RESUMEN
Dupilumab, the first biologic approved for treatment of atopic dermatitis, has demonstrated significant clinical effect and quality of life-enhancing capacity in clinical trials. In these, dupilumab-associated conjunctivitis where reported in a minority of patients. The present case series describe 10 patients treated with dupilumab where eye complications were very common. We have described patient characteristics, including FLG mutations, atopic history and clinical effect of dupilumab. Nine of 10 developed eye-complications, most commonly conjunctivitis (in 7/10). Other adverse events were herpes simplex virus uveitis and varicella-zoster virus meningitis. Although our case series is small, we conclude that dupilumab is an effective treatment option in severe atopic dermatitis, but that the risk of adverse events from the eyes and recurrence of herpes virus infections should be kept in mind. Close collaboration with an ophthalmologist is recommended, especially among patients with severe, long-lasting atopic dermatitis and/or previous eye disease.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Productos Biológicos/efectos adversos , Conjuntivitis/inducido químicamente , Dermatitis Atópica/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados , Conjuntivitis/diagnóstico , Conjuntivitis/inmunología , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/inmunología , Infecciones Virales del Ojo/inducido químicamente , Infecciones Virales del Ojo/inmunología , Femenino , Proteínas Filagrina , Herpes Simple/inducido químicamente , Herpes Simple/inmunología , Herpes Simple/virología , Herpes Zóster/inducido químicamente , Herpes Zóster/inmunología , Herpes Zóster/virología , Humanos , Huésped Inmunocomprometido , Masculino , Meningitis Viral/inducido químicamente , Meningitis Viral/inmunología , Meningitis Viral/virología , Persona de Mediana Edad , Infecciones Oportunistas/inducido químicamente , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/virología , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Uveítis Anterior/inducido químicamente , Uveítis Anterior/inmunología , Uveítis Anterior/virología , Adulto JovenAsunto(s)
Terapia PUVA/efectos adversos , Fotoquimioterapia/efectos adversos , Hipersensibilidad a las Drogas , Herpes Simple/inducido químicamente , Herpes Zóster/inducido químicamente , Humanos , Hipersensibilidad Tardía/inducido químicamente , Trastornos por Fotosensibilidad/inducido químicamente , Riesgo , Enfermedades Cutáneas Vesiculoampollosas/inducido químicamente , Neoplasias Cutáneas/inducido químicamente , Factores de TiempoRESUMEN
Five patients with plaque type mycosis fungoides (MF) and five patients with erythrodermic MF responded favorably to oral psoralen photochemotherapy (PUVA). The mean total UVA irradiation dose was less for erythrodermic than for plaque type MF, but the mean number of treatments to achieve clearing was greater in the erythrodermic patients. Histologic examination at clearing revealed persistence of an inflammatory infiltrate in the lower dermis in most cases. Subsequent recurrent lesions in five patients revealed a more extensive dermal inflammatory infiltrate, although findings were not always diagnostic of MF due to a lack of epidermal involvement. Resumption of more intensive PUVA therapy again resulted in clinical clearing in all five patients. The follow-up period for six patients who received long-term PUVA maintenance ranged from 1 1/2 to 3 1/2 years. During PUVA therapy, five of ten patients developed epithelial malignancies or premalignancies, and one patient developed a malignant fibrous histiocytoma. Most of these patients had received prior treatment with electron beam and topical nitrogen mustard.