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KMID : 1149120220190020049
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Journal of the Korean Society for Psoriasis
2022 Volume.19 No. 2 p.49 ~ p.52
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A Case of Psoriasis Developed During Treatment with Dupilumab in Severe Atopic Dermatitis Patient
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Kim Young-Chan
Kim Han-Na
Kim Ko-Eun
Jeon Jie-Hyun
Baek Yoo-Sang
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Abstract
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Dupilumab, a human monoclonal antibody that blocks IL-4 and IL-13 receptors, has been approved for patients with moderate to severe atopic dermatitis. Psoriasiform dermatitis or psoriasis is a rare paradoxical reaction associated with dupilumab. Selectively inhibiting certain type of helper T cell pathway can provoke skewing of T cell polarization to others. Although pathogenesis of dupilumab-induced psoriasis has not been fully elucidated, it is postulated to be caused by shift of balance toward Th17 predominance due to selective suppression of Th2 pathway by dupilumab. A 24-year-old male with severe atopic dermatitis, who had been treated with dupilumab for 9 months, developed multiple well-demarcated erythematous plaques with scales on his back. Histopathology of the lesion revealed typical features of psoriasis, and the diagnosis of dupilumab-induced psoriasis was made. The lesions were significantly improved and well controlled within 3~4 months of applying topical and intra-lesional corticosteroids and topical tacrolimus without discontinuing dupilumab.
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KEYWORD
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Atopic dermatitis, Dupilumab, Paradoxical reaction, Psoriasiform dermatitis, Psoriasis
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