Alopecia areata-like and psoriasis after dupilumab use for atopic dermatitis

Alopecia areata-like and psoriasis after dupilumab use for atopic dermatitis ଝ,ଝଝ Dear Editor, Atopic dermatitis (AD) and psoriasis are chronic inflammatory dermatoses, considered to be extreme phenotypes of the immune mechanism modulated by T cells. 1 Dupilumab inhibits the signaling of IL-4 and IL-13, cytokines that mediate the skin barrier inflammation and dysfunction in AD, through Th2.There is no direct interference on the Th1 pathway. 2 The present report describes a rare manifestation of alopecia areata-like psoriasis, associated with skin lesions after dupilumab use.A 22-year-old male patient was diagnosed with AD since childhood and submitted to several previous treatments, such as topical and systemic steroids, azathioprine and methotrexate, which were withdrawn due to therapeutic failure.Additionally, he had been prescribed cyclosporine, with a reduction in SCORAD (Severity Scoring of Atopic Dermatitis) from 58 to 18, but with dose reduction due to an increase in liver transaminases (3-fold the reference value).In this context, dupilumab was started at the dose recommended in the leaflet, subcutaneously.After five months, he developed a scaling, erythematous alopecia plaque, with pruritus, on the vertex region, measuring 5 cm in diameter (Fig. 1), with erythema and follicular and interfollicular desquamation, suggesting an eczema pattern on dermoscopy.Scaling erythematous plaques were observed on the left wrist and toes, as well as onychodystrophy on the right hallux and nail pitting in the fingers (Fig. 2).The direct mycological test and cultures of the alopecia plaque were negative.The histopathological analysis showed psori-ଝ How to cite this article: Maiolini VM, Sousa NA, Marsillac PF, Bressan AL.Alopecia areata-like and psoriasis after dupilumab use for atopic dermatitis.2021;