Demodex Infestation in Patients With Atopic Dermatitis Treated With Dupilumab: A Case-Control Study

Area of Science:

• Dermatology
• Microbiology
• Immunology

Background:

• Atopic dermatitis (AD) is a chronic inflammatory skin condition.
• Dupilumab is a key therapy for moderate-to-severe AD.
• Persistent facial erythema during dupilumab treatment requires further investigation.

Purpose of the Study:

• To investigate the prevalence of Demodex infestation in patients with moderate-to-severe AD treated with dupilumab.
• To compare Demodex infestation rates between dupilumab-treated AD patients and controls not on systemic immunosuppression.
• To explore potential associations between Demodex infestation and persistent facial symptoms in dupilumab-treated AD patients.

Main Methods:

• Retrospective case-control study.
• Inclusion of 61 patients: 31 on dupilumab, 30 controls.
• Assessment of Demodex density via skin surface biopsy (≥5 mites/cm² positive).

Main Results:

• Demodex positivity was significantly higher in dupilumab-treated patients (45.2%) versus controls (6.7%).
• Dupilumab-treated patients with Demodex infestation were older.
• Demodex-positive patients often reported persistent facial erythema, pruritus, and ocular symptoms.

Conclusions:

• Demodex infestation is more prevalent in AD patients receiving dupilumab therapy.
• Findings suggest Demodex may be associated with persistent head and neck symptoms in this population.
• Consideration of Demodex testing for AD patients with refractory facial symptoms during dupilumab treatment is warranted.