Alcohol-induced facial erythema in patients treated with dupilumab: a case series and systematic review.

Background: Dupilumab-associated head and neck dermatitis in patients with atopic dermatitis has been extensively documented. A distinctive short-lived facial erythema after alcohol ingestion in patients treated with dupilumab has recently emerged.

Objectives: To characterize alcohol-induced facial erythema on treatment with dupilumab.

Methods: We conducted a systematic review based on PubMed and Google Scholar searches for publications on alcohol-induced facial erythema on treatment with dupilumab. A case series from our centre was added to this review. Data were summarized using descriptive statistics and a narrative review. This systematic review adhered to PRISMA reporting guidelines and was registered with PROSPERO (CRD42024571723).

Results: Seven publications describing nine patients and five more from our case series were included. All were adults treated for atopic dermatitis (nine males; mean age 32.4 years, SD 9.8). Six patients applied concomitant topical calcineurin inhibitors. At a median of 26 weeks (range 3 weeks to 3 years) from dupilumab initiation, patients exhibited facial erythema/flushing within minutes of alcohol consumption, resolving spontaneously in an hour. No patient discontinued dupilumab. One patient reported initial successful prophylaxis with a histamine H2-receptor antagonist.

Conclusions: Alcohol-induced facial erythema/flushing on dupilumab has only been described in atopic dermatitis and is characterized by an acute onset and rapid resolution. Topical calcineurin inhibitor applications did not account for most patients' cases. Although seemingly an uncommon phenomenon, its social media presence suggests that it is underreported and troublesome to patients.