BACKGROUND Lichen amyloidosis(LA)is a chronic,severely pruritic skin disease,which is the most common form of primary cutaneous amyloidosis.The treatment of LA has been considered to be difficult.LA may be associated ...BACKGROUND Lichen amyloidosis(LA)is a chronic,severely pruritic skin disease,which is the most common form of primary cutaneous amyloidosis.The treatment of LA has been considered to be difficult.LA may be associated with atopic dermatitis(AD),and in this setting,the treatment options may be more limited.Herein,we report four cases of LA associated with AD successfully treated by dupilumab.CASE SUMMARY In this article,we describe four cases of patients who presented with recurrent skin rash accompanied by severe generalized intractable pruritus,diagnosed with refractory LA coexisting with chronic AD.Previous treatments had not produced any apparent improvement.Thus,we administered dupilumab injection subcutaneously at a dose of 600 mg for the first time and 300 mg every 2 wk thereafter.Their lesions all markedly improved.CONCLUSION Dupilumab may be a new useful treatment for LA coexisting with AD.展开更多
BACKGROUND Lichenoid amyloidosis(LA)is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules,usually on the lower leg,back,forearm,or thigh.LA may be associat...BACKGROUND Lichenoid amyloidosis(LA)is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules,usually on the lower leg,back,forearm,or thigh.LA may be associated with several skin diseases,including atopic dermatitis(AD).The treatment of LA is considered to be difficult.However,as there is some overlap in the etiopathogenesis of LA and AD,AD treatment may also be effective for LA.CASE SUMMARY Case 1:A 70-year-old man was diagnosed with severe AD with LA based on large dark erythema and papules on the trunk and buttocks and dense hemispherical millet-shaped papules with pruritus on the extensor side of the lower limbs.He had a long history of the disease(8 years),with repeated and polymorphic skin lesions.Given the poor efficacy of traditional treatments,this patient was recommended to receive dupilumab treatment.At the initial stage,300 mg was injected subcutaneously every 2 wk.After 28 wk,the drug interval was extended to 1 mo due to the pandemic.Follow-up observations revealed that the patient reached an Eczema Area Severity Index of 90(skin lesions improved by 90%compared with the baseline)by the end of the study.Moreover,Investigator's Global Assessment score was 1,and scoring atopic dermatitis index and numeric rating scale improved by 97.7%and 87.5%compared with the baseline,respectively,with LA skin lesions having largely subsided.Case 2:A 30-year-old woman was diagnosed with severe AD with LA,due to dense and substantial papules on the dorsal hands similar to changes in cutaneous amyloidosis,and erythema and papules scattered on limbs and trunk with pruritus,present for 25 years.After 16 wk of dupilumab treatment,she stopped,and skin lesions completely subsided,without recurrence since the last follow-up.CONCLUSION Dupilumab shows rational efficacy and safety in the treatment of severe AD with LA,in addition to benefits in the quality of life of the patients.展开更多
BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an allergic reaction to Aspergillus species that aggravates bronchial asthma.Previous studies demonstrated the glucocorticoid-sparing effect of dupilumab in p...BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an allergic reaction to Aspergillus species that aggravates bronchial asthma.Previous studies demonstrated the glucocorticoid-sparing effect of dupilumab in patients with ABPA.There is no report of complete withdrawal of glucocorticoids after dupilumab.CASE SUMMARY The patient was a 54-year-old woman with bronchial asthma treated with inhaled corticosteroids and a long-acting beta-2 agonist.She consulted our institution for productive cough and fever in March 2017.Chest computed tomography scan revealed mucoid impaction,and the bronchial lavage fluid culture was positive for Aspergillus fumigatus.The diagnosis was ABPA.The patient was treated with oral glucocorticoids from April 2017 to November 2017.In January 2019,she had bronchial asthma exacerbation,and a chest computed tomography scan showed recurrent mucoid impaction.She was treated with oral glucocorticoids and itraconazole.In February 2020,during tapering of oral glucocorticoid,she had the third episode of bronchial asthma exacerbation and a mucoid impaction.The patient was treated with dupilumab in addition to oral glucocorticoid and itraconazole.The clinical response improved,and oral glucocorticoid was discontinued in June 2020.CONCLUSION This is the first case of ABPA in which complete withdrawal of glucocorticoid was possible after treatment with dupilumab.展开更多
Food-dependent,exercise-induced anaphylaxis(FDEIA)is a potentially life-threatening disorder that often occurs with exercise,and patients typically have eaten a specific food within hours before disease onset.This dis...Food-dependent,exercise-induced anaphylaxis(FDEIA)is a potentially life-threatening disorder that often occurs with exercise,and patients typically have eaten a specific food within hours before disease onset.This disease is exceedingly rare,with a prevalence of 0.02%.No well-recognized prevention or treatment strategy has been available for FDEIA except avoiding triggers strictly.Here we report an 11-year-old boy with a history of recurrent anaphylaxis of unknown etiology more than 10 times within two years.As the anaphylactic symptoms had not been controlled after traditional treatments,the patient was given subcutaneous injection of dupilumab seven times within 33 weeks.During dupilumab treatments,the patient was exposed to culprit mushrooms plus exercises at least twice a month but without notable anaphylaxis.Thus,dupilumab may improve the allergic reactions in FDEIA patients.展开更多
<strong>Background:</strong> Dupilumab is the biological drug approved for the treatment of moderate to severe atopic dermatitis (AD) and has demonstrated impressive clinical effect and quality of life-enh...<strong>Background:</strong> Dupilumab is the biological drug approved for the treatment of moderate to severe atopic dermatitis (AD) and has demonstrated impressive clinical effect and quality of life-enhancing capacity in clinical trials. The most commonly observed adverse effects of dupilumab therapy included upper respiratory tract infection, headache, nasopharyngitis, injection-site reaction, herpes viral infection, and conjunctivitis. Lacrimal duct obstruction or punctal stenosis is rarely reported side effect of dupilumab therapy and not fully documented. <strong>Aim:</strong> To document a new case presentation of a young female with a history of AD without previous significant ocular manifestations who developed right eye punctal stenosis while she was on Dupilumab therapy for a one-year duration. <strong>Case Report:</strong> A 19-year-old female with a long-standing history of AD and on dupilumab therapy for one year duration who developed severe punctal stenosis and continued tearing from her right eye in the last two months not responded to conservative ophthalmological medications but completely improved on discontinuation dupilumab injection over 6 months followed-up. <strong>Conclusions:</strong> Conjunctivitis is a well-known adverse effect of Dupilumab injection of a patient with AD. However, persistent conjunctivitis and tearing from the eye not improving on ophthalmology treatment might rule out punctal stenosis and discontinuation of dupilumab should be considered.展开更多
<strong>Background:</strong> Topical corticosteroids (TCS) are used frequently for various inflammatory skin conditions. The prolonged daily and inappropriate use of TCS may cause adverse effects such as e...<strong>Background:</strong> Topical corticosteroids (TCS) are used frequently for various inflammatory skin conditions. The prolonged daily and inappropriate use of TCS may cause adverse effects such as erythema, atrophy, and telangiectasia. Steroid rosacea or addiction is a distinct adverse effect of inappropriate use of TCS. It occurs most commonly in adult women applying mid- or high-potency TCS to the face. Dupilumab is an interleukin 4 (IL-4) receptor α-antagonist approved for treatment Moderate-to-Severe Atopic Dermatitis in childhoods and adults. The role of dupilumab injection in steroid-induced rosacea management is rarely discussed. <strong>Aim:</strong> To document a new case presentation of atopic dermatitis on high potency topical facial steroid addiction for a duration of 4 years in a young female patient who was successful treated with dupilumab injection and withdrawal therapy. <strong>Case Report:</strong> A 32-year-old female patient with a history of atopic dermatitis presented with a history of worsening pruritic facial rashes for a one-month duration and on high potency TCS (Clobetasol Propionate ointment 0.05%) since 4 years ago with multiple treatments failure of steroidal withdrawal treated successfully in combination with dupilumab injection. <strong>Conclusion:</strong> Dupilumab injection considers effective and inducing rapid resolution of signs and symptoms of steroid-induced rosacea in patients with a history of atopic dermatitis in combination with withdrawal therapy without a rebound effect.展开更多
BACKGROUND Prurigo nodularis(PN)is a chronic condition characterized by a papulonodular pruriginous eruption of unknown aetiology.Currently,there are no medications for PN that the United States Food and Drug Administ...BACKGROUND Prurigo nodularis(PN)is a chronic condition characterized by a papulonodular pruriginous eruption of unknown aetiology.Currently,there are no medications for PN that the United States Food and Drug Administration has approved,which leads to very variable practices in the prescription of off-label treatments.Treatment of PN is based on clinical experience rather than controlled trials.We present our case of generalized PN,in which we had a dramatic response with dupilumab.CASE SUMMARY A 58-year-old female patient was admitted to our clinic with severe itchy,erythematous nodular lesions that were widespread all over her body,especially on the legs and back.It was learned that the patient's complaints started 4 years ago,and there was a significant increase in the lesions in the last period.Dermatological examination revealed diffuse firm erythematous excoriated nodular lesions all over the body.In the blood tests of the patient,serum Immunoglobulin E(IgE)was measured at 9330 IU/mL.The patient was diagnosed with generalized prurigo nodularis together with clinical and histopathological findings.Due to severe clinical findings and the presence of comorbidities,dupilumab treatment was planned for the patient.In the follow-up 4 mo later,it was observed that all nodular lesions healed with postinflammatory hypopigmentation.The IgE value decreased to 1500 IU/mL after 4 mo of dupilumab treatment.CONCLUSION Dupilumab treatment stands out as an effective and safe systemic treatment agent among existing systemic treatments.展开更多
Objective:Limited information is available on the use of dupilumab for the treatment of atopic dermatitis(AD)in the Chinese population.Methods:We analyzed laboratory data from a previously published randomized,double-...Objective:Limited information is available on the use of dupilumab for the treatment of atopic dermatitis(AD)in the Chinese population.Methods:We analyzed laboratory data from a previously published randomized,double-blind phase III trial(NCT03912259)to provide further insight into the safety of dupilumab in Chinese adults with moderate to severe AD.The trial participants received either 300 mg of dupilumab or placebo every 2 weeks for 16 weeks.Hematology,blood chemistry,serum thymus and activation-regulated chemokine(TARC),and total immunoglobulin E(IgE)were evaluated.Results:In total,82 participants received dupilumab and 83 received placebo.With the exception of eosinophil counts of>0.8×109/L,which were found less frequently with dupilumab(9.8%)than with placebo(18.7%),the hematology and blood chemistry values were generally stable in both treatment groups.There were no clinically significant differences between the dupilumab and placebo groups,and no participants developed treatment-emergent abnormalities of potential clinical significance.However,compared with placebo,greater decreases in serum lactate dehydrogenase(mean change,−97.4 vs.−33.5 IU/L),TARC(median percent change,−78.6%vs.−30.8%),and total IgE(median percent change,−53.4%vs.−0.2%)were observed with dupilumab than placebo at week 16.Conclusion:Dupilumab demonstrated a favorable laboratory safety profile in Chinese adults with moderate to severe AD.展开更多
文摘BACKGROUND Lichen amyloidosis(LA)is a chronic,severely pruritic skin disease,which is the most common form of primary cutaneous amyloidosis.The treatment of LA has been considered to be difficult.LA may be associated with atopic dermatitis(AD),and in this setting,the treatment options may be more limited.Herein,we report four cases of LA associated with AD successfully treated by dupilumab.CASE SUMMARY In this article,we describe four cases of patients who presented with recurrent skin rash accompanied by severe generalized intractable pruritus,diagnosed with refractory LA coexisting with chronic AD.Previous treatments had not produced any apparent improvement.Thus,we administered dupilumab injection subcutaneously at a dose of 600 mg for the first time and 300 mg every 2 wk thereafter.Their lesions all markedly improved.CONCLUSION Dupilumab may be a new useful treatment for LA coexisting with AD.
基金Supported by National Natural Science Foundation of China,No.81803160Scientific Development Program of Jilin Province,No.20200801078GH.
文摘BACKGROUND Lichenoid amyloidosis(LA)is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules,usually on the lower leg,back,forearm,or thigh.LA may be associated with several skin diseases,including atopic dermatitis(AD).The treatment of LA is considered to be difficult.However,as there is some overlap in the etiopathogenesis of LA and AD,AD treatment may also be effective for LA.CASE SUMMARY Case 1:A 70-year-old man was diagnosed with severe AD with LA based on large dark erythema and papules on the trunk and buttocks and dense hemispherical millet-shaped papules with pruritus on the extensor side of the lower limbs.He had a long history of the disease(8 years),with repeated and polymorphic skin lesions.Given the poor efficacy of traditional treatments,this patient was recommended to receive dupilumab treatment.At the initial stage,300 mg was injected subcutaneously every 2 wk.After 28 wk,the drug interval was extended to 1 mo due to the pandemic.Follow-up observations revealed that the patient reached an Eczema Area Severity Index of 90(skin lesions improved by 90%compared with the baseline)by the end of the study.Moreover,Investigator's Global Assessment score was 1,and scoring atopic dermatitis index and numeric rating scale improved by 97.7%and 87.5%compared with the baseline,respectively,with LA skin lesions having largely subsided.Case 2:A 30-year-old woman was diagnosed with severe AD with LA,due to dense and substantial papules on the dorsal hands similar to changes in cutaneous amyloidosis,and erythema and papules scattered on limbs and trunk with pruritus,present for 25 years.After 16 wk of dupilumab treatment,she stopped,and skin lesions completely subsided,without recurrence since the last follow-up.CONCLUSION Dupilumab shows rational efficacy and safety in the treatment of severe AD with LA,in addition to benefits in the quality of life of the patients.
文摘BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an allergic reaction to Aspergillus species that aggravates bronchial asthma.Previous studies demonstrated the glucocorticoid-sparing effect of dupilumab in patients with ABPA.There is no report of complete withdrawal of glucocorticoids after dupilumab.CASE SUMMARY The patient was a 54-year-old woman with bronchial asthma treated with inhaled corticosteroids and a long-acting beta-2 agonist.She consulted our institution for productive cough and fever in March 2017.Chest computed tomography scan revealed mucoid impaction,and the bronchial lavage fluid culture was positive for Aspergillus fumigatus.The diagnosis was ABPA.The patient was treated with oral glucocorticoids from April 2017 to November 2017.In January 2019,she had bronchial asthma exacerbation,and a chest computed tomography scan showed recurrent mucoid impaction.She was treated with oral glucocorticoids and itraconazole.In February 2020,during tapering of oral glucocorticoid,she had the third episode of bronchial asthma exacerbation and a mucoid impaction.The patient was treated with dupilumab in addition to oral glucocorticoid and itraconazole.The clinical response improved,and oral glucocorticoid was discontinued in June 2020.CONCLUSION This is the first case of ABPA in which complete withdrawal of glucocorticoid was possible after treatment with dupilumab.
文摘Food-dependent,exercise-induced anaphylaxis(FDEIA)is a potentially life-threatening disorder that often occurs with exercise,and patients typically have eaten a specific food within hours before disease onset.This disease is exceedingly rare,with a prevalence of 0.02%.No well-recognized prevention or treatment strategy has been available for FDEIA except avoiding triggers strictly.Here we report an 11-year-old boy with a history of recurrent anaphylaxis of unknown etiology more than 10 times within two years.As the anaphylactic symptoms had not been controlled after traditional treatments,the patient was given subcutaneous injection of dupilumab seven times within 33 weeks.During dupilumab treatments,the patient was exposed to culprit mushrooms plus exercises at least twice a month but without notable anaphylaxis.Thus,dupilumab may improve the allergic reactions in FDEIA patients.
文摘<strong>Background:</strong> Dupilumab is the biological drug approved for the treatment of moderate to severe atopic dermatitis (AD) and has demonstrated impressive clinical effect and quality of life-enhancing capacity in clinical trials. The most commonly observed adverse effects of dupilumab therapy included upper respiratory tract infection, headache, nasopharyngitis, injection-site reaction, herpes viral infection, and conjunctivitis. Lacrimal duct obstruction or punctal stenosis is rarely reported side effect of dupilumab therapy and not fully documented. <strong>Aim:</strong> To document a new case presentation of a young female with a history of AD without previous significant ocular manifestations who developed right eye punctal stenosis while she was on Dupilumab therapy for a one-year duration. <strong>Case Report:</strong> A 19-year-old female with a long-standing history of AD and on dupilumab therapy for one year duration who developed severe punctal stenosis and continued tearing from her right eye in the last two months not responded to conservative ophthalmological medications but completely improved on discontinuation dupilumab injection over 6 months followed-up. <strong>Conclusions:</strong> Conjunctivitis is a well-known adverse effect of Dupilumab injection of a patient with AD. However, persistent conjunctivitis and tearing from the eye not improving on ophthalmology treatment might rule out punctal stenosis and discontinuation of dupilumab should be considered.
文摘<strong>Background:</strong> Topical corticosteroids (TCS) are used frequently for various inflammatory skin conditions. The prolonged daily and inappropriate use of TCS may cause adverse effects such as erythema, atrophy, and telangiectasia. Steroid rosacea or addiction is a distinct adverse effect of inappropriate use of TCS. It occurs most commonly in adult women applying mid- or high-potency TCS to the face. Dupilumab is an interleukin 4 (IL-4) receptor α-antagonist approved for treatment Moderate-to-Severe Atopic Dermatitis in childhoods and adults. The role of dupilumab injection in steroid-induced rosacea management is rarely discussed. <strong>Aim:</strong> To document a new case presentation of atopic dermatitis on high potency topical facial steroid addiction for a duration of 4 years in a young female patient who was successful treated with dupilumab injection and withdrawal therapy. <strong>Case Report:</strong> A 32-year-old female patient with a history of atopic dermatitis presented with a history of worsening pruritic facial rashes for a one-month duration and on high potency TCS (Clobetasol Propionate ointment 0.05%) since 4 years ago with multiple treatments failure of steroidal withdrawal treated successfully in combination with dupilumab injection. <strong>Conclusion:</strong> Dupilumab injection considers effective and inducing rapid resolution of signs and symptoms of steroid-induced rosacea in patients with a history of atopic dermatitis in combination with withdrawal therapy without a rebound effect.
文摘BACKGROUND Prurigo nodularis(PN)is a chronic condition characterized by a papulonodular pruriginous eruption of unknown aetiology.Currently,there are no medications for PN that the United States Food and Drug Administration has approved,which leads to very variable practices in the prescription of off-label treatments.Treatment of PN is based on clinical experience rather than controlled trials.We present our case of generalized PN,in which we had a dramatic response with dupilumab.CASE SUMMARY A 58-year-old female patient was admitted to our clinic with severe itchy,erythematous nodular lesions that were widespread all over her body,especially on the legs and back.It was learned that the patient's complaints started 4 years ago,and there was a significant increase in the lesions in the last period.Dermatological examination revealed diffuse firm erythematous excoriated nodular lesions all over the body.In the blood tests of the patient,serum Immunoglobulin E(IgE)was measured at 9330 IU/mL.The patient was diagnosed with generalized prurigo nodularis together with clinical and histopathological findings.Due to severe clinical findings and the presence of comorbidities,dupilumab treatment was planned for the patient.In the follow-up 4 mo later,it was observed that all nodular lesions healed with postinflammatory hypopigmentation.The IgE value decreased to 1500 IU/mL after 4 mo of dupilumab treatment.CONCLUSION Dupilumab treatment stands out as an effective and safe systemic treatment agent among existing systemic treatments.
基金The phase III trial on which this subanalysis is based (NCT03912259) was sponsored by Sanofi. Medical writing assistance with the preparation of this article was also funded by Sanofi.
文摘Objective:Limited information is available on the use of dupilumab for the treatment of atopic dermatitis(AD)in the Chinese population.Methods:We analyzed laboratory data from a previously published randomized,double-blind phase III trial(NCT03912259)to provide further insight into the safety of dupilumab in Chinese adults with moderate to severe AD.The trial participants received either 300 mg of dupilumab or placebo every 2 weeks for 16 weeks.Hematology,blood chemistry,serum thymus and activation-regulated chemokine(TARC),and total immunoglobulin E(IgE)were evaluated.Results:In total,82 participants received dupilumab and 83 received placebo.With the exception of eosinophil counts of>0.8×109/L,which were found less frequently with dupilumab(9.8%)than with placebo(18.7%),the hematology and blood chemistry values were generally stable in both treatment groups.There were no clinically significant differences between the dupilumab and placebo groups,and no participants developed treatment-emergent abnormalities of potential clinical significance.However,compared with placebo,greater decreases in serum lactate dehydrogenase(mean change,−97.4 vs.−33.5 IU/L),TARC(median percent change,−78.6%vs.−30.8%),and total IgE(median percent change,−53.4%vs.−0.2%)were observed with dupilumab than placebo at week 16.Conclusion:Dupilumab demonstrated a favorable laboratory safety profile in Chinese adults with moderate to severe AD.
