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219: Dupixent Red Face + Neck Rash Associated With Fungal Overgrowth

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Did you know that about 10% of people using Dupixent develop awful face and neck dermatitis?

This issue (more officially called Dupilumab Facial Redness (DFR)) wasn’t flagged during the randomized FDA trials, but has some dermatologists concerned because DFR can be incredibly severe, just as it was for one of my clients.

Since Dupixent is a biologic drug used by some with Eczema and Topical Steroid Withdrawal to ease symptoms, this new problem isn’t ideal.

Rather than just assume that the person has a sensitivity to Dupixent, new research is showing that this may be a different problem — Malasezzia hypersensitivity.

If you recall, Malasezzia is a fungal organism that normally lives in your skin’s microbiome.

It really shouldn’t be causing an issue like this, but something about the way that Dupixent interacts with your immune system along with a compromised skin barrier could play a role.

Here are the current papers discussing this topic so you have something to bring to your prescribing dermatologist so you can get the help you need if you are experiencing this!

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In this episode:

  • Facial + neck redness that occurs in about 10% of Dupixent users
  • What current research on what may be driving this weird “side effect”
  • Treatment options listed in currently published articles
  • The blood test marker that could be helpful in getting a clear diagnosis
  • What to do if YOU have face + neck redness from Dupixent

Quotes:

Approximately 10% of Dupixent users develop red, inflamed, dry, scaly and itchy face + neck rashes requiring antifungal medication treatment.

Dupixent Facial Redness was never described or mentioned in the Dupixent clinical trials for the FDA (which is surprising considering that it impacts approximately 10% of patients).

 

Woman with clipboard thinking about Dupixent research

219: Dupixent Red Face + Neck Rash Associated With Fungal Overgrowth (FULL TRANSCRIPT)

Welcome back to episode #219 of the Healthy Skin Show!

In today’s episode, I want to talk about some emerging information that is crucial for anyone on Dupixent (or considering the medication) to hear about.

The reason is that in about 10% of people who try Dupixent (even those using it for Topical Steroid Withdrawal) may develop a red face, neck and upper chest area that can be very inflamed, scaly, dry and itchy.(1)

Everywhere else will likely look great, but this area becomes a real problem.

Cases had been reported online, but no one really had any idea what was causing certain individuals to develop this weird reaction…

Until now — and wow, is this going to blow your mind!

Surprised woman

How I Learned About This Crazy Dupixent Side Effect

A wonderful client of mine has been really miserable with TSW for a while now and was seeking some relief so that she could be a better mom to her kids.

We discussed her starting Dupixent to see if it could help lower the severity of her symptoms.

But we didn’t anticipate that she’d end up with a bright red, inflamed and itchy face, neck and chest while everything else seemed to heal up.

Her prescribing dermatologist was stumped and wasn’t sure what was going on. My client shared her concern that it could potentially be coming from Dupixent from what she’d read online.

So her doctor stopped her on the medication.

A few weeks later, her doctor returned from a medical conference and mentioned to her that information was presented at this conference that her face and neck flare-up could be connected to a fungal problem, but refused to treat her since my client had stopped Dupixent.

This info was relayed to me and I started searching for research online about this.

Scientist doing research

How Dupixent Red Face + Neck Is Connected To Fungal Overgrowth

Turns out that a few papers had already popped up about this topic known more formally as dupilumab (aka. Dupixent) facial redness (DFR)…

One research letter published in September 2019 in JAMA Dermatology mentions that the new occurrence of Head-Neck dermatitis in some Dupixent users could be due to a potential activation of the Th17 pathway that allows for the proliferation of Malassezia and thus an increasing severity of what would later become known as DFR.(2)

Another paper published in October 2019 in the Journal of American Academy of Dermatology details the exact issue in two cases wherein the patients became sensitized to Malassezia. The one patient was found to have an “elevated serum level of Malassezia-specific immunoglobulin E”. Treatment in both of these cases was “oral itraconazole 200 mg once daily” for 1 month.(1)

Then Dr. Julie Greenberg (one of my favorite guests here on the Healthy Skin Show) gave a presentation at the Integrative Dermatology Symposium 2021 mentioning the connection between dupilumab facial redness and Malassezia. For practitioners out there, you can likely find the presentation called “Yeasty Beasty! Malassezia in Skin Disease + an Integrative Approach to Treatment” on the LearnSkin platform.

You might recall that Dr. Greenberg came on the show to discuss Malasezzia on episode 173 and its role in chronic skin problems. I highly recommend that you check that episode out — but as a quick refresher to help you connect some dots here — Malassezia is a commensal fungal organism that lives within the skin microbiome.

Upon arriving home from the conference, I found yet another paper on this published in Dermatologic Therapy in September 2021 called “Dupilumab facial redness: Clinical characteristics and proposed treatment in a cohort” and subsequently reported on Dermatology Advisor.(3)

To briefly summarize, researchers reviewed 101 eczema patients for dupilumab facial redness and found that 13 patients fit the criteria and were subsequently treated for hypersensitivity to Malassezia. They used 200mg of oral Fluconazole weekly along with a topical antifungal for 4 weeks. One person required a second round of meds which was 100 mg of Itraconazole daily for a month. Unfortunately, about half of the group seemed to relapse after approximately 3 months time.(4)

Woman thinking about Dupixent

What To Do If You’re On Dupixant + Develop Red Face and Neck

I’m not saying with 100% certainty that if you develop dupilumab facial redness that you have fungal overgrowth.

At the time of this episode’s publication, there’s simply not enough research out there on this topic… especially considering that DFR was never described or mentioned in the Dupixent clinical trials for the FDA (which is rather surprising considering that it seems to impact around 10% of patients).(5)

But more research and papers are coming out pointing in this direction which is why I wanted to create this episode (and its corresponding show notes with all current research) so you now have something to bring to your prescribing doctor.

There’s a real chance that they have no idea about this research and papers published connecting dots between Malasezzia hypersensitivity and Dupixent.

I asked a rep from Dupixent about this problem at the Integrative Dermatology Symposium 2021 and she didn’t have any answers for me about it and said she’d refer my question to their team of experts whom I’d hear back from.

Well, it’s now two weeks later and I’ve never heard from anyone who works for Dupixent to answer my questions.

Rather than hold my breath, I’d rather educate you on this issue so you can seek help with proof of current research in hand (linked studies are below in the references section). Your prescribing doctor is the point person who needs to be notified so you can hopefully get appropriate treatment.

Perhaps they can also run testing for serum Malassezia-specific immunoglobulin E to help identify what’s going on rather than just assume you’re sensitive to the medication itself.

If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them.

Then take a moment to share this episode with people who are dealing with eczema + TSW so that they can be informed (just as you are) about this challenge facing those who use Dupixent. This information could help them find relief on their healing journey.

Thank you so much for turning in and I look forward to seeing you in the next episode!

Woman checking references in library

REFERENCES

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818397/
  2. https://jamanetwork.com/journals/jamadermatology/fullarticle/2749354 
  3. https://onlinelibrary.wiley.com/doi/10.1111/dth.15140
  4. https://www.dermatologyadvisor.com/home/topics/dermatitis/oral-and-topical-antifungals-beneficial-for-dupilumab-facial-redness-in-ad/
  5. https://www.jaad.org/article/S0190-9622(19)30990-9/fulltext

Approximately 10% of Dupixent users develop red, inflamed, dry, scaly and itchy face + neck rashes requiring antifungal medication treatment.


Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.


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