‐standing AD and PN who developed scaly, erythematous plaques on the elbows, hands, and trunk 5 months after initiating dupilumab. While prurigo nodules had markedly improved, the new lesions resembled psoriasis clinically. A biopsy from the elbow revealed features consistent with psoriasiform dermatitis—regular acanthosis, thickened granular layer, and perivascular lymphocytic infiltration without neutrophils—suggesting DPE rather than true psoriasis. Topical vitamin D3 and corticosteroids were ineffective, prompting a switch to tralokinumab, an IL‐13–specific inhibitor. Following this transition, psoriasiform lesions on the trunk and hands resolved, and PN did not recur. However, plaques on both elbows persisted for over a year and remained after tralokinumab discontinuation. Histologically, these lesions lacked features of psoriasis and were more consistent with PN, suggesting a Th2‐driven relapse mimicking psoriasiform disease. This case highlights the potential of tralokinumab to manage DPE while sustaining PN control but also underscores the heterogeneity of psoriasiform eruptions during type 2 biologic therapy. Not all lesions represent Th1/Th17‐mediated processes; some may reflect residual Th2‐driven disease such as PN with atypical morphology. Histopathological evaluation is essential for distinguishing true paradoxical reactions from overlapping or relapsing dermatoses and for guiding optimal treatment selection in patients receiving targeted immunomodulators.

Atopic dermatitis (AD), a common chronic inflammatory skin disorder in children, often shows limited response to conventional therapies with potential adverse effects. This real-world study evaluated dupilumab-a monoclonal antibody targeting IL-4/IL-13 signaling-in 59 Chinese pediatric patients (aged 6 months-12 years) with moderate-to-severe AD, stratified by body weight. Over a median 33-week follow-up (up to 96 weeks), we dynamically assessed efficacy metrics including Eczema Area and Severity Index (EASI), Peak Pruritus Numerical Rating Scale, and Dermatology Life Quality Index, alongside systematic surveillance of treatment-emergent adverse events (TEAEs). At Week 16, 68.97% (40/58) achieved EASI-75, accompanied by significant symptom relief (68.17% itch reduction; 77.4% quality-of-life improvement). Efficacy persisted beyond Week 16 (>58.82% sustained EASI-75) without age or sex differences. TEAEs occurred in 25.42% (15/59) of patients, primarily conjunctivitis (10.17%) and paradoxical eczema flares (5.08%). Notably, we report the first pediatric cases of acute rash exacerbation within 72 hours post-initial dose (3 patients, EASI increase: 39.90%-61.13%) and a unique late-onset pustular dermatitis with fever. These findings confirm dupilumab's sustained effectiveness and manageable safety in Chinese children with AD while highlighting the need for vigilance against early paradoxical flares and rare inflammatory reactions, providing critical real-world evidence for long-term use in this population.

Keloids and bullous pemphigoid (BP) are two clinically and pathophysiologically distinct dermatologic disorders – the former involves abnormal scar formation due to excess collagen deposition, while the latter is an autoimmune blistering disease. We report a case of a 67-year-old man with a 19-year history of abdominal keloids and the subsequent appearance of vesicular skin lesions. Histopathologic examination revealed both keloidal fibrosis and subepidermal blister formation. Serum testing demonstrated elevated anti-BP180 antibody levels. Initial treatment with topical and systemic agents, including neomycin, glycyrrhizin, spironolactone, and minocycline, resulted in limited improvement. Subsequently, dupilumab – a monoclonal antibody against the interleukin (IL)-4 receptor α – was introduced. After two months of dupilumab therapy, the vesicular lesions resolved, keloids stabilized, serum anti-BP180 antibody levels normalized, and the Dermatology Life Quality Index (DLQI) score decreased from 11 to 2.

Yan Liu,1,2 Shan Wang,1 Ying Liu,1 Dan Yu,3 Qing Wang,3 Yuanyuan Tian,1 Lin Ma1 1Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2Department of Dermatology, Beijing Aerospace General Hospital, Beijing, People’s Republic of China; 3Laboratory of Infection and Microbiology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of ChinaCorrespondence: Lin Ma, Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China, Email bch_maleen@aliyun.comPurpose: We aimed to investigate alterations in the skin microbiome following treatment and discontinuation of dupilumab in children with atopic dermatitis (AD).Methods: In all, 24 pediatric AD patients and 10 pediatric health volunteers (HVs) were included. AD patients were treated with dupilumab for 16 weeks and following by a 12-week discontinuation. Cutaneous samples were collected from HVs, and AD patients at baseline and during dupilumab application period (Week 2, Week 4, Week 8, Week 12, and Week 16) and discontinuation period (Week 22 and Week 28) to conduct sequencing targeting the 16s rRNA V3-V4 regions. Clinical severity was assessed using the Eczema Area and Severity Index (EASI), Individual Signs Score (ISS), Children’s Dermatology Life Quality Index scores (CDLQI), Patient Oriented Eczema Measure (POEM), and peak pruritus Numerical Rating Scale (NRS itch).Results: Dupilumab treatment significantly improved AD characteristics, with reductions in EASI, ISS, CDLQI, POEM, and NRS itch scores (all P < 0.01). Concurrently, 16s rRNA sequencing indicated decline in Staphylococcus aureus abundance and increase in microbial diversity. These changes began to reverse upon treatment discontinuation, coinciding with a trend toward worsening EASI scores. Moreover, a dupilumab-responsive reduction in other bacterial genera such as Aggregatibacter, and Megasphaera were observed; and these alterations could be reversed after treatment cessation.Conclusion: We provided a dynamical pattern of skin bacterial community during and after dupilumab therapy in pediatric AD patients. Our findings suggest that the therapeutic action of dupilumab may extend to modulating a wider range of bacteria than previously recognized. The roles of our identified candidate microbial taxa require further investigation in larger and functional studies.Keywords: atopic dermatitis, dupilumab, pediatrics, Staphylococcus aureus, microbiome

Dear Editor, We present a rare but clinically significant case of acute generalized exanthematous pustulosis (AGEP) following the administration of dupilumab in a patient with refractory atopic dermatitis (AD). While dupilumab is widely regarded as a safe and effective biologic agent for moderate-to-severe AD across age groups – including adolescents, adults, and increasingly children – emerging reports underscore the need to remain vigilant for uncommon, severe cutaneous reactions. [...]

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and significantly impacts patients’ lives, particularly in its severe forms. AD clinical presentation varies over the course of the disease, throughout different age groups, and across ethnicities. AD is characterized by a spectrum of clinical phenotypes as well as endotypes. Starting from the current description of AD pathogenesis, this review explores the rationale of approved AD therapies from emollients to biologicals and introduces novel promising drugs.

Dupilumab, a monoclonal antibody targeting the IL-4/13 signaling pathway, effectively treats moderate-to-severe atopic dermatitis (AD). Common side effects include injection site reactions, conjunctivitis, and respiratory infections. We report the case of a 28-year-old woman with severe AD involving the periocular and chin regions, genital areas, arms, and legs (Eczema Area and Severity Index [EASI]: 24, itch Visual Analog Scale [VAS]: 8) who showed significant improvement after initiating dupilumab therapy. However, following ketoprofen intake for headache relief, she developed a lupus-like erythematous maculopapular rash on the periocular and malar regions. Immunological tests (antinuclear antibody [ANA] and extractable nuclear antigen [ENA]) and photopatch testing ruled out autoimmune or allergic causes. Dupilumab was stopped, and treatment with oral prednisone and cetirizine led to complete resolution. This case highlights a potential drug interaction between dupilumab and ketoprofen, emphasizing the need for awareness of paradoxical facial erythema reactions in patients undergoing dupilumab therapy.

Background Dupilumab has been shown to be an effective treatment in moderate‐to‐severe atopic dermatitis (AD) and severe asthma (SA). However, comparative real‐world analyses of adverse events (AE), particularly dupilumab‐associated ocular surface disease (DAOSD), are lacking. Objective This is the first real‐world study to provide insight into the prevalence of AEs associated with dupilumab in AD compared with SA. Secondary objectives were to assess the prevalence, onset and therapeutic strategies of DAOSD and evaluate dupilumab discontinuation rates. Methods Data from two daily practice registries including AD and SA patients receiving dupilumab treatment were analyzed. Adverse events, including DAOSD, were evaluated. Results In total, 322 AD and 148 SA patients were included. Headaches (23.6%), injection site reactions (10.1%), and influenza‐like symptoms (13.5%) were more prevalent in SA patients. Interestingly, ocular AEs were significantly more prevalent in AD patients (62.1%, p < 0.001), including conjunctivitis (17.1%, p = 0.004). 88% AD and 47% SA patients with ocular AEs received one or more ophthalmic treatment(s). Additionally, 20% of AD and 17.6% of SA patients discontinued dupilumab treatment due to ocular AEs, while only 65% of these AD and none of these SA patients were referred to an ophthalmologist. Conclusion The higher incidence of DAOSD in AD patients compared with SA patients in this real‐world study highlights the importance of physician awareness, especially when prescribing dupilumab to AD patients. Conversely, the findings of this study help alleviate potential concerns about ocular AEs in patients with SA who do not have comorbid AD. Furthermore, the effective management of most ocular AEs with ophthalmic treatments suggests favorable tolerability of dupilumab in daily practice, and multidisciplinary collaboration is essential to proactively manage ocular AEs before discontinuing dupilumab.

BackgroundBullous pemphigoid (BP) is the most common autoimmune subepidermal bullous disease of the skin. First-line treatment of systemic corticosteroids may cause serious adverse events. Rituximab, omalizumab, and dupilumab should be explored as alternative treatment options to improve outcomes.ObjectiveTo systematically review the rituximab, omalizumab, and dupilumab treatment outcomes in bullous pemphigoid.MethodsA PubMed, Embase, Web of Science, and Cochrane library search were conducted on March 10, 2022. A total of 75 studies were included using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.ResultsUse of rituximab (n=122), omalizumab (n=53) and dupilumab (n=36) were reported in 211 patients with BP. Rituximab led to complete remission in 70.5% (n=86/122) and partial remission in 23.8% (n=29/122) of patients within 5.7 months, with a recurrence rate of 20.5% (n=25/122). 9.0% (n=11/122) of patients died and infection (6.6%, n=8/122) was the most common adverse event. Omalizumab led to complete remission in 67.9% (n=36/53) and partial remission in 20.8% (n=11/53) of patients within 6.6 months, with a recurrence rate of 5.7% (n=3/53). 1.9% (n=1/53) of patients died and thrombocytopenia (1.9%, n=1/53) was observed as the most common adverse event. Dupilumab led to complete remission in 66.7% (n=24/36) and partial remission in 19.4% (n=7/36) of patients within 4.5 months of treatment without any reported adverse events, with a recurrence rate of 5.6% (n=2/36).ConclusionsRituximab, omalizumab, and dupilumab have similar clinical benefits for BP patients. However, rituximab resulted in higher recurrence rates, adverse events, and mortality rates.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022316454.