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. 2021 Nov;38(6):1500-1505.
doi: 10.1111/pde.14820. Epub 2021 Oct 14.

Psoriasiform dermatitis during dupilumab treatment for moderate-to-severe atopic dermatitis in children

Jennifer J Parker  1 , Jeffrey L Sugarman  2 , Nanette B Silverberg  3 , Mercedes Elena Gonzalez  4 , Michele L Ramien  4 , Joyce M C Teng  5   6 , Amy S Paller  1
Affiliations

Psoriasiform dermatitis during dupilumab treatment for moderate-to-severe atopic dermatitis in children

Jennifer J Parker et al. Pediatr Dermatol. 2021 Nov.

Abstract

Background/objectives: Psoriasiform eruptions after initiation of dupilumab have been previously described in adults. This report details the risk of developing or unmasking psoriasiform eruptions after initiation of dupilumab in children.

Methods: Records of patients ≤18 years of age with atopic dermatitis who developed psoriasiform dermatitis during treatment with dupilumab were reviewed retrospectively.

Results: Six children, 4-18 years of age, on dupilumab for severe atopic dermatitis developed new-onset psoriasiform dermatitis at a median duration of 8 months (range, 6-12 months) after dupilumab initiation. Typical locations of psoriasis were involved (face, scalp, trunk, and extensor extremities). The majority showed clearance or near clearance with the use of medium-strength to potent topical corticosteroid ointments and 83% continued use of the dupilumab. A 7th patient had psoriasis, in addition to severe atopic dermatitis, and the psoriasis was unmasked by its failure to respond to dupilumab.

Conclusion: Although unusual, psoriasiform lesions can appear during effective treatment with dupilumab for atopic dermatitis, potentially reflecting a shift toward cutaneous IL-23/TH 17 pathway activation with dupilumab-induced suppression of type 2 immunity.

Keywords: atopic dermatitis; children; dupilumab; psoriasiform; psoriasis.

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References

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