Atopic dermatitis (AD) is a common, chronic, inflammatory skin condition that affects up to 25% of children and 5% of adults worldwide. In a recent case report, researchers have reported that treatment of palpebral and facial eczemas linked to conjunctivitis development. The research has been published in the Journal of the European Academy of Dermatology and Venerology on March 03, 2021.
Ocular disorders, including allergic conjunctivitis, are common in patients with atopic dermatitis (AD). In most dupilumab AD trials, dupilumab-treated patients had higher conjunctivitis incidence than those receiving placebo. To further evaluate this association, researchers assessed 277 patients affected by moderate-severe forms of atopic dermatitis for the treatment with dupilumab. Among 277 patients, 27% presented with facial seborrheic-like dermatitis, and 26% presented with facial eczema without signs of seborrheic dermatitis. They were treated with an antifungal corticosteroid cream, itraconazole tablets, and tacrolimus 0.1% ointment. The researchers prescribed a trehalose/hyaluroate tear substitute to hydrate conjunctival mucosa to all patients.
Key findings of the study were:
Upon analysis, the researchers identified 20 cases of conjunctivitis (incidence rate, 7.2%) among which, 6 cases reported nonadherence to preventive therapy and were excluded, resulting in an incidence rate of 5%.
They also observed other ocular outcomes such as nonspecific keratoconjunctivitis associated with dry eye (n=19) and follicular conjunctivitis associated with limbitis (n=1).
They further noted a history of prior conjunctivitis in 6 patients (42.8%).
They also noted that the mean EASI score of patients with conjunctivitis was 37, which was higher than the mean EASI score of the total (N=277) cohort.
The mean time of conjunctivitis onset from the start of therapy was six months (time-lapse, 3 to 14 months).
Patients with conjunctivitis were treated with cortico-antibiotic eye drops and were recovery except for 2 patients.
The patient with follicular conjunctivitis required cyclosporine ophthalmic drops.
The authors concluded, "A possible association between facial eczema and conjunctivitis is probable, but more data are needed," and further added, "It is likely that prophylactic therapy, based on trehalose/hyaluroate tear substitute, associated with the treatment for palpebral and facial eczema, worsened dry eye and consequently, conjunctivitis."
For further information:
https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.17210