Lichenoid-granulomatous drug reactions to dupilumab: A report of 2 cases
Zahra Rehan, Melanie D. Pratt, Melanie D. Pratt, Iris Teo, Stephanie Petkiewicz, Yasmine Ayroud, John Evans, Michelle E. Pratt, Michelle E. Pratt
Abstract
Dupilumab is a fully humanized monoclonal antibody to the interleukin 4 (IL-4) receptor alpha subunit, inhibiting IL-4 and IL-13 signaling pathways which leads to downregulation of T helper (Th) 2 mediated inflammation.1 There are several reports of drug hypersensitivity reactions (DHR) to dupilumab, including conjunctivitis, psoriasiform, eczematous, and lichenoid eruptions.2-4 It has been theorized that dupilumab-mediated inhibition of Th2 pathways may upregulate Th1/Th17 dominated response in patients with atopic dermatitis (AD); a Th1 hyperresponse can lead to development of psoriasiform dermatitis.