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

J Am Acad Dermatol. 2021 Jan 08;:

Authors: Jo CE, Finstad A, Georgakopoulos JR, Piguet V, Yeung J, Drucker AM

Abstract
BACKGROUND: Dupilumab-associated facial and/or neck erythema was not 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 and/or neck erythema to better characterize this adverse event, 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 and/or neck erythema. 52/101 (52%) had baseline atopic dermatitis facial and/or neck involvement and 45/101 (45%) reported different cutaneous symptoms from pre-existing 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 AE, improvement was seen in 29, clearance in 4, no response in 16, and worsening in 8 patients. 11/101 (11%) discontinued dupilumab due to this adverse event.
LIMITATIONS: Limited diagnostic testing, non-standardized data collection and reporting across studies, and reliance on retrospective case reports and case series.
CONCLUSION: Some patients on dupilumab develop facial and/or neck erythema which differs from their usual atopic dermatitis symptoms. Prompt identification and empiric treatment may minimize distress and potential discontinuation of dupilumab due to this adverse event.

PMID: 33428978 [PubMed - as supplied by publisher]

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