PMC9366075_01
Intensely pruritic, erythematic, lichenified, scaly patches on the trunk (A,C) and extensor and flexural surfaces on upper extremities (B,D) in both patients before dupilumab treatment initiation.
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F1
Seventeen-year-old (Asian, Chinese) teenage twin brothers with a history of AD since childhood were diagnosed clinically using Hanifin and Rajka criteria for AD (Figure 1). Patients have intensely pruritic, erythematic, lichenified, scaly patches on the trunk, the head, and the neck, and extensor and flexural surfaces on upper and lower extremities in both patients (Figure 1).
Psoriasiform eruptions on the trunk and the elbow in both patients (A,B,D,E), dermoscopic image showing pinpoint bleeding (C,F).
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F2
However, after 20 weeks of dupilumab treatment, the patients observed welldefined erythematic scaly plaques (Figures 2A,B,D,E). IgE and eosinophilia in both patients and elevated IL-6 and IL-17 levels in Patient 1. In our patients, dermoscopy showed pinpoint bleeding and white scales on the pink background (Figures 2C,F).
Histopathology showing acanthosis, ectatic capillaries, perivascular lymphocytes infiltration, and parakeratosis with the absence of the granular cell layer (A,B), interestingly the absence of spongiosis.
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F3
Surprisingly, spongiosis and eosinophils were absent (Figures 3A,B).