Abstract：
OBJECTIVE: Psoriasiform eruptions after initiation of dupilumab have been previously described in adults. This report details the risk of developing or unmasking psoriasiform eruptions after initiation of dupilumab in children.
METHODS: Records of patients ≤18 years of age with atopic dermatitis who developed psoriasiform dermatitis during treatment with dupilumab were reviewed retrospectively.
RESULTS: Six children, 4-18 years of age, on dupilumab for severe atopic dermatitis developed new-onset psoriasiform dermatitis at a median duration of 8 months (range, 6-12 months) after dupilumab initiation. Typical locations of psoriasis were involved (face, scalp, trunk, and extensor extremities). The majority showed clearance or near clearance with the use of medium-strength to potent topical corticosteroid ointments and 83% continued use of the dupilumab. A 7th patient had psoriasis, in addition to severe atopic dermatitis, and the psoriasis was unmasked by its failure to respond to dupilumab.
CONCLUSIONS: Although unusual, psoriasiform lesions can appear during effective treatment with dupilumab for atopic dermatitis, potentially reflecting a shift toward cutaneous IL-23/TH 17 pathway activation with dupilumab-induced suppression of type 2 immunity.
METHODS: Records of patients ≤18 years of age with atopic dermatitis who developed psoriasiform dermatitis during treatment with dupilumab were reviewed retrospectively.
RESULTS: Six children, 4-18 years of age, on dupilumab for severe atopic dermatitis developed new-onset psoriasiform dermatitis at a median duration of 8 months (range, 6-12 months) after dupilumab initiation. Typical locations of psoriasis were involved (face, scalp, trunk, and extensor extremities). The majority showed clearance or near clearance with the use of medium-strength to potent topical corticosteroid ointments and 83% continued use of the dupilumab. A 7th patient had psoriasis, in addition to severe atopic dermatitis, and the psoriasis was unmasked by its failure to respond to dupilumab.
CONCLUSIONS: Although unusual, psoriasiform lesions can appear during effective treatment with dupilumab for atopic dermatitis, potentially reflecting a shift toward cutaneous IL-23/TH 17 pathway activation with dupilumab-induced suppression of type 2 immunity.
摘要：
目的：之前已经在成人中描述了dupilumab开始后的Psoriasiform爆发。本报告详细介绍了在儿童开始使用dupilumab后发生或掩盖银屑病样爆发的风险。
方法：回顾性分析了在使用dupilumab治疗期间发生银屑病样皮炎的≤18岁特应性皮炎患者的记录。
结果：六个孩子，4-18岁,在dupilumab治疗严重特应性皮炎时，中位持续时间为8个月（范围，dupilumab开始后6-12个月）。涉及银屑病的典型部位（面部，头皮,树干,和伸肌四肢）。使用中等强度至强效局部皮质类固醇软膏，大多数显示清除或接近清除，83％继续使用dupilumab。第七位病人得了牛皮癣,除了严重的特应性皮炎，牛皮癣因对dupilumab无反应而被揭露.
结论：虽然不寻常，在用dupilumab有效治疗特应性皮炎期间可出现银屑病样病变，可能反映了dupilumab诱导的2型免疫抑制向皮肤IL-23/TH17通路激活的转变。
方法：回顾性分析了在使用dupilumab治疗期间发生银屑病样皮炎的≤18岁特应性皮炎患者的记录。
结果：六个孩子，4-18岁,在dupilumab治疗严重特应性皮炎时，中位持续时间为8个月（范围，dupilumab开始后6-12个月）。涉及银屑病的典型部位（面部，头皮,树干,和伸肌四肢）。使用中等强度至强效局部皮质类固醇软膏，大多数显示清除或接近清除，83％继续使用dupilumab。第七位病人得了牛皮癣,除了严重的特应性皮炎，牛皮癣因对dupilumab无反应而被揭露.
结论：虽然不寻常，在用dupilumab有效治疗特应性皮炎期间可出现银屑病样病变，可能反映了dupilumab诱导的2型免疫抑制向皮肤IL-23/TH17通路激活的转变。
