Phelps-Polirer Kendall, Alkhatib Bailey L, Davis Charles
Internal Medicine, USF Health, Bradenton, USA.
Infectious Disease, University of South Carolina School of Medicine, Columbia, USA.
Cureus. 2022 Jul 29;14(7):e27439. doi: 10.7759/cureus.27439. eCollection 2022 Jul.
Atopic dermatitis is a condition characterized by xerotic and pruritic skin. While the onset of the disease is usually in childhood, it may persist into adulthood. First-line treatments include adequate moisturization, avoidance of irritants, and the application of topical corticosteroids. Dupilumab is a biologic therapy, approved for moderate-to-severe atopic dermatitis, that dampens the pruritus sensation by inhibiting the downstream effects of the T helper cell type 2 pathway by binding to the interleukin-4 receptor α subunit. The monoclonal antibody is typically well-tolerated. We present a novel case of the development of generalized granuloma annulare after treatment with dupilumab. A 71-year-old male with a history of hypertension, hyperlipidemia, chronic kidney disease, gout, and bipolar disorder presented to clinic with biopsy-proven severe atopic dermatitis. First-line treatments had been exhausted, and the patient was not an ideal candidate for traditional systemic options secondary to his poor renal function. Therapy with dupilumab was initiated and continued for two years until the patient developed biopsy-proven generalized granuloma annulare. At this time, dupilumab was discontinued and the pharmaceutical company was made aware of this side effect.
特应性皮炎是一种以皮肤干燥和瘙痒为特征的疾病。虽然该病通常在儿童期发病，但可能会持续到成年期。一线治疗包括充分保湿、避免刺激物以及外用糖皮质激素。度普利尤单抗是一种生物疗法，被批准用于治疗中重度特应性皮炎，它通过与白细胞介素-4受体α亚基结合来抑制2型辅助性T细胞途径的下游效应，从而减轻瘙痒感。这种单克隆抗体通常耐受性良好。我们报告了一例在用度普利尤单抗治疗后发生泛发性环状肉芽肿的新病例。一名71岁男性，有高血压、高脂血症、慢性肾病、痛风和双相情感障碍病史，因活检证实为重度特应性皮炎前来就诊。一线治疗均已用尽，且由于其肾功能不佳，该患者并非传统全身治疗方案的理想人选。开始使用度普利尤单抗治疗并持续了两年，直到患者经活检证实发生了泛发性环状肉芽肿。此时，停用了度普利尤单抗，并告知了制药公司这一副作用。
