Clinical Management of Dupilumab-related Conjunctivitis, Erythema, and Arthralgia in Atopic Dermatitis: Evidence From Two Cases Treated with Nemolizumab.

Atopic dermatitis (AD) is the most common chronic inflammatory skin condition and typically presents with pruritus, xerosis, eczematous lesions, and lichenification. Treatment options vary depending on severity; however, core management involves trigger avoidance, daily skin care, and anti-inflammatory therapies. Dupilumab, a monoclonal antibody that blocks interleukin-4 (IL-4) receptor α, is approved for the treatment of moderate-to-severe AD in patients aged 6 months or older. While this approval represents a significant advancement in AD therapy, the full extent of its side effect profile continues to emerge. Herein, we report two cases of refractory AD in which dupilumab therapy was limited by conjunctivitis and paradoxical worsening of cutaneous symptoms. We present these cases to describe the presentation, clinical progression, and management of dupilumab-associated adverse reactions in AD treatment, thereby contributing to a deeper understanding of its side effect profile. Notably, these cases demonstrate the successful use of nemolizumab as a therapeutic alternative in the setting of dupilumab intolerance.