A patient being treated with dupilumab may develop a Demodex-related dermatosis.
Patient selection: receipt of dupilumab
Dupilumab is a monoclonal antibody targeting the IL-5 receptor alpha (paper says IL-4) on eosinophils, causing a rapid depletion of circulating eosinophils.
Dupilumab (brand-name Dupixent) is approved therapy for:
(1) eczema
(2) severe asthma
(3) chronic rhinosinusitis with nasal polyposis
(4) eosinophilic esophagitis
(5) prurigo nodularis
Clinical features:
(1) sudden onset (< 2 weeks)
(2) spreading acneiform eruption, folliculitis or rosacea-like
(3) presence of numerous Demodex mites in affected areas
(4) response to topical 1% ivermectin cream
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