度普利尤单抗相关头颈部皮炎研究进展

doi:10.35541/cjd.20250040

Abstract

Abstract: 【Abstract】 Dupilumab has demonstrated remarkable efficacy in the treatment of atopic dermatitis; however, it is also associated with a noteworthy adverse reaction—dupilumab?associated head and neck dermatitis （DAHND）. This review systematically summarizes the epidemiology, pathogenesis, and diagnostic and therapeutic strategies for DAHND, with the aim of providing clinicians with a reference for identifying and managing adverse reactions related to dupilumab.

Key words: Dermatitis, atopic, Facial dermatoses, Antibodies, monoclonal, Drug?related side effects and adverse reactions, Diagnosis, Therapy

Li Zifan¹, Yu Ruoxi¹, Lin Ying². Dupilumab?associated head and neck dermatitis[J]. Chinese Journal of Dermatology,2026,e20250040. doi:10.35541/cjd.20250040

References ［52］

［1］	Kolkhir P, Akdis CA, Akdis M, et al. Type 2 chronic inflammatory diseases: targets, therapies and unmet needs［J］. Nat Rev Drug Discov, 2023,22（9）:743⁃767. DOI: 10.1038/s41573⁃023⁃00750⁃1.
［2］	中国医师协会皮肤科医师分会, 中华医学会皮肤性病学分会, 中国医疗保健国际交流促进会皮肤医学分会, 等. 特应性皮炎治疗药物应用管理专家共识（2024版）［J］. 中华皮肤科杂志, 2024,57（2）:97⁃108. DOI: 10.35541/cjd.20230358.
［3］	马东霞, 祝戎飞, 邹晓燕. 度普利尤单抗引起儿童面部红斑1例［J］. 中国皮肤性病学杂志, 2025,39（2）:202⁃206. DOI: 10. 13735/j.cjdv.1001⁃7089.202405042.
［4］	D'Agostino M, Potestio L, Patruno C, et al. The use of dupilumab in difficult⁃to⁃treat areas of atopic dermatitis: lessons from real⁃world studies［J］. Clin Exp Dermatol, 2026,51（2）:202⁃211. DOI: 10.1093/ced/llaf441.
［5］	Ahn J, Lee DH, Na CH, et al. Facial erythema in patients with atopic dermatitis treated with dupilumab ⁃ a descriptive study of morphology and aetiology［J］. J Eur Acad Dermatol Venereol, 2022,36（11）:2140⁃2152. DOI: 10.1111/jdv.18327.
［6］	中华医学会皮肤性病学分会特应性皮炎研究中心，中华医学会皮肤性病学分会儿童学组. 度普利尤单抗治疗特应性皮炎专家共识［J］. 中华皮肤科杂志，2022，55（6）：465⁃470. DOI：10.35541/cjd.20210885.
［7］	Kozera E, Stewart T, Gill K, et al. Dupilumab⁃associated head and neck dermatitis is associated with elevated pretreatment serum Malassezia⁃specific IgE: a multicentre, prospective cohort study［J］. Br J Dermatol, 2022,186（6）:1050⁃1052. DOI: 10. 1111/bjd.21019.
［8］	Ashbaugh AG, Murase EM, Raffi J, et al. Characterization of residual facial dermatitis during dupilumab therapy: a retrospective chart review to delineate the potential role of expanded series patch testing［J］. Dermatitis, 2022,33（1）:51⁃61. DOI: 10.1097/DER.0000000000000801.
［9］	Soria A, Du⁃Thanh A, Seneschal J, et al. Development or exacerbation of head and neck dermatitis in patients treated for atopic dermatitis with dupilumab［J］. JAMA Dermatol, 2019,155（11）:1312⁃1315. DOI: 10.1001/jamadermatol.2019. 2613.
［10］	Napolitano M, Fabbrocini G, Patruno C. Dupilumab⁃associated cutaneous adverse events among adult patients with atopic dermatitis: a retrospective study［J］. J Dermatol, 2023,50（7）:880⁃887. DOI: 10.1111/1346⁃8138.16764.
［11］	Dybała A, Sernicola A, Gomes V, et al. Dupilumab facial redness: histologic characterization on a series of four cases［J］. Immunotherapy, 2022,14（4）:183⁃188. DOI: 10.2217/imt⁃2021⁃0122.
［12］	Gu C, Wu Y, Luo Y, et al. Real⁃world efficacy and safety of dupilumab in Chinese patients with atopic dermatitis: a single⁃centre, prospective, open⁃label study［J］. J Eur Acad Dermatol Venereol, 2022,36（7）:1064⁃1073. DOI: 10.1111/jdv.18109.
［13］	Muzumdar S, Zubkov M, Waldman R, et al. Characterizing dupilumab facial redness in children and adolescents: a single⁃institution retrospective chart review［J］. J Am Acad Dermatol, 2020,83（5）:1520⁃1521. DOI: 10.1016/j.jaad.2020.06.1003.
［14］	Ferrucci S, Angileri L, Tavecchio S, et al. Elevation of peripheral blood eosinophils during dupilumab treatment for atopic dermatitis is associated with baseline comorbidities and development of facial redness dermatitis and ocular surface disease［J］. J Dermatolog Treat, 2022,33（5）:2587⁃2592. DOI: 10.1080/09546634.2022.2049588.
［15］	de Beer FSA, Bakker DS, Haeck I, et al. Dupilumab facial redness: positive effect of itraconazole［J］. JAAD Case Rep, 2019, 5（10）: 888⁃891. DOI: 10.1016/j.jdcr.2019.07.020.
［16］	Russo F, Rizzo A, Santi F, et al. A paradoxical head and neck erythema: an adverse event due to dupilumab in adult patients with atopic dermatitis［J］. Int J Dermatol, 2022, 61（6）: e204⁃e206. DOI: 10.1111/ijd.15871.
［17］	Quint T, Brunner PM, Sinz C, et al. Dupilumab for the treatment of atopic dermatitis in an Austrian cohort⁃real⁃life data shows rosacea⁃like folliculitis［J］. J Clin Med, 2020,9(4):1241. DOI: 10.3390/jcm9041241.
［18］	Chong AC, Navarro ⁃ Triviño FJ, Su M, et al. Fungal head and
	neck dermatitis: current understanding and management［J］.
	Clin Rev Allergy Immunol, 2024,66（3）:363⁃375. DOI: 10.1007/
	s12016⁃024⁃09000⁃7.
［19］	See Tow HX, Yew YW. Malassezia specific IgE in head and neck dermatitis of eczema: a systematic review & meta⁃analysis［J］. Exp Dermatol, 2024,33（6）:e15108. DOI: 10.1111/exd.15108.
［20］	Umemoto N, Kakurai M, Matsumoto T, et al. Dupilumab alters both the bacterial and fungal skin microbiomes of patients with atopic dermatitis［J］. Microorganisms, 2024,12（1）:224. DOI: 10.3390/microorganisms12010224.
［21］	Kozera E, Flora A, Stewart T, et al. Dupilumab⁃associated head and neck dermatitis resolves temporarily with itraconazole therapy and rapidly with transition to upadacitinib, with Malassezia⁃specific immunoglobulin E levels mirroring clinical response［J］. J Am Acad Dermatol, 2023,88（1）:255⁃257. DOI: 10.1016/j.jaad.2022.05.021.
［22］	Yamamura Y, Nakashima C, Otsuka A. Interplay of cytokines in the pathophysiology of atopic dermatitis: insights from murin models and human［J］. Front Med （Lausanne）, 2024,11:1342176. DOI: 10.3389/fmed.2024.1342176.
［23］	Laska J, Tota M, Łacwik J, et al. IL⁃22 in atopic dermatitis［J］. Cells, 2024,13（16）:1398. DOI: 10.3390/cells13161398.
［24］	Nograles KE, Zaba LC, Guttman⁃Yassky E, et al. Th17 cytokines interleukin （IL）⁃17 and IL⁃22 modulate distinct inflammatory and keratinocyte⁃response pathways［J］. Br J Dermatol, 2008,159（5）:1092⁃1102. DOI: 10.1111/j.1365⁃2133.2008.08769.x.
［25］	Sparber F, De Gregorio C, Steckholzer S, et al. The skin commensal yeast Malassezia triggers a type 17 response that coordinates anti⁃fungal immunity and exacerbates skin inflammation［J］. Cell Host Microbe, 2019,25（3）:389⁃403. DOI: 10.1016/j.chom.2019.02.002.
［26］	Bangert C, Alkon N, Chennareddy S, et al. Dupilumab⁃associated head and neck dermatitis shows a pronounced type 22 immune signature mediated by oligoclonally expanded T cells［J］. Nat Commun, 2024,15（1）:2839. DOI: 10.1038/s41467⁃024⁃46540⁃0.
［27］	Uchida H, Kamata M, Egawa S, et al. Newly developed erythema and red papules in the face and neck with detection of demodex during dupilumab treatment for atopic dermatitis improved by discontinuation of dupilumab, switching to upadacitinib or treatment with oral ivermectin: a report of two cases［J］. J Eur Acad Dermatol Venereol, 2023,37（3）:e300⁃e302. DOI: 10.1111/jdv.18743.
［28］	El⁃Moamly A, El⁃Swify O. Raising awareness of Demodex mites: a neglected cause of skin disease［J］. Infection, 2025,53（4）:1273⁃1298. DOI: 10.1007/s15010⁃025⁃02521⁃z.
［29］	Wei F, Li L, Kong Y, et al. Evidence for the clinical association between Demodex and rosacea: a review［J］. Dermatology, 2024,240（1）:95⁃102. DOI: 10.1159/000534245.
［30］	Wang H, Zhou C. Advances in the pathogenesis of rosacea［J］. Front Immunol, 2025,16:1705588. DOI: 10.3389/fimmu.2025. 1705588.
［31］	Ricardo⁃Gonzalez RR, Kotas ME, O'Leary CE, et al. Innate type 2 immunity controls hair follicle commensalism by Demodex mites［J］. Immunity, 2022,55（10）:1891⁃1908. DOI: 10.1016/j.immuni.2022.08.001.
［32］	Gazi U, Gureser AS, Oztekin A, et al. Skin⁃homing T⁃cell responses associated with Demodex infestation and rosacea［J］. Parasite Immunol, 2019, 41（8）: e12658. DOI: 10.1111/pim.12658.
［33］	Dhingra N, Shemer A, Correa da Rosa J, et al. Molecular profiling of contact dermatitis skin identifies allergen⁃dependent differences in immune response［J］. J Allergy Clin Immunol, 2014,134（2）:362⁃372. DOI: 10.1016/j.jaci.2014.03.009.
［34］	Bocquel S, Soria A, Raison⁃Peyron N, et al. Impact of dupilumab on patch test results and allergic contact dermatitis: a prospective multicenter study［J］. J Am Acad Dermatol, 2024,90（3）:512⁃520. DOI: 10.1016/j.jaad.2023.10.029.
［35］	Mufti A, Lu JD, Sachdeva M, et al. Patch testing during immunosuppressive therapy: a systematic review［J］. Dermatitis, 2021,32（6）:365⁃374. DOI: 10.1097/DER.0000000000000726.
［36］	Chu D, Tao K, Guo W, et al. Effect of dupilumab therapy on patch test results for atopic contact dermatitis: a systematic review［J］. Int J Dermatol, 2026,65（4）:819⁃821. DOI: 10.1111/ijd.70041.
［37］	Takeshita K, Yamasaki T, Akira S, et al. Essential role of MHC Ⅱ⁃independent CD4+ T cells, IL⁃4 and STAT6 in contact hypersensitivity induced by fluorescein isothiocyanate in the mouse［J］. Int Immunol, 2004, 16（5）: 685⁃695. DOI: 10.1093/intimm/dxh073.
［38］	Crepy MN, Nosbaum A, Bensefa⁃Colas L. Blocking type 2 inflammation by dupilumab does not control classic （type 1⁃driven） allergic contact dermatitis in chronic hand eczema［J］. Contact Dermatitis, 2019,81（2）:145⁃147. DOI: 10.1111/cod. 13266.
［39］	Trimeche K, Lahouel I, Belhadjali H, et al. Contact allergy in atopic dermatitis: a prospective study on prevalence, incriminated allergens and clinical insights［J］. Contact Dermatitis, 2024, 90（5）: 514⁃519. DOI: 10.1111/cod.14494.
［40］	Su Z, Zeng YP. Dupilumab⁃associated psoriasis and psoriasiform manifestations: a scoping review［J］. Dermatology, 2023,239（4）:646⁃657. DOI: 10.1159/000530608.
［41］	Li Y, Liu H, Zhang F. Biologics⁃induced immunophenotypic cross⁃switching in patients with psoriasis and atopic dermatitis［J］. Indian J Dermatol, 2023,68（2）:186⁃191. DOI: 10.4103/ijd.ijd_871_22.
［42］	Burlando M, Schiavetti I, Parodi A, et al. Biologic treatments for psoriasis have different anatomical specificities in residual PASI［J］. J Dtsch Dermatol Ges, 2026, 24（5）: 628⁃632. DOI: 10.1111/ddg.15924.
［43］	Waldman RA, DeWane ME, Sloan B, et al. Characterizing dupilumab facial redness: a multi⁃institution retrospective medical record review［J］. J Am Acad Dermatol, 2020,82（1）:230⁃232. DOI: 10.1016/j.jaad.2019.06.026.
［44］	Seok SH, An JH, Shin JU, et al. Facial redness in atopic dermatitis patients treated with dupilumab: a case series［J］. Allergy Asthma Immunol Res, 2020,12（6）:1063⁃1065. DOI: 10.4168/aair.2020.12.6.1063.
［45］	Choi H, Shim DH, Kim MS, et al. New onset of alcohol flushing in an atopic dermatitis patient treated with dupilumab［J］. Ann Dermatol, 2023,35（Suppl 1）:S163⁃S164. DOI: 10.5021/ad. 21b.038.
［46］	Tsai YC, Tsai TF. Facial erythema during dupilumab treatment for atopic dermatitis successfully remedied with topical crisaborole ointment: a case report［J］. Dermatol Ther, 2022, 35（11）: e15843. DOI: 10.1111/dth.15843.
［47］	Gao DX, Song S, Kahn JS, et al. Treatment of patients experiencing dupilumab facial redness with itraconazole and fluconazole: a single⁃institutional, retrospective medical record review［J］. J Am Acad Dermatol, 2022,86（4）:938⁃940. DOI: 10.1016/j.jaad.2021.03.070.
［48］	Liane JG, Morgado⁃Carrasco D. Dupilumab⁃associated facial erythema successfully treated with oral ivermectin［J］. Dermatol Pract Concept, 2022,12（4）:e2022184. DOI: 10.5826/dpc.1204 a184.
［49］	艾丽珍, 余兰慧, 赖瑶, 等. 不同浓度茶树精油治疗蠕形螨睑缘炎的有效性及安全性［J］. 国际眼科杂志, 2022,22（1）:104⁃108. DOI: 10.3980/j.issn.1672⁃5123.2022.1.22.
［50］	Beyrouti A, Deuze J, Fontas E, et al. Switching from dupilumab to tralokinumab or Janus kinase inhibitors in cases of ocular and/or facial adverse events in patients with atopic dermatitis: a multicenter retrospective study［J］. J Allergy Clin Immunol Pract, 2025,13（2）:353⁃360. DOI: 10.1016/j.jaip.2024.12.001.
［51］	Santosa A, Yew YW. Dupilumab⁃associated head and neck dermatitis: rapid response with abrocitinib treatment［J］. Skin Health Dis, 2024,4（1）:e312. DOI: 10.1002/ski2.312.
［52］	Takegami T, Yonekura S, Kataoka K, et al. A case of dupilumab⁃resistant facial erythema successfully managed with topical delgocitinib［J］. J Dermatol, 2025,52（7）:e592⁃e593. DOI: 10.1111/1346⁃8138.17713.

[1]	Li Yanhong, Jiang Kun, Wu Zhuoxuan, Zhang Jianlan, Fang Meizhen, Liu Shuting, Wang Linlin, Hu Lei, Zhou Xiaoyong, Chen Liuqing, Chen Jinbo. Analysis of 18 cases of cutaneous adverse reactions associated with programmed death-1 inhibitors [J]. Chinese Journal of Dermatology, 2026, 59(8): 783-787.
[2]	Expert Group on the “Chinese expert consensus on sirolimus in the treatment of Kaposiform hemangioendothelioma （ edition）”. Chinese expert consensus on sirolimus in the treatment of Kaposiform hemangioendothelioma （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(8): 728-737.
[3]	Chinese Society of Dermatology, China Dermatologist Association. Chinese guideline for the diagnosis and treatment of cutaneous squamous cell carcinoma （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(8): 703-716.
[4]	Writing Committee Expert Group on “Diagnosis and treatment of pustular psoriasis: a Chinese expert consensus statement （ edition）”. Diagnosis and treatment of pustular psoriasis: a Chinese expert consensus statement （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(8): 717-727.
[5]	He Qing, Zhang Tao, Wang Xiuli, Gao Xinghua, Chen Hongduo, Liu Min, Qi Ruiqun. Biomarkers associated with malignant progression of actinic keratosis [J]. Chinese Journal of Dermatology, 2026, 59(7): 687-690.
[6]	Wei Jin¹, Yan Huiwen¹, Zhang Jianzhong², Lun Wenhui¹. Efficacy and safety of secukinumab in the treatment of moderate-to-severe plaque psoriasis complicated by HIV infection: a clinical observation of 10 cases [J]. Chinese Journal of Dermatology, 2026, 59(7): 671-674.
[7]	Wang Linlin, Cao Lijuan, Chen Liuqing, Li Dongsheng, Hu Yanyan. Efficacy and safety of hemoporfin-mediated photodynamic therapy for port-wine stains on the extremities: a retrospective analysis [J]. Chinese Journal of Dermatology, 2026, 59(7): 637-644.
[8]	Zhang Guolong, Zhao Zijun. Aminolevulinic acid-based photodynamic therapy for cutaneous squamous cell carcinoma: current status, challenges, and perspectives [J]. Chinese Journal of Dermatology, 2026, 59(7): 626-631.
[9]	Hu Yu, Lu Yan, Chen Kun, Gu Heng. Standardization, precision, and full-cycle management: interpretation of Specifications for the Management of Vitiligo Patients Undergoing Home Phototherapy [J]. Chinese Journal of Dermatology, 2026, 59(7): 632-636.
[10]	Dermatology Professional Committee of Chinese Research Hospital Society, China Dermatologist Association. Guideline for the clinical application of narrowband ultraviolet B phototherapy in dermatology （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(7): 595-610.
[11]	Photodynamic Therapy Research Cooperative Group, Chinese Society of Dermatology, Chinese Association of Rehabilitation Dermatology & Photodynamic Therapy, Photomedicine Therapeutic Equipment Group, Committee on Skin Disease and Cosmetic Dermatology, China Association of Medical Equipment. Guideline for the clinical application of aminolevulinic acid-based photodynamic therapy in the treatment of condyloma acuminatum （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(7): 611-618.
[12]	Pediatric Dermatology Group, Chinese Society of Dermatology, Dermatology Group, Chinese Pediatric Society, Chinese Medical Association, Pediatric Group, Chinese Association of Rehabilitation Dermatology, Atopic Dermatitis Group, Chinese Association of Rehabilitation Dermatology, Pediatric Dermatology Group, China Dermatologist Association, Dermatology Group, the Society of Pediatrics, Chinese Medical Doctor Association. Chinese consensus on the prevention, treatment, and management of atopic dermatitis in children（2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(6): 487-504.
[13]	Du Xinran, Wang Xinhe, Li Siyu, Chen Moan, Yuan Shaojie, Yan Ran, Cheng Linyan, Guo Wanjun, Wang Yi, Li Fulun. Development and evaluation of a diagnostic scale for atopic dermatitis with the syndrome of wind dryness due to blood deficiency [J]. Chinese Journal of Dermatology, 2026, 59(6): 540-546.
[14]	Li Wei¹, Yao Xu². Research on atopic dermatitis in China: current status and future perspectives [J]. Chinese Journal of Dermatology, 2026, 59(6): 505-511.
[15]	Tian Jing, Song Zhiqiang. Application of tape stripping to the detection of biomarkers in atopic dermatitis [J]. Chinese Journal of Dermatology, 2026, 59(6): 578-581.

Dupilumab?associated head and neck dermatitis

PDF

PDF (Mobile)

Knowledge

Abstract

Cite this article

share this article

References ［52］

Related Articles 15

Metrics

Comments

Recommended 0