Atopic dermatitis associated with systemic tacrolimus: Case report and review

A 10-month-old female was referred to dermatology clinic for evaluation of eczema, noted at 110 days after deceased-donor liver transplant while receiving systemic tacrolimus as monotherapy for posttransplant immunosuppression. She was seen and diagnosed with new onset atopic dermatitis (AD), thought to be in part related to her tacrolimus. After failing conventional treatment, her immunosuppression was switched from tacrolimus to sirolimus, and she received 1 dose of dupilumab. After 1 month, her skin had considerably improved and further doses of dupilumab were not pursued. At last follow-up, her eczema had completely cleared. Although infrequently reported in the literature, there is a growing body of evidence to suggest systemic tacrolimus may induce AD in transplant recipients.