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Dermbits

Can dupilumab cause cutaneous T-cell lymphoma (CTCL)?

Atopic Dermatitis

There have been some recent publications, some of them in the Journal of the American Academy of Dermatology regarding utilizing depiliumab in patients that you're treating them for atopic dermatitis, but it turns out that they actually have cutaneous T cell lymphoma. Right. And so the question is, did they have cutaneous T cell lymphoma from the start, and the clinician just thought it was atopic dermatitis? Did the atopic dermatitis emerge into becoming cutaneous T cell lymphoma, and did dupliumab have any role in that particular situation occurring? To answer the last part of the question, that's a very difficult thing to determine because you're finding out somewhat after the fact that the patient had cutaneous T cell lymphoma. And they may have had that from the start, because we know, especially with patients, adult patients, that have a diagnosis of atopic dermatitis. And I would suggest looking carefully at how you're making that diagnosis, especially with adult onset, because that's a relatively uncommon condition. Think about the possibility of cutaneous t cell lymphoma, and you may want to get a biopsy if there's any question about the diagnosis. I had a patient recently where that happened, where I'm convinced that they didn't have atopic dermatitis before, because I went back and drilled down on the history, and the diagnosis of atopic dermatitis really wasn't that strong. They didn't get better. I biopsied them, and they had atypical lymphocytic proliferation. They didn't have called a cutaneous T cell lymphoma, though that may emerge. We treated them as parasiriasis with phototherapy, and they're doing very well. So you have to really make sure you feel comfortable, especially in adults, with the diagnosis of atopic dermatitis. And if there's any question, you can do a biopsy and try to differentiate.