Title : Development of drug-associated psoriasis vulgaris following dupilumab therapy
Abstract:
Biologics are a type of medication often derived from a natural source such as an animal or microorganism, and are designed to target specific components of the immune system. Of the variety of biologics that currently exist, dupilumab is most notably utilized in the treatment of severe atopic dermatitis that has failed conventional therapies. Dupilumab treats atopic dermatitis by inhibiting pro-inflammatory cytokine signaling, specifically IL-4 and IL-13; critical players in the disease pathogenesis. These cytokines, secreted by type 2 helper T cells (Th2), contribute to epidermal thickening, inflammation, and pruritus. While dupilumab effectively suppresses Th2-driven inflammation, it may shift immune responses toward Th1 and Th17 pathways, which are implicated in psoriasis pathogenesis. In this case, the patient was a 50-year-old woman with chronic, refractory atopic dermatitis who had no personal or family history of psoriasis. After ten months of dupilumab therapy, she developed well-demarcated plaques with a silvery scale on her occipital scalp and inner ear canal. These findings on physical exam were consistent with psoriasis vulgaris and the patient was diagnosed by clinical observation. While biologics like dupilumab come with known immunomodulatory risks, chronic inflammatory conditions such as psoriasis are not widely recognized as adverse effects of dupilumab therapy. Though rare, cases like this suggest these events are unlikely to be purely coincidental, highlighting the need for further research into the immunological mechanisms underlying such reactions. A deeper understanding of why these rare events occur, whether due to epigenetic factors or other unknown immune interactions, is crucial in optimizing the safety and efficacy of biologic therapies.
