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

Jennifer J. Parker, Jeffrey L. Sugarman, Nanette B. Silverberg, Mercedes Elena Gonzalez, Michele L. Ramien, Joyce M.C. Teng, Amy S. Paller*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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/TH17 pathway activation with dupilumab-induced suppression of type 2 immunity.

Original languageEnglish (US)
Pages (from-to)1500-1505
Number of pages6
JournalPediatric dermatology
Volume38
Issue number6
DOIs
StatePublished - Nov 1 2021

Keywords

  • atopic dermatitis
  • children
  • dupilumab
  • psoriasiform
  • psoriasis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Dermatology

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