PMC8722565_01
Clinical manifestations in a 45-year-old male with CAD before treatment (A), and following treatment with conventional therapies (B), treatment with cyclosporine A and dupilumab (C), and treatment with dupilumab (D).
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Physical examination revealed severe erythema and papulae with crusted lesions, scratch marks, and diffuse pigmentation on his face and neck (Figure 1A). A to 100 mg/day (Figure 1B). After discussion with the patient and obtaining his consent, dupilumab was initiated with a loading dose of 600 mg followed by 300 mg every 2 weeks thereafter. Two months after the combined treatment, the patient was free from pruritus and achieved rapid and progressive improvement of the erythema and the papulae, although diffuse pigmentation remained (Figure 1C). Then, he stopped the oral cyclosporine A and received 300 mg dupilumab every month, since the itchy erythema had improved dramatically (Figure 1D).
Parakeratosis and mild spongiosis in the epidermis, as well as perivascular lymphocytes, fibrocollagenous and mononuclear cells in the dermis. (Hematoxylin and eosin; magnifications: (A) x40, (B) x400.)
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The skin biopsy was favorable for eczema with parakeratosis and mild spongiosis in the epidermis, as well as perivascular lymphocytes, fibrocollagenous and mononuclear cells in the dermis (Figure 2).