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Do you see persistent facial dermatitis in AD patients who have responded to dupilumab?

Atopic Dermatitis

You? Yes. A resounding yes. This is, unfortunately one of the most common reasons in my practice that I have to stop dupliumab, and I have a lot of patients who are on it, many of whom are doing great. It's been a big game changer for a lot of people. But one of the number one reasons that I have to stop it is due to this kind of face and neck dermatitis. Now, this is different from, although sometimes associated with the conjunctivitis, people get this kind of duplium, have related conjunctivitis that looks very much like an allergic conjunctivitis, but is a little bit different here. It's face and neck involvement. It tends to be very difficult to treat, and it can be enough that patients just say, I need to stop. I've seen it where their whole body was very severe atopic dermatitis before they started. Now, that is crystal clear. We can give them an IG score of zero, but then their face is an IJ score of three moderate or four severe. And it's bizarre. They never even had facial involvement before. So we wrote a paper about this. Vivian, she and others, we put this together where we talked about some of the different possibilities. Could it be malassesia that we know this can be a subtype of atopic dermatitis where there's a malassesia, either overgrowth and or inappropriate allergic or immune reaction to it. Could that be playing a role? We talked about the fact. Could it be contact dermatitis? Could it be topical storied withdrawal syndrome? That they've kind of stopped using steroids and now they're getting this red face? We don't really know. Sometimes we're able to treat it. Sometimes it's even rosacea. I've even had some patients where it's just plain rosacea. Don't know why it's flaring up in this context, but normal rosacea treatments can help. So we try a number of things, but in truth, sometimes I do actually have to stop the medication, which is really unfortunate.

Do you see persistent facial dermatitis in AD patients who have responded to dupilumab?

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