We retrospectively analyzed three adult patients (denoted A, B, C) with a history of eczema herpeticum on antiviral prophylaxis (valcyclovir) who initiated Dupilumab therapy. We calculated an Eczema Area and Severity Index (EASI) score for each patient beforeand after Dupilumab therapy and analyzed reported side effects in the first month of therapy.
None of the patients had exacerbations of eczema herpeticum, herpes simplex or any herpes related symptoms in the first month of treatment. Patient A had no change in EASI and discontinued dupilumab due to increased intraocular pressure and headaches. Patient B had some improvement in EASI and has continued therapy but reports arthralgia. Patient C had no change in EASI score and discontinued dupilumab due to fatigue, headaches and arthralgia.
Dupilumab therapy in patients with a history eczema herpeticum did not result in eczema herpeticum in the first month of therapy but was discontinued in 2 of 3 patients because of other possible medication related symptoms. We suggest prospective studies of safety and efficacy of dupilumab in patients with a history of eczema herpeticum are indicated.