ABSTRACT
In December 2020, a major vaccination program against COVID-19 commenced in Europe with vaccines such as Pfizer's mRNABNT162b2 (Comirnaty®). Subsequent reports of immediate and delayed skin reactions emerged. This study presents a case of a 64-year-old male who developed multiple keratoacanthomas approximately two weeks after receiving a second booster dose of the Pfizer vaccine. The patient, who had significant medical history of hypertension and diabetes, presented with erythematous, crateriform lesions on his limbs. A physical examination and histopathological analysis confirmed the diagnosis of Generalized Eruptive Keratoacanthoma (GEKA). Treatment involved cemiplimab I.v. 350 mg administered every three weeks. Within two months, the patient showed significant improvement, with the disappearance of all lesions. Dermoscopy and histopathological exams supported the GEKA diagnosis, which is a rare variant of multiple keratoacanthomas. This case suggests a potential immune-mediated mechanism triggered by the COVID-19 vaccine, leading to the rapid development of keratoacanthomas. Treatment with cemiplimab showed promise, highlighting the potential of immune checkpoint inhibitors in managing multiple keratoacanthomas. Further research is needed to explore the efficacy and safety of such treatments.
Subject(s)
Antibodies, Monoclonal, Humanized , BNT162 Vaccine , COVID-19 , Keratoacanthoma , Humans , Male , Middle Aged , Keratoacanthoma/drug therapy , Keratoacanthoma/pathology , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/prevention & control , SARS-CoV-2 , COVID-19 Vaccines/adverse effects , Vaccination , Treatment OutcomeABSTRACT
Dupilumab is a fully humanized IgG4 monoclonal antibody, inhibiting IL-4 and IL-13 signaling, which are the main cytokines involved in type 2 inflammatory diseases. Its introduction was a breakthrough in the treatment of moderate-to-severe atopic dermatitis, but it is also used in other inflammatory diseases, including asthma, eosinophilic esophagitis and chronic rhinosinusitis with nasal polyposis. Recent advances in the understanding of inflammatory pathways have revealed that Th2-type inflammation is involved in a wider range of diseases than previously thought. The aim of our review is to examine off-label therapeutic indications of dupilumab, including bullous dermatoses (pemphigus, bullous pemphigoid) and alopecia areata, and to investigate its potential applications in cancer patients on anti-PD1 therapy.
Subject(s)
Antibodies, Monoclonal, Humanized , Th2 Cells , Humans , Antibodies, Monoclonal, Humanized/therapeutic use , Th2 Cells/immunology , Th2 Cells/drug effects , Inflammation/drug therapy , Alopecia Areata/drug therapy , Off-Label Use , Skin Diseases, Vesiculobullous/drug therapyABSTRACT
The correlation between health and diet has always been a subject of interest in the field of dermatology and medicine in general. However, studies in the literature are still scarce, and need further investigation in the field of inflammatory skin diseases. In this paper, we report a case of a patient with atopic dermatitis whose complete recovery occurred only after combining dupilumab therapy with a Mediterranean diet regimen.