Roflumilast Cream for Residual Disease in Patients With Atopic Dermatitis on Dupilumab: A Retrospective Chart Review Study

Residual disease is relatively common in dupilumab-treated patients with atopic dermatitis (AD). Adjunctive topical treatment, including topical corticosteroids or non-steroidal treatments, are often needed. In this study, we evaluated the clinical characteristics and outcomes of patients with AD on dupilumab with residual disease who were subsequently treated with roflumilast cream. This was a retrospective chart review conducted at a single academic center. Electronic medical records were searched to identify patients with AD who were prescribed dupilumab and were subsequently prescribed roflumilast cream for persistent or residual disease between July 2022 and January 2026. Of the 676 cases of AD identified and included in this review, there were 30 cases of dupilumab-treated patients with residual AD disease. One additional patient with de novo facial erythema on dupilumab was described qualitatively. Following roflumilast cream treatment, physician-documented clinical improvement was reported in 83% (25/30) of these patients. Of 18 patients with patient-reported outcomes, ten reported improvement with roflumilast cream (including resolution of disease, near resolution, or significant improvement with decreased flares); five reported reduced pruritus (1 with fully resolved itch); three reported no improvement; and one discontinued roflumilast cream due to burning. No additional adverse events were documented in the medical records. In this retrospective case series, adjunctive roflumilast cream was associated with physician-documented clinical improvement in most dupilumab-treated patients with residual AD. Atopic dermatitis (AD), often called eczema, is a chronic inflammatory skin condition that results in dry, itchy, red patches of skin. Dupilumab is an injectable biologic that is used to treat the inflammatory response of moderate-to-severe AD when topical medications do not control patient symptoms. However, it is still common for patients to have residual disease while using dupilumab, so topical medications are sometimes required to be used in conjunction with dupilumab. Topical steroids are one of the most common additional treatments, but the potential for side effects can limit their duration of use or application to sensitive skin areas. Roflumilast cream is a non-steroidal, topical medication approved for AD that can be applied once daily to the skin on any affected body location and is safe for long-term use. This retrospective chart review evaluated the addition of roflumilast cream in patients who had residual disease while taking dupilumab, as well as in one patient who developed new facial redness while taking dupilumab. Following treatment with roflumilast cream, the majority of patients (83%) showed improvements as documented by physicians with no documented safety issues observed.