Dupilumab-Induced Psoriasis in a Patient With Chronic Rhinosinusitis With Nasal Polyps: A Case Report.

Dupilumab, an IL-4Rα antagonist, has shown substantial efficacy in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, paradoxical dermatologic side effects, including new-onset psoriasis, have recently been reported. We describe a 42-year-old woman with CRSwNP who developed psoriatic skin lesions after initiating dupilumab, despite no personal or family history of psoriasis. She was started on roflumilast 0.3% topical foam daily, resulting in partial resolution of the psoriatic plaques over the following months. This adverse event may be attributed to an immune shift from a Th2-dominant to a Th1/Th17-driven inflammatory response. Clinicians should remain vigilant for new-onset cutaneous reactions during dupilumab therapy. Early recognition may support timely intervention and modification of therapy.