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Pretreatment Demodex infestation predicts dupilumab-associated blepharoconjunctivitis in atopic dermatitis
Paulina Stepinska1, Kamila Zawadzinska-Halat1, Maciej Pastuszczak1
1Clinical Department of Dermatology, Medical University of Silesia, Zabrze, Poland.
Background:
Dupilumab has revolutionized treatment of moderate-to-severe atopic dermatitis (AD). However, its use has been associated with ophthalmologic adverse events referred to as dupilumab-associated ocular surface disease (DAOSD), reported in up to 30% of patients. Although several risk factors have been proposed, the role of Demodex folliculorum remains poorly defined.
Objectives:
To evaluate the association between eyelid Demodex infestation and DAOSD development during the first 16 weeks of dupilumab therapy.
Methods:
This prospective study enrolled 30 adults with moderate-to-severe AD initiating dupilumab. All patients underwent ophthalmologic evaluation, Ocular Surface Disease Index (OSDI) scoring, Schirmer testing, conjunctival cultures, and Demodex detection. Follow-up was performed at 16 weeks. Patients were stratified by DAOSD status.
Results:
DAOSD developed in 33% (n = 10), presenting as blepharoconjunctivitis. Baseline Demodex infestation was significantly more frequent in the DAOSD group (70.0% vs. 5.0%; p = .0004; OR = 44.3). Baseline Eczema Area and Severity Index (EASI) scores, IgE levels, and Schirmer results did not differ. Post-treatment OSDI scores were higher in DAOSD patients (median 37.5 vs. 4.6; p = .0001). Bacterial cultures were not associated with DAOSD.
Conclusions:
Eyelid Demodex infestation is strongly associated with DAOSD development. Pretreatment screening may identify high-risk individuals. As most cases occur within 16 weeks, this study focused on the early treatment phase.
Insights
Eyelid Demodex infestation significantly increases the risk of developing dupilumab-associated ocular surface disease (DAOSD) in patients with atopic dermatitis. Early screening for Demodex may help identify individuals at high risk for this condition.
Area of Science:
- Ophthalmology
- Dermatology
- Microbiology
Background:
- Dupilumab is a key treatment for moderate-to-severe atopic dermatitis (AD).
- Dupilumab-associated ocular surface disease (DAOSD) affects up to 30% of patients.
- The role of Demodex folliculorum in DAOSD is not well understood.
Purpose of the Study:
- To investigate the association between eyelid Demodex infestation and the development of DAOSD.
- To assess this link within the initial 16 weeks of dupilumab therapy.
Main Methods:
- Prospective study of 30 adults with moderate-to-severe AD starting dupilumab.
- Ophthalmologic evaluations included OSDI, Schirmer testing, and Demodex detection.
- Patients were followed for 16 weeks and stratified by DAOSD development.
Main Results:
- DAOSD (blepharoconjunctivitis) developed in 33% of patients.
- Pre-treatment Demodex infestation was significantly higher in the DAOSD group (70% vs. 5%).
- Higher post-treatment OSDI scores were observed in DAOSD patients.
Conclusions:
- Eyelid Demodex infestation is a strong predictor of DAOSD.
- Pretreatment screening for Demodex can identify patients at higher risk.
- The early phase of dupilumab treatment (16 weeks) is critical for DAOSD onset.
