Dupilumab-resistant facial erythema - Dermoscopic, histological and clinical findings of three patients

• Published in: Allergology International Vol. 70; no. 1; pp. 156 - 158
• Main Authors: Nakanishi, Mari, Tamagawa-Mineoka, Risa, Arakawa, Yukiyasu, Masuda, Koji, Katoh, Norito
• Format: Journal Article
• Language: English; Japanese
• Published: England Elsevier B.V 01.01.2021; JAPANESE SOCIETY OF ALLERGOLOGY; Elsevier
• ISSN: 1323-8930; 1440-1592
• DOI: 10.1016/j.alit.2020.07.001

Dear Editor, Some atopic dermatitis (AD) patients have facial redness that is resistant to dupilumab, even though the lesions on other parts of their body are responsive to treatment. The reason for this phenomenon is unclear. We report the dermoscopic, histological, and clinical findings of dupilumab-resistant facial erythema (DRFE). Case 1: A 49-year-old female patient had suffered from AD and used topical corticosteroids on her face, trunk, and extremities from childhood. Before she was treated with dupilumab, her face exhibited erythema and lichenification with mild itching. We performed a pretreatment biopsy of her cheek erythema, which showed epidermal acanthosis with spongiosis, perifollicular inflammatory infiltrates, composed of histiocytes and lymphocytes, and dilated superficial vessels. After 52 weeks of dupilumab treatment, the lichenification lesions had gradually improved; however, the facial erythema remained; i.e., she had DRFE.