A case of dupilumab‐resistant facial erythema successfully managed with topical delgocitinib

The Journal of Dermatology, Journal Year: 2025, Volume and Issue: unknown

Published: March 24, 2025

Dupilumab is a human monoclonal immunoglobulin antibody blocking the interleukin–4/13 pathway and used to treat moderate-to-severe atopic dermatitis (AD). There are increasing reports of dupilumab-resistant facial erythema (DRFE),1 which characterized by persistent despite significant improvement other lesions. Herein, we present case DRFE successfully managed with topical delgocitinib, pan Janus kinase (JAK) inhibitor. A 62-year-old Japanese man presented 14-year history adult-onset AD. He had no prior allergic contact (ACD). Disease control remained inadequate daily oral cyclosporine (CyA; 100–200 mg/day) use corticosteroids, including class II for body extremities III face. Consequently, treatment was transitioned dupilumab (600 mg at week 0, followed 300 every 2 weeks, subcutaneously). Before initiation dupilumab, eczema area severity index (EASI) 21.6, EASI 7.2 head neck 14.4 areas (Figure 1a). Two months resulted in improved skin conditions on his trunk extremities, 1.5 this area, allowing reduction CyA dose 50 mg/day. However, persistent, 4.75 1b), treatments such as tacrolimus ketoconazole were attempted but proved ineffective, 4.5 neck. As showed limited amelioration areas, leading diagnosis DRFE, delgocitinib (0.5%) initiated. 1c). After discontinued, well-controlled delgocitinib. may be associated seborrheic dermatitis, rosacea, ACD. Some patients respond antifungal treatment,2 implicating fungal colonization pathogenesis DRFE,2 while others rosacea-like telangiectasia,1 patch testing reveals shampoo ingredient sensitivity certain cases.3 Gene expression analysis revealed elevated Th1/Th17-associated markers, IP-10, MIG, IL-17, forehead lesions AD patients. This finding reflect Malassezia- or Demodex-related inflammation sebum-rich allergen-induced responses.4 In our case, efficacy pan-JAK inhibitor explained its ability suppress non-Th2 inflammatory pathways. because immune response, Th1/17 signaling pathway, differs between face areas. Key limitations lack diagnostic confirmation underlying through histopathology, microscopic examination scrapings potassium hydroxide, testing, dermoscopic examinations, serum IgE levels Malassezia, well impossibility exclude delayed effects dupilumab. While has been reported improve that newly develops after starting dupilumab,5 specifically demonstrates potential resistance treatment. Further studies needed validate better delineate mechanisms. None declared. The patient manuscript given written informed consent participation study their de-identified, anonymized, aggregated data details publication. support findings available request from corresponding author. not publicly due privacy ethical restrictions.

Language: Английский

The immune network across organs

Allergology International, Journal Year: 2025, Volume and Issue: 74(2), P. 175 - 176

Published: March 30, 2025

Language: Английский