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Patch Testing in Patients With Severe Atopic Dermatitis Treated With Dupilumab: A Multicentric Approach in Spain
Alexandre Docampo-Simón1, María J Sánchez-Pujol1, Maria A Pastor-Nieto2
1From the Dermatology Department, Hospital General Universitario de Alicante, Alicante, Spain.
Dermatitis : Contact, Atopic, Occupational, Drug
|March 31, 2023
Summary
Persistent localized dermatitis and eczema flare-ups in atopic dermatitis patients on dupilumab were often due to poorly controlled disease, not allergic contact dermatitis. Dupilumab may affect patch test results.
Area of Science:
- Dermatology
- Immunology
- Allergology
Background:
- Atopic dermatitis (AD) patients treated with dupilumab can experience persistent localized dermatitis (PLD) or eczema flare-ups (EF).
- These events may sometimes be linked to concomitant allergic contact dermatitis (ACD) unmasked by dupilumab's Th2 pathway inhibition.
Purpose of the Study:
- To determine the prevalence and causes of PLD and EF in AD patients undergoing dupilumab therapy.
- To assess the impact of dupilumab on patch test outcomes in this patient cohort.
Main Methods:
- Patch testing was conducted on 54 AD patients receiving dupilumab.
- Prevalence and diagnoses of EF and PLD were evaluated, alongside patch test results.
Main Results:
- Patch test positivity was observed in 37.0% of patients.
- PLD affected 38.9% and EF affected 22.2%; 18.5% experienced both.
- The majority of PLD/EF cases were attributed to inadequately controlled AD (83.9% and 90.9%, respectively), with only a small percentage diagnosed with ACD (9.7% and 4.5%).
- Patch test results showed variability over time, with 42.9% of patients tested twice showing changes.
Conclusions:
- Patch testing is valuable for ruling out ACD as a cause of PLD/EF in dupilumab-treated AD patients.
- Most PLD and EF in this context are likely manifestations of poorly controlled AD.
- Dupilumab treatment appears to influence patch test outcomes.
