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. 2021 May;84(5):1339-1347.
doi: 10.1016/j.jaad.2021.01.012. Epub 2021 Jan 8.

Facial and neck erythema associated with dupilumab treatment: A systematic review

Christine E Jo  1 , Alexandra Finstad  1 , Jorge R Georgakopoulos  2 , Vincent Piguet  3 , Jensen Yeung  4 , Aaron M Drucker  5
Affiliations

Facial and neck erythema associated with dupilumab treatment: A systematic review

Christine E Jo et al. J Am Acad Dermatol. 2021 May.

Abstract

Background: Neither dupilumab-associated facial erythema nor neck erythema was reported in phase 3 clinical trials for the treatment of atopic dermatitis, but there have been a number of reports of patients developing this adverse event in clinical practice.

Objective: To outline all cases of reported dupilumab-associated facial or neck erythema to better characterize this adverse event, and identify potential etiologies and management strategies.

Methods: A search was conducted on EMBASE and PubMed databases. Two independent reviewers identified relevant studies for inclusion and performed data extraction.

Results: A total of 101 patients from 16 studies were reported to have dupilumab-associated facial or neck erythema. A total of 52 of 101 patients (52%) had baseline atopic dermatitis facial or neck involvement and 45 of 101 (45%) reported different cutaneous symptoms from preexisting atopic dermatitis, possibly suggesting a different etiology. Suggested etiologies included rosacea, allergic contact dermatitis, and head and neck dermatitis. Most commonly used treatments included topical corticosteroids, topical calcineurin inhibitors, and antifungal agents. In the 57 patients with data on the course of the adverse events, improvement was observed in 29, clearance in 4, no response in 16, and worsening in 8. A total of 11 of 101 patients (11%) discontinued dupilumab owing to this adverse event.

Limitations: Limited diagnostic testing, nonstandardized data collection and reporting across studies, and reliance on retrospective case reports and case series.

Conclusion: Some patients receiving dupilumab develop facial or neck erythema that differs from their usual atopic dermatitis symptoms. Prompt identification and empiric treatment may minimize distress and potential discontinuation of dupilumab owing to this adverse event.

Keywords: alcohol-induced facial flushing; allergic contact dermatitis; dupilumab; facial erythema; facial flush; facial redness; head and neck dermatitis; rosacea.

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Conflict of interest statement

Conflicts of interest Dr Piguet has received honoraria or fees for consulting or speaking for AbbVie, Almirall, Celgene, Janssen, Novartis, and Pfizer; and has received departmental support for Cardiff University from AbbVie, Almirall, Alliance, Beiersdorf UK Ltd, Biotest, Celgene, Dermal, Eli Lilly, Galderma, Genus Pharma, GlobeMicro, Janssen-Celag, LaRoche-Posay, L’Oréal, LEO Pharma, Meda, MSD, Novartis, Pfizer, Sinclair Pharma, Spirit, Stiefel, Samumed, Thornton Ross, TyPham, and UCB and for University of Toronto from Sanofi. Dr. Yeung has been a speaker, consultant, and investigator for AbbVie, Allergan, Amgen, Astellas, Boehringer Ingelheim, Celgene, Centocor, Coherus, Dermira, Eli Lilly, Forward, Galderma, GSK, Janssen, Leo, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Takeda, UCB, Valeant, and Xenon. In the last 3 years, Dr Drucker has served as an investigator and has received research funding from Sanofi and Regeneron and has been a consultant for Sanofi, RTI Health Solutions, Eczema Society of Canada, and Canadian Agency for Drugs and Technology in Health. He has received honoraria from Prime Inc, Spire Learning, CME Outfitters, Eczema Society of Canada, and the Canadian Dermatology Association. His institution has received educational grants from Sanofi. Dr Georgakopoulos and Authors Jo and Finstad have no conflicts of interest to declare.

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