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- Title
Dupilumab-Associated Lymphoid Reactions in Patients With Atopic Dermatitis.
- Authors
Boesjes, Celeste M.; van der Gang, Lian F.; Bakker, Daphne S.; ten Cate, Tess A.; Spekhorst, Lotte S.; de Graaf, Marlies; van Dijk, Marijke R.; de Bruin-Weller, Marjolein S.
- Abstract
Key Points: Question: What are the clinical and histopathologic features of dupilumab-associated lymphoid reactions in patients with atopic dermatitis? Findings: This case series presents 11 patients with atopic dermatitis who developed a dupilumab-associated lymphoid reaction with deterioration of symptoms (eg, burning sensation, itch) after initial response, which mimics a cutaneous T-cell lymphoma but has distinctive histopathologic features (a sprinkled distribution of small hyperchromatic lymphocytes in the upper epidermal section, a dysregulated CD4:CD8 ratio, CD30 overexpression, and no loss of pan-T-cell antigens [CD2, CD3, and CD5]). Meaning: Clinical and histopathologic recognition of a lymphoid reaction is important, and dupilumab discontinuation is recommended in these patients. This case series presents and describes 11 patients with atopic dermatitis who developed a lymphoid reaction during treatment with dupilumab. Importance: Since the increased use of dupilumab for atopic dermatitis (AD) in daily practice, several cases have been reported on the development of cutaneous T-cell lymphomas (CTCL) and lymphoid infiltrates. Objective: To provide insight in the clinical and histopathologic features of patients with AD clinically suspected for CTCL during dupilumab treatment. Design, Setting, and Participants: This retrospective observational case series included adult (≥18 years) patients with AD treated with dupilumab between October 2017 and July 2022 at the University Medical Center Utrecht in the Netherlands. Main outcomes and measures: Relevant patient, disease, and treatment characteristics were evaluated. Skin biopsies before, during, and after treatment were collected and reassessed. Results: Fourteen patients (54.5% male) with a median (IQR) age of 56 (36-66) years suspected for CTCL with deterioration of symptoms during dupilumab treatment were included. Of 14 patients, 3 were retrospectively diagnosed with preexistent mycosis fungoides (MF). Eleven patients with AD were eventually diagnosed with a lymphoid reaction (LR). These patients showed MF-like symptoms; however, histopathologic findings were different, and included sprinkled distribution of small hyperchromatic lymphocytes in the upper epidermal section, a dysregulated CD4:CD8 ratio, and CD30 overexpression, without loss of CD2/CD3/CD5. The median time to clinical worsening was 4.0 months (IQR, 1.4-10.0). Posttreatment biopsies showed complete clearance of the LR in all patients. Conclusions and relevance: This study found that dupilumab treatment can cause a reversible and benign LR, which mimics a CTCL, though has distinctive histopathologic features.
- Publication
JAMA Dermatology, 2023, Vol 159, Issue 11, p1240
- ISSN
2168-6068
- Publication type
Article
- DOI
10.1001/jamadermatol.2023.3849