Background: Dupilumab is the first approved IL-4Rα inhibitor for the treatment of atopic dermatitis (AD) at present with good efficacy and safety. However, there have been several reports of psoriasis and psoriasiform manifestations occurring after dupilumab therapy in recent years, showing a new paradoxical cutaneous reaction associated with biologics. Summary: This is a scoping review in order to summarize the demographics and epidemiology, clinical manifestations, diagnosis, potential pathogenesis, and promising management of dupilumab-associated psoriasis and psoriasiform manifestations (DAPs/PsM). Key Message: The present review suggests that DAPs/PsM may occur in approximately 1.8-3.3% of AD patients after dupilumab therapy. In general, DAPs/PsM manifests similar clinical and histological features to classic psoriasis but not identical. T-cell polarization skewing between Th17 and Th2 spectrum may act as the core mechanism of DAPs/PsM, characterized by up-regulated IL-23/Th17 axis. Mild-to-moderate DAPs/PsM responds well to topical therapies while discontinuation of dupilumab is recommended in severe cases. Currently, JAK inhibitors and the combination of dupilumab with other biologics are considered as potential treatments for concurrent AD and psoriasis. Future researches are needed to clarify the detailed mechanism of this phenomenon in order to seek more effective management and prevention.

The Author(s). Published by S. Karger AG, Basel