중증 아토피피부염 환자에서 dupilumab 치료 도중 발생한 건선 1예

초록

Dupilumab, a human monoclonal antibody that blocks IL-4 and IL-13 receptors, has been approved for patients with moderate to severe atopic dermatitis. Psoriasiform dermatitis or psoriasis is a rare paradoxical reaction associated with dupilumab. Selectively inhibiting certain type of helper T cell pathway can provoke skewing of T cell polarization to others. Although pathogenesis of dupilumab-induced psoriasis has not been fully elucidated, it is postulated to be caused by shift of balance toward Th17 predominance due to selective suppression of Th2 pathway by dupilumab. A 24-year-old male with severe atopic dermatitis, who had been treated with dupilumab for 9 months, developed multiple well-demarcated erythematous plaques with scales on his back. Histopathology of the lesion revealed typical features of psoriasis, and the diagnosis of dupilumab-induced psoriasis was made. The lesions were significantly improved and well controlled within 3~4 months of applying topical and intra-lesional corticosteroids and topical tacrolimus without discontinuing dupilumab.

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