{
  "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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Dermatology, Faculty of Medicine, Fukuoka University"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Miku Otsuka"
    },
    {
      "affs": [
        0
      ],
      "name": "Emi Sato"
    },
    {
      "affs": [
        0
      ],
      "name": "Shiori Katayama"
    },
    {
      "affs": [
        0
      ],
      "name": "Shinichi Imafuku"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/01xqqq15qnw7v.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1991039",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13730924/",
  "id": "01xqqq15qnw7v",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1991039/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2708|Dermatology and Skin Diseases"
    ]
  ],
  "openalex": "W7223112302",
  "pdf_url": "https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1991039/pdf",
  "pmcid": "PMC13730924",
  "pmid": "42984631",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/01xqqq15qnw7v.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:17Z",
      "native_id": "10.3389/fimmu.2026.1991039",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1991039/full"
    },
    {
      "first_seen": "2026-11-07T12:23:53Z",
      "native_id": "PMC13730924",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fimmu.2026.1991039"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-3224",
      "subfield": "immunology"
    }
  ],
  "title": "Case Report: Dupilumab-associated psoriasiform eruption followed by depigmentation in a patient with prurigo nodularis and Vogt-Koyanagi-Harada disease",
  "title_text": "Case Report: Dupilumab-associated psoriasiform eruption followed by depigmentation in a patient with prurigo nodularis and Vogt-Koyanagi-Harada disease",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:21:13Z",
  "url": "https://research.draconitic.com/paper/01xqqq15qnw7v",
  "venue": "Frontiers in Immunology",
  "versions": []
}