Author(s)

Huiting Lu ¹, Xin Yang ¹, Shasha Jin ¹, Chan Zhao ²

Affiliation(s)

¹ First Clinical School of Medicine, Shannxi University of Chinese Medicine, Xianyang, China
² Department of Dermatology, Baoji Hospital of Traditional Chinese Medicine Affiliated with Shaanxi University of Chinese Medicine, Baoji, China

Corresponding Author

Huiting Lu

ABSTRACT

A 72-year-old male presented with generalized maculopapular rash and nodules accompanied by pruritus for over 3 years, which had worsened over the past 2 months.During the disease course, he developed bullous pemphigoid (BP) and prurigo nodularis. He was treated with dupilumab. One year later, erythema and hypertrophic white scales appeared on both lower limbs. A skin biopsy from the right upper arm revealed elongated and downward extension of rete ridges, and perivascular lymphocytic infiltration in the superficial dermis. These findings were consistent with psoriasiform dermatitis.A previous biopsy during the BP phase showed subepidermal bullae and eosinophilic infiltration in the superficial dermis (Th2 phenotype).The diagnosis was dupilumab associated immune deviation (psoriasiform dermatitis).This case suggests that in the context of overlapping Th2 diseases, immune deviation toward Th1/Th17 phenotype may occur during dupilumab therapy. However, it is often overlooked due to phenotypic overlap. Biopsy remains crucial for definitive diagnosis.

KEYWORDS

Immune deviation; Dupilumab; Bullous pemphigoid; Prurigo nodularis; Psoriasiform dermatitis

CITE THIS PAPER

Huiting Lu, Xin Yang, Shasha Jin, Chan Zhao. Immune Deviation Following Dupilumab Therapy: A Case of Psoriasiform Dermatitis. MEDS Clinical Medicine (2026). Vol. 7, No. 3, 70-74. DOI: http://dx.doi.org/10.23977/medsc.2026.070310.

REFERENCES

[1] SU Z, ZENG Y P. Dupilumab-Associated Psoriasis and Psoriasiform Manifestations: A Scoping Review [J]. Dermatology (Basel, Switzerland), 2023, 239(4): 46-57.
[2] CIRONE K D, LOVEGROVE F E. Dupilumab-induced psoriasis in a patient with atopic dermatitis successfully treated with Upadacitinib: A case report [J]. SAGE open medical case reports, 2025,13:8-11.
[3] WEISS L, MARBET C P, BRANCA L B, et al. Janus Kinase Inhibitors as Successful Treatment Alternative in Dupilumab-Induced Psoriasis [J]. Case reports in dermatology, 2024, 16(1): 144-148.

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