Omalizumab in Refractory Adult-Onset Facial Atopic Dermatitis: A Case Report

Adult-onset facial atopic dermatitis (AFAD) is a distinct subtype of atopic dermatitis that predominantly affects the face and is frequently misdiagnosed as rosacea or other facial dermatoses. The management of AFAD is challenging, particularly in patients who respond poorly to conventional therapies. At present, reports on the use of anti-immunoglobulin E (IgE) therapy in AFAD are limited. Herein, we report a case of AFAD with markedly elevated serum IgE levels that showed a favorable response to omalizumab.

A retrospective analysis was conducted on the clinical characteristics, laboratory findings, treatment course, and therapeutic outcomes of a patient with AFAD. Pruritus severity was assessed using a visual analog scale (VAS, 0-10). Facial erythema and skin dryness were evaluated using the objective sign components of the SCORAD index. Clinical photographs and objective assessment results were recorded during follow-up.

A 41-year-old woman presented with a 10-year history of recurrent facial erythema accompanied by pruritus and burning sensations, with poor responses to multiple conventional systemic and topical treatments. Total serum IgE levels were markedly elevated. The patient received subcutaneous omalizumab at a dose of 300 mg every 4 weeks for a total of three injections. During treatment, facial erythema, scaling, pruritus, and burning sensations gradually improved. Symptom-related scores decreased, and no adverse events were observed in this case.

This case suggests that even in the absence of a typical atopic history, omalizumab may represent a potential therapeutic option for patients with adult-onset facial atopic dermatitis who exhibit elevated serum IgE levels and poor responses to conventional treatments.