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Dupilumab for the Treatment of Atopic Dermatitis in an Austrian Cohort-Real-Life Data Shows Rosacea-Like Folliculitis.

J Clin Med. 2020 Apr 24;9(4):

Authors: Quint T, Brunner PM, Sinz C, Steiner I, Ristl R, Vigl K, Kimeswenger S, Neubauer K, Pirkhammer D, Zikeli M, Hoetzenecker W, Reider N, Bangert C

Dupilumab is the first biological treatment approved for moderate-to-severe atopic dermatitis (AD). Efficacy and safety have been demonstrated in clinical trials, but real-life data is still limited. The objective of this study was to retrospectively evaluate Dupilumab treatment in AD patients in a real-life clinical setting. Effectiveness and safety outcomes were collected at baseline and after 2, 6, 10, 24, 39, and 52 weeks by using clinical scores for disease activity, as well as serological markers. Ninety-four patients from five dermatological hospitals were included. After 24 weeks of treatment, the median Investigator Global Assessment (IGA) and Eczema Area and Severity Index (EASI) showed a significant reduction compared to baseline (3.9 ± 0.7 vs. 1.4 ± 0.8 and 26.5 ± 12.5 vs. 6.4 ± 6.5). Interestingly, we observed rosacea-like folliculitis as an unexpected side effect in 6.4% of patients. Dupilumab proves to be an effective and well-tolerated treatment under real-life conditions. The occurrence of rosacea-like folliculitis warrants further mechanistic investigation.

PMID: 32344789 [PubMed]

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Wikipedia notes about this treatment, "As of 2019 it costs about US$46,000 per year."

"In conclusion, dupilumab is a safe and effective treatment option for patients with moderate-to-severe atopic dermatitis and in specific subsets of patients with asthma."
Hum Vaccin Immunother. 2019; 15(9): 2129–2139.
A review of dupilumab in the treatment of atopic diseases
Quinn Thibodeaux, Mary Patricia Smith, Karen Ly, Kristen Beck, Wilson Liao, and Tina Bhutani

Side Effects & Risks

"We describe a paradoxical erythema in a head and neck distribution that developed in patients with AD during dupilumab treatment."

Br J Dermatol. 2020 Oct; 183(4): 745–749.
Clinical and histopathological characterization of paradoxical head and neck erythema in patients with atopic dermatitis treated with dupilumab: a case series
L.E.M. de Wijs,  N.T. Nguyen,  A.C.M. Kunkeler,  T. Nijsten,  J. Damman,   D.J. Hijnen

"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."

J Am Acad Dermatol. 2021 Jan 08;:
Facial and neck erythema associated with dupilumab treatment: A systematic review.
Jo CE, Finstad A, Georgakopoulos JR, Piguet V, Yeung J, Drucker AM

"We recommend that pediatricians consider Demodex potentially etiologic in patients presenting with new onset acneiform or rosacea-like dermatoses in patients treated with dupilumab."

Demodex Folliculitis and Recent Dupilumab Administration

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