Background and Importance Adverse reaction (erythema on head and neck) not described in the technical datasheet.

Aim and Objectives Describing the resolution of erythema associated with dupilumab by extending the dosing interval.

Material and Methods Descriptive, retrospective study of a series of cases presenting erythema as an adverse reaction associated with the use of dupilumab. Patients with atopic dermatitis on treatment with dupilumab in January 2023 were selected. By telephone interview, electronic medical records and outpatient dispensing module, the following information was collected: sex, age, date of treatment initiation, date of erythema onset, other adverse reactions, dosage, extension of dupilumab dosing interval, date of change of dosage, resolution or not of erythema and other adverse effects after dosing adjustment, influence of alcohol consumption on erythema.

Results At the time of the study, 44 patients were receiving dupilumab, three patients developed erythema (6.81%), mainly on their head and neck. All three were women, receiving 300 mg/2 weeks at the time of erythema onset. Two of the patients reported the resolution of erythema one month after spacing dupilumab to 300 mg/3 weeks. One of them debuted with facial erythema a year after starting with dupilumab, the dose spacing was made the same month as the appearance of erythema. The other one presented erythema one month after the start of dupilumab, starting the dosing schedule 5 months after the onset of erythema. The third patient reported erythema one month after the start of dupilumab. Three months after the onset of erythema, she discontinued treatment due to primary inefficacy. One month after discontinuation of dupilumab, the erythema completely subsided. All three patients also experienced ocular adverse effects (dryness, irritation and/or conjunctivitis episodes), which resolved completely with dosage adjustment or discontinuation of dupilumab. A possible trigger for dupilumab-associated erythema is alcohol consumption. Two of the three patients confirmed worsening of erythema after alcohol consumption.

Conclusion and Relevance Head and neck erythema appears to be associated with the use of dupilumab, as an adverse effect not described in the data sheet. Extension of the experimental dosing interval to 300 mg/3 weeks or discontinuation of dupilumab partially or completely resolves the erythema in the patients in this case series.

Conflict of Interest No conflict of interest.