Post-Hematopoietic Stem Cell Transplantation Eczematous Dermatitis Spectrum Successfully Treated With Dupilumab: A Case Series and Review of the Literature.

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) is associated with several dermatological adverse events, including the de novo onset of pruritus and eczema. Some authors consider this a variant of graft-versus-host disease (GvHD) and refer to it as eczematous or atopic dermatitis (AD)-like GvHD, while others categorize it separately as eczematous or AD-like dermatitis. This study aimed to report a pediatric case series and review previously published cases treated with dupilumab.

METHODS

Retrospective multicenter study including patients aged 0-18 treated with dupilumab for new eczematous lesions following HSCT up to 2024 in three tertiary hospitals in Spain. A literature review in PubMed identified all reported pediatric and adult cases.

RESULTS

A total of 24 cases were identified: 9 from our centers and 15 from the literature. Median onset was 3 months post-HSCT. All patients presented with pruritus and eczema. 47% showed flexural involvement. Histology revealed eczematous features in 73%, mixed GvHD/eczema in 20%, and pure GvHD in 7%. 38% were classified as post-HSCT eczema, and 63% as eczematous or AD-like GvHD. All were refractory to topical corticoids and different systemic immunosuppressants. Dupilumab led to complete or near-complete resolution in 96% of cases. No serious adverse events were reported.

CONCLUSION

Dupilumab appears to be effective and safe for eczematous lesions occurring after HSCT, regardless of whether the histopathological characteristics align with eczema or GvHD. This supports a shared spectrum between eczematous dermatitis and GvHD, and the use of a neutral diagnostic term. Further research is needed to clarify its pathogenesis.