Pustular Psoriasis After Dupilumab: A Case Report and Systematic Review

Dupilumab is a human monoclonal antibody targeting the interleukin-4 receptor alpha subunit, inhibiting type-2 inflammatory responses through its dual blockade of interleukin-4 (IL-4) and IL-13 signaling. Dupilumab is approved for the treatment of moderate to severe atopic dermatitis (AD), asthma, and chronic rhinosinusitis with nasal polyposis. However, recent reports have documented the emergence of pustular psoriasis (PP) during treatment of AD with dupilumab. Whether dupilumab causes pustular psoriasis or merely renders its presentation in patients misdiagnosed with AD remains unclear. By presenting this case and conducting a systematic review, we aim to contribute to the understanding of the potential association between dupilumab therapy and the development of pustular psoriasis. This knowledge will help clinicians in accurately diagnosing and managing patients who develop pustular psoriasis while on dupilumab.