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Atopic Eczema — SCE Dermatology MCQ

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ModerateInflammatory DermatosesAtopic EczemaSCE Dermatology

A 30-year-old woman with severe atopic eczema controlled on Dupilumab develops new-onset facial erythema with papules and pustules, predominantly affecting the centrofacial area. She has no prior history of rosacea. What is the most likely explanation?

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Correct answer: E — Dupilumab-associated facial erythema (Dupilumab face)

Dupilumab-associated facial erythema ('Dupilumab face') is a recognised adverse effect presenting as erythema, papules, and sometimes pustules predominantly on the face. The mechanism is debated but may involve Demodex proliferation (due to altered sebaceous gland function from IL-4/IL-13 blockade), psoriasiform dermatitis, or rosacea-like dermatitis. It occurs in approximately 5-10% of patients. Management includes topical Ivermectin (anti-Demodex), topical calcineurin inhibitors, or low-dose Doxycycline. It does not usually necessitate Dupilumab discontinuation. The condition may improve with time or with topical treatment.

Reference: BJD 2021 Dupilumab facial dermatitis; AAD 2023