Dupilumab treatment for pruritus-associated cutaneous sarcoidosis

Sarcoidosis is a chronic multisystemic, inflammatory disease characterized by the formation of noncaseating granulomas, with cutaneous involvement in a fraction of patients. Although existing literature reports dupilumab to cause sarcoidosis-like reactions, we present a 57-year-old man with erythrodermic sarcoidosis and atopic dermatitis refractory to numerous systemic medications that later improved with dupilumab. The improvement of his pruritus and cutaneous lesions after dupilumab initiation, followed by worsening after temporary discontinuation, then re-improvement after re-initiation supported dupilumab's therapeutic role. IL-4 and IL-13 stimulate tissue fibrosis and irreversible tissue damage in sarcoidosis, perhaps explaining dupilumab's therapeutic mechanism in this patient's case. For patients with severe sarcoidosis refractory to numerous medications, clinicians should keep in mind dupilumab as a potential option, particularly for those patients with concomitant atopic dermatitis.