Prophylactic therapy in people with facial eczema might be necessary to prevent conjunctivitis in patients being treated with dupilumab, according to research published in the Journal of the European Academy of Dermatology and Venerology.
Between May 2018 and January 2020, patients with moderate to severe atopic dermatitis at an academic dermatology unit in Naples, Italy, were enrolled to undergo treatment with dupilumab.
Within the larger cohort of dupilumab-treated patients, 27% presented with facial seborrheic-like dermatitis, and 26% presented with facial eczema without signs of seborrheic dermatitis. Treatments included antifungal corticosteroid cream, itraconazole tablets, and tacrolimus 0.1% ointment. All received a prescription of trehalose/hyaluroate tear substitute to hydrate conjunctival mucosa.
Investigators identified 20 cases of conjunctivitis (incidence rate, 7.2%). Six of these patients reported that they did not take the preventative therapy; after exclusion, the incidence of conjunctivitis was 5%. Other ocular outcomes included nonspecific keratoconjunctivitis associated with dry eye (n=19) and follicular conjunctivitis associated with limbitis (n=1). A history of prior conjunctivitis was noted in 6 patients (42.8%). The therapy was interrupted in 2 patients for nonresponsive conjunctivitis.
Mean age of patients with conjunctivitis was 35 years (range, 18 to 53 years); mean age of dupilumab-treated patients was 36 years (range, 18 to 83 years), and 78.5% were men. Mean EASI score of patients with conjunctivitis was 37 (range, 26 to 60), which was higher than the mean EASI score of the total (N=277) cohort. Mean time of conjunctivitis onset from the start of therapy was 6 months (time-lapse, 3 to 14 months).
All conjunctivitis cases were treated with cortico-antibiotic eye drops and all but 2 patients experienced a complete response. The patient with follicular conjunctivitis required cyclosporine ophthalmic drops.
“A possible association between facial eczema and conjunctivitis is probable, but more data are needed,” the research concludes. They add that it is likely that prophylactic therapy, based on trehalose/hyaluroate tear substitute, associated with the treatment for palpebral and facial eczema, worsened dry eye and consequently, conjunctivitis.
Calabrese G, Gambardella A, Licata G, et al. Dupilumab and conjunctivitis: A case-series of twenty patients. J Eur Acad Dermatol Venerol. Published online March 3, 2021. doi:10.1111/jdv.17210