COVID-19 in Patients with Atopic Dermatitis Treated with Dupilumab: Three Cases and a Literature Review

Justyna Ceryn,1,* Michał Niedźwiedź,1,* Małgorzata Skibińska,1 Magdalena Ciążyńska,2 Aleksandra Lesiak,1 Joanna Narbutt1 1Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, International Doctoral School of the Medical University of Lodz, Lodz, 91-347, Poland; 2Department of Proliferative Diseases, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, Lodz, Poland*These authors contributed equally to this workCorrespondence: Justyna CerynDepartment of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, gen. Karola Kniaziewicza 1/5, Lodz, 91347, PolandEmail justyna.ceryn@stud.umed.lodz.plAbstract: There are limited clinical data on the impact of the SARS-CoV2 infection on patients with dermatological conditions treated with biologics. Dupilumab is a recombinant human IgG4 human monoclonal antibody that inhibits IL4 and IL13 signaling, and is used for moderate–severe atopic dermatitis treatment. We present three patients with atopic dermatitis (AD) treated with dupilumab who contracted COVID-19. In all patients, the infection had a mild course, and only in one, as documented by SCORAD, EASI, and DLQI scores, the condition of the skin deteriorated, and a prolonged positive PCR COVID-19 test was observed. The mechanism of dupilumab action and more evidence for IL13 importance in lung damage caused by SARS-CoV2 suggest a possible explanation for a mild–moderate course of the infection in treated AD patients. Based on current knowledge, there is evidence to continue dupilumab treatment in AD patients with mild–moderate COVID-19; however, careful assessment is needed for each patient.Keywords: COVID-19, dupilumab, atopic dermatiti