Dupilumab-associated facial redness not responsive to antifungal therapy successfully treated with tralokinumab

Luca Ambrosio; Ersilia Tolino; Ilaria Proietti; Nicoletta Bernardini; Nevena Skroza; Concetta Potenza

doi:10.23750/abm.v95i5.15784

Dupilumab-associated facial redness not responsive to antifungal therapy successfully treated with tralokinumab

Authors

Luca Ambrosio Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
Ersilia Tolino Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy
Ilaria Proietti Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy
Nicoletta Bernardini Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy
Nevena Skroza Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy
Concetta Potenza Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy

DOI: https://doi.org/10.23750/abm.v95i5.15784

Keywords:

Atopic dermatitis, Dupilumab, trralokinumab, Dupilumab-associated facial redness, Antifungal therapy

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by eczematous lesions and intense itching. Dupilumab, was the first biological drugs approved for this disease. Dupilumab-associated facial redness (DFR), characterized by facial and/or neck erythema, was never reported during pivotal clinical trials. It has been observed in 4-10% of patients treated with dupilumab in real-life settings.A twenty-one-year-old male developed non-pruritic erythematous patches in the frontal, palpebral, malar, latero-cervical, and nuchal areas after about eight weeks of treatment with Dupilumab. Since the patient did not perform patch test before starting dupilumab, to rule out possible allergic contact dermatitis (ACD), patch tests were performed using standard and personal product series pediatric series, which yielded negative results. A skin scraping and a microscopic examination with negative result were performed in order to rule out possible Demodicosis and head and neck dermatitis due to Malassezia species. After conducting a literature review, it was decided to discontinue Dupilumab and start fluconazole therapy. However, this approach did not significantly improve the EASI score for the head/neck region. Due to the negative impact that the Dupilumab therapy-related manifestation had on the patient's quality of life, a decision was made to switch to Tralokinumab. This treatment resulted in the resolution of DFR after only three administrations while maintaining excellent disease control. Tralokinumab also demonstrated an excellent safety profile even after sixteen weeks of treatment. This paper presents what could be the first case of DFR to be successfully treated with Tralokinumab.

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