{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:09:31Z","timestamp":1790726971663,"version":"4.1.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Dupilumab is a human monoclonal antibody, targeting the alpha subunit of the interleukin (IL)-4 receptor, shared by both IL-4 and IL-13 cytokines. Paradoxical reactions have been reported with its use, including psoriatic manifestations, but reports of associated psoriatic alopecia are sparse. We report a case of a 29-year-old man with severe atopic dermatitis from childhood who developed a psoriasiform rash and inflammatory alopecia affecting the scalp 7 weeks after the initiation of dupilumab. Histological features from a scalp biopsy were in keeping with psoriatic alopecia, including overlapping psoriasiform and spongiotic features, and the presence of peribulbar, deeper inflammation with eosinophils and plasma cells. Dupilumab was stopped and the scalp treated topically with steroids and ketoconazole shampoo. The patient was commenced on abrocitinib and within 6 months he had full regrowth of hair and his eczema was well controlled. Psoriatic alopecia has rarely been reported as a paradoxical reaction and can mimic the more common presentation of paradoxical alopecia areata. Histology is helpful in distinguishing these presentations, and cessation of the medication often leads to resolution. Paradoxical psoriatic manifestations are more common with tumour necrosis factor-\u03b1 inhibitors, and a proposed mechanism for this reaction is a shift between the T helper (Th) 2 pathway to the Th1\/Th17 pathway. Clinicians should be aware of this paradoxical reaction when prescribing dupilumab, and consider switching therapy to an alternative agent with a different mechanism of action should they encounter it.<\/jats:p>","DOI":"10.1093\/skinhd\/vzaf101","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T13:01:11Z","timestamp":1765630871000},"page":"798-802","source":"Crossref","is-referenced-by-count":0,"title":["A case of dupilumab-induced psoriatic alopecia"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0505-2913","authenticated-orcid":false,"given":"Julian","family":"Pearce","sequence":"first","affiliation":[{"name":"Dermatology Department, St George\u2019s University Hospitals NHS Foundation Trust , London ,","place":["UK"]},{"name":"Genetics Research Section, Cardiovascular & Genomics Research Institute, City St George\u2019s, University of London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe Jane","family":"Avila","sequence":"additional","affiliation":[{"name":"Cellular Pathology Department, St George\u2019s University Hospitals NHS Foundation Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"2026092919521441300_vzaf101-B1","doi-asserted-by":"crossref","first-page":"adv00191","DOI":"10.2340\/00015555-3549","article-title":"Massive acute alopecia of the scalp in a patient treated with dupilumab","volume":"100","author":"Gallo","year":"2020","journal-title":"Acta Derm Venereol"},{"key":"2026092919521441300_vzaf101-B2","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.3390\/biomedicines10071485","article-title":"Pathogenesis of paradoxical reactions associated with targeted biologic agents for inflammatory skin diseases","volume":"10","author":"Miyagawa","year":"2022","journal-title":"Biomedicines"},{"key":"2026092919521441300_vzaf101-B3","doi-asserted-by":"crossref","first-page":"100211","DOI":"10.1016\/j.jtauto.2023.100211","article-title":"Paradoxical psoriasis: the flip side of idiopathic psoriasis or an autocephalous reversible drug reaction?","volume":"7","author":"Lu","year":"2023","journal-title":"J Transl Autoimmun"},{"key":"2026092919521441300_vzaf101-B4","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.jaad.2020.12.010","article-title":"Paradoxical eruptions to targeted therapies in dermatology: a systematic review and analysis","volume":"86","author":"Murphy","year":"2022","journal-title":"J Am Acad Dermatol"},{"key":"2026092919521441300_vzaf101-B5","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.jaad.2019.06.010","article-title":"Cause or cure? Review of dupilumab and alopecia areata","volume":"88","author":"Marks","year":"2023","journal-title":"J Am Acad Dermatol"},{"key":"2026092919521441300_vzaf101-B6","doi-asserted-by":"crossref","DOI":"10.3109\/9781841847344","volume-title":"An Atlas of Hair Pathology with Clinical Correlations","author":"Sperling","year":"2012","edition":"2nd edn"},{"key":"2026092919521441300_vzaf101-B7","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1159\/000530608","article-title":"Dupilumab-associated psoriasis and psoriasiform manifestations: a scoping review","volume":"239","author":"Su","year":"2023","journal-title":"Dermatology"},{"key":"2026092919521441300_vzaf101-B8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1080\/14740338.2024.2326480","article-title":"Dupilumab in real-life settings: a review of adverse events and their pathogenesis","volume":"23","author":"Camela","year":"2024","journal-title":"Expert Opin Drug Saf"},{"key":"2026092919521441300_vzaf101-B9","doi-asserted-by":"crossref","first-page":"2258240","DOI":"10.1080\/09546634.2023.2258240","article-title":"Paradoxical tralokinumab-induced psoriasis in a patient with atopic dermatitis","volume":"34","author":"Balakirski","year":"2023","journal-title":"J Dermatolog Treat"},{"key":"2026092919521441300_vzaf101-B10","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/ijd.17397","article-title":"Tralokinumab-induced psoriasis relapse in a patient with atopic dermatitis","volume":"64","author":"Chiei Gallo","year":"2025","journal-title":"Int J Dermatol"},{"key":"2026092919521441300_vzaf101-B11","doi-asserted-by":"crossref","first-page":"e1432","DOI":"10.1111\/jdv.19351","article-title":"Successful treatment with tralokinumab in patients with atopic dermatitis and dupilumab-induced psoriasis","volume":"37","author":"Quattrini","year":"2023","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2026092919521441300_vzaf101-B12","doi-asserted-by":"crossref","first-page":"100323","DOI":"10.1016\/j.jacig.2024.100323","article-title":"Successful treatment of the dupilumab-induced psoriatic dermatitis\/arthritis and atopic dermatitis with a JAK inhibitor: a case report and literature review","volume":"3","author":"Tsunoda","year":"2024","journal-title":"J Allergy Clin Immunol Glob"}],"container-title":["Skin Health and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/skinhd\/article-pdf\/6\/5\/798\/68721530\/vzaf101.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/skinhd\/article-pdf\/6\/5\/798\/68721530\/vzaf101.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:52:20Z","timestamp":1790725940000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/skinhd\/article\/6\/5\/798\/8728466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":12,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,7,8]]},"published-print":{"date-parts":[[2026,9,30]]}},"URL":"https:\/\/doi.org\/10.1093\/skinhd\/vzaf101","relation":{},"ISSN":["2690-442X"],"issn-type":[{"value":"2690-442X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,7,8]]}}}