Cicatricial Ectropion in the Setting of IL-13 Inhibition

Interleukin (IL)-13 is a key mediator of type 2 inflammation and an important therapeutic target in atopic dermatitis (AD). Although IL-4/IL-13 and IL-13 inhibitors demonstrate favorable safety profiles, ocular adverse events are recognized complications. Conjunctivitis is most commonly reported, and cicatricial ectropion has been described with IL-4/IL-13 inhibition. We report what is, to our knowledge, the first reported case of cicatricial ectropion associated with inhibition of soluble IL-13.

An 81-year-old man with longstanding AD involving 60% body surface area was treated with dupilumab with marked improvement. Seven months later, he developed ocular pruritus and tearing and was diagnosed with atopic keratoconjunctivitis. One month later, ophthalmologic examination revealed inferior cicatricial ectropion of the left lower eyelid. Discontinuation of dupilumab and treatment with oral prednisone and topical tacrolimus led to resolution. Subsequent treatment with tralokinumab resulted in recurrence of cicatricial ectropion within one month, prompting discontinuation and treatment with topical polymyxin B-trimethoprim and oral prednisone. Upadacitinib was initiated with sustained clearance of AD and no recurrence of ocular symptoms.

Cicatricial ectropion has been rarely reported with dupilumab but has not previously been described with soluble IL-13 inhibition. In this case, ectropion developed with dupilumab, resolved after discontinuation, and recurred with tralokinumab, suggesting a direct effect of IL-13 inhibition. This case highlights the need for awareness of rare ocular complications associated with targeted therapies for AD and underscores the importance of multidisciplinary management.  .