Dupilumab Facial Redness (DFR) Cleared With Oral Itraconazole

Dupilumab is the first US FDA-approved biologic for moderate to severe atopic dermatitis (AD) in adults and children of age more than six months. It is a fully monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signal transmission. The initial product monograph mentioned major side effects like hypersensitivity reactions and eye problems like conjunctivitis, dry eye, and keratitis. Persistent facial redness with dupilumab administration has been reported in the past, and itraconazole proved to be effective for its treatment. We report a case of adult AD, on treatment with dupilumab, experiencing dupilumab facial redness (DFR), giving a positive response to itraconazole. DFR is a recognized complication of dupilumab therapy for AD. Clinicians should maintain a high index of suspicion for DFR, especially in patients presenting with new-onset facial symptoms during dupilumab treatment. Itraconazole can be considered a standard therapy for DFR, given its efficacy and tolerability profile in this context.