Dupilumab May Influence Blepharoconjunctivitis Occurrence in Atopic Dermatitis

The severity of dry eye syndrome and the presence of blepharoconjunctivitis should be determined prior to dupilumab initiation.

Dupilumab-induced blepharoconjunctivitis cases tend to be de novo, according to study results published in Journal of the European Academy of Dermatology and Venereology.

Researchers conducted a multicenter, prospective, real-life cohort study of patients with atopic dermatitis (AD) that evaluated the systematic dermatologic and ophthalmologic influence of dupilumab.

A total of 181 participants aged 15 years and older (IQR, 26-48) who received dupilumab for moderate-to-severe AD and did not respond well to ciclosporin were included in the study. Following an initial dose of dupilumab 600 mg, the participants received dupilumab 300 mg every 2 weeks.

Approximately 15% of participants had conjunctivitis at baseline. After 16 weeks, all but 2 of those cases had improved; there were 2 cases that remained stable. Dupilumab induced blepharoconjunctivitis in about 20% of cases. A total of 32 of the 34 cases were de novo while the others were worsening of underlying blepharoconjunctivitis. Approximately 4 in 5 of the blepharoconjunctivitis cases were moderate.

Ophthalmological history does not seem to be associated with an increased risk of dupilumab-induced blepharoconjunctivitis.

Head and neck AD (odds ratio [OR], 7.254; 95% CI, 1.938-30.07; P =.004), erythroderma (OR, 5.635; 95% CI, 1.635-21.50; P =.007), and presence of dry eye syndrome at baseline (OR, 3.51; 95% CI, 3.158-13.90; P =.031) were associated with dupilumab-induced blepharoconjunctivitis.

Limitations of the study include possible underestimation of lesions compared with previous studies, length of follow-up, and possible use of prescriptions that influence conjunctivitis.

“Ophthalmological history does not seem to be associated with an increased risk of dupilumab-induced blepharoconjunctivitis,” the researchers conclude. “However, an initial ophthalmologic evaluation is advised in patients with risk factors such as erythroderma or head and neck involvement, to educate patients to detect the severity of dry eye syndrome and the presence of blepharo-conjunctivitis prior to initiation of dupilumab.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Dermatology Advisor


Costedoat I, Wallaert M, Gaultier A, et al. Multicenter prospective observational study of dupilumab-induced ocular events in atopic dermatitis patients. J Eur Acad Dermatol Venereol. Published online February 2, 2023. doi:10.1111/jdv.18932