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Case Report: Dupilumab-associated psoriasiform eruption followed by depigmentation in a patient with prurigo nodularis and Vogt-Koyanagi-Harada disease

Year: 2026

Type: article

Abstract: Dupilumab blocks interleukin (IL)-4 and IL-13 signaling and is effective for type 2 inflammatory diseases, including atopic dermatitis and prurigo nodularis. Paradoxical psoriasiform eruptions and, less commonly, new-onset or worsening vitiligo have been reported during treatment, suggesting that selective type 2 blockade can alter the cutaneous immune balance in susceptible individuals. We describe a 70-year-old Japanese man with long-standing atopic dermatitis that had evolved into prurigo nodularis and a medical history of Vogt-Koyanagi-Harada (VKH) disease, a melanocyte-directed autoimmune disorder. At follow-up approximately two weeks after a single 600-mg loading dose of dupilumab, the patient presented with a rapidly generalized psoriasiform eruption in a striking distribution that largely spared pre-existing pruriginous nodules. Dupilumab was discontinued, and a biopsy of a new plaque supported a treated or drug-associated psoriasiform inflammatory eruption. Oral cyclosporine was initiated, with improvement of the eruption. Approximately six months after dupilumab administration, marked depigmentation was documented at sites corresponding to the preceding psoriasiform eruption. The pigmentary change was clinically considered severe post-inflammatory hypopigmentation; however, vitiligo remained an important alternative diagnosis because of the patient's VKH background. The temporal sequence raises the hypothesis that selective type 2 blockade may alter cutaneous immune balance in patients with pre-existing melanocyte-directed autoimmunity, but it does not establish dupilumab-induced vitiligo or systemic VKH reactivation. Broader pathway-directed approaches, including modulation of the IFN-γ-JAK-STAT axis, warrant further investigation in such patients.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2026.1991039

Authors: Miku Otsuka, Emi Sato, Shiori Katayama, Shinichi Imafuku

Institution: Fukuoka University

Language: English

Topic: Dermatology and Skin Diseases

Subfield: Dermatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801