Ogawa Hiroki, Izumi Kentaro
Dermatology, KKR Sapporo Medical Center, Sapporo, JPN.
Cureus. 2025 Apr 3;17(4):e81636. doi: 10.7759/cureus.81636. eCollection 2025 Apr.
Dupilumab is a monoclonal antibody targeting the interleukin-4 (IL-4) and interleukin-13 (IL-13) receptor complex and is used for the treatment of atopic dermatitis (AD), severe asthma, chronic rhinosinusitis with nasal polyps, and prurigo nodularis (PN). Dupilumab has shown high efficacy in PN; however, adverse effects such as conjunctivitis, injection site reactions, and pharyngitis have been reported. Meanwhile, dupilumab-induced psoriasis is a relatively rare adverse effect. Here, we present a case of a 71-year-old woman with a seven-year history of PN that was refractory to topical corticosteroids and narrow-band ultraviolet B (UVB) therapy. The patient received dupilumab injections every two weeks, resulting in an improvement in pruritic nodules. However, three months after the initiation of dupilumab, multiple scaly erythematous plaques appeared on the trunk and extremities. Skin biopsy revealed parakeratosis, regular acanthosis with epidermal thickening, loss of the granular layer, and subcorneal neutrophilic infiltration. Based on these findings, the patient was diagnosed with dupilumab-induced psoriasis. After discontinuing dupilumab and initiating topical corticosteroid therapy, the psoriatic lesions showed significant improvement within three months. Psoriasis induced by dupilumab has been documented in multiple reports involving patients with atopic dermatitis. Only one case of dupilumab-induced psoriasis in a PN patient has been reported, which was limited to the scalp. To the best of our knowledge, this case represents the first report of extensive psoriasiform lesions on the trunk and extremities in a PN patient. While mild cases may be managed without discontinuing dupilumab, severe cases may require cessation of the drug. This case highlights the first report of extensive psoriasiform lesions in a PN patient with dupilumab. Dermatologists should be aware that dupilumab can induce psoriasiform lesions in PN patients and should conduct careful monitoring during treatment. Additionally, discontinuation of dupilumab should be considered in severe cases.
度普利尤单抗是一种靶向白细胞介素-4（IL-4）和白细胞介素-13（IL-13）受体复合物的单克隆抗体，用于治疗特应性皮炎（AD）、重度哮喘、伴有鼻息肉的慢性鼻-鼻窦炎和结节性痒疹（PN）。度普利尤单抗在PN中显示出高疗效；然而，已报告有结膜炎、注射部位反应和咽炎等不良反应。同时，度普利尤单抗诱发的银屑病是一种相对罕见的不良反应。在此，我们报告一例71岁女性，有7年PN病史，对局部糖皮质激素和窄谱中波紫外线（UVB）治疗无效。该患者每两周接受一次度普利尤单抗注射，瘙痒性结节有所改善。然而，在开始使用度普利尤单抗三个月后，躯干和四肢出现了多个鳞屑性红斑斑块。皮肤活检显示角化不全、表皮增厚伴规则性棘层肥厚、颗粒层消失和角质层下中性粒细胞浸润。基于这些发现，该患者被诊断为度普利尤单抗诱发的银屑病。停用度普利尤单抗并开始局部糖皮质激素治疗后，银屑病皮损在三个月内有显著改善。度普利尤单抗诱发的银屑病在多份涉及特应性皮炎患者的报告中已有记载。仅报告过一例PN患者发生度普利尤单抗诱发的银屑病，且仅限于头皮。据我们所知，本病例是首例关于PN患者躯干和四肢出现广泛银屑病样皮损的报告。轻度病例可能无需停用度普利尤单抗即可处理，而重度病例可能需要停药。本病例突出了首例PN患者使用度普利尤单抗后出现广泛银屑病样皮损的报告。皮肤科医生应意识到度普利尤单抗可在PN患者中诱发银屑病样皮损，在治疗期间应进行仔细监测。此外，重度病例应考虑停用度普利尤单抗。
