Treatment of Atopic Dermatitis with Dupilumab

A new study published in the JAMA Dermatology suggests that treatment of atopic dermatitis with dupilumab is associated with a reversible and benign lymphoid reaction.

Since the increased use of dupilumab for atopic dermatitis (AD) in daily practice, several cases have been reported on the development of cutaneous T-cell lymphomas (CTCL) and lymphoid infiltrates.

A study was conducted to provide insight into the clinical and histopathologic features of patients with AD clinically suspected for cutaneous T-cell lymphomas (CTCL) during dupilumab treatment.

Study Details

This retrospective observational case series included adult (≥18 years) patients with AD treated with dupilumab between October 2017 and July 2022 at the University Medical Center Utrecht in the Netherlands. Relevant patient, disease, and treatment characteristics were evaluated. Skin biopsies before, during, and after treatment were collected and reassessed.

Results

In the research, fourteen patients (54.5% male) with a median (IQR) age of 56 (36-66) years suspected for CTCL with deterioration of symptoms during dupilumab treatment were included. Of 14 patients, 3 were retrospectively diagnosed with preexistent mycosis fungoides (MF). Eleven patients with AD were eventually diagnosed with a lymphoid reaction (LR). These patients showed MF-like symptoms; however, histopathologic findings were different, and included:

• Sprinkled distribution of small hyperchromatic lymphocytes in the upper epidermal section
• A dysregulated CD4:CD8 ratio
• CD30 overexpression, without loss of CD2/CD3/CD5

The median time to clinical worsening was 4.0 months (IQR, 1.4-10.0). Posttreatment biopsies showed complete clearance of the lymphoid reaction in all patients.

This study found that dupilumab treatment can cause a reversible and benign lymphoid reaction which mimics cutaneous T-cell lymphomas (CTCL) though has distinctive histopathologic features.

Reference

Boesjes CM, van der Gang LF, Bakker DS, et al. Dupilumab-Associated Lymphoid Reactions in Patients With Atopic Dermatitis. JAMA Dermatol. Published online October 18, 2023. doi:10.1001/jamadermatol.2023.3849

Keywords

Treatment, atopic, dermatitis, dupilumab, associated, reversible, benign, lymphoid, reaction, Boesjes CM, van der Gang LF, Bakker DS, JAMA Dermatology