Dupilumab therapy in atopic dermatitis when cutaneous lymphoma is suspected: Consensus recommendations from the EORTC Cutaneous Lymphoma Tumour Group

Dupilumab is highly effective for moderate-to-severe atopic dermatitis (AD). Increasing reports of cutaneous T-cell lymphoma (CTCL) diagnosed during or after dupilumab therapy have raised concern, although a causal relationship remains unproven. Interpretation of the available evidence is limited by its retrospective, observational nature, diagnostic overlap between AD and early CTCL, and detection and surveillance bias. These clinical consensus recommendations, developed through expert consensus among European CTCL specialists, primarily address dupilumab receipt in patients initially diagnosed with AD in whom CTCL is suspected, while briefly considering selective IL-13 inhibitors for which evidence remains limited. Clinical, epidemiologic, and mechanistic evidence is synthesized to develop practice-oriented recommendations. Dupilumab remains an appropriate treatment for moderate-to-severe AD but should be avoided if mycosis fungoides or Sézary syndrome is suspected or confirmed. In atypical or treatment-refractory disease, particularly adult-onset AD without atopic history, clinicians should maintain a high index of suspicion for CTCL, with a low threshold for skin biopsy, clinicopathologic correlation, and T-cell clonality assessment. Lack of response, disease worsening, or emerging atypical features during therapy should prompt reassessment. These recommendations reflect expert consensus that is based on available evidence and highlight the need for prospective studies to better define risk profiles and guide patient selection.