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已发表论文
度普利尤单抗诱导的泛发性扁平苔藓：一例报告
Authors Feng HS , Zhang C, Guo Y, Jia YN, Zhai Y, Zheng XR, Zhang T, Zhu BC, Zhang WT, Hua GD
Received 26 August 2025
Accepted for publication 10 October 2025
Published 17 October 2025 Volume 2025:18 Pages 14457—14463
DOI https://doi.org/10.2147/JIR.S561924
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Anish R. Maskey
Hui-shang Feng,1,2 Chuang Zhang,3 Yang Guo,1 Yuan-ning Jia,1 Ye Zhai,1 Xiao-ran Zheng,1 Tai Zhang,4 Bao-chen Zhu,4 Wan-tong Zhang,5 Guo-dong Hua4
1Department of Dermatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 2Second Clinical Medical School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Department of Dermatology, Peking University First Hospital, Beijing, People’s Republic of China; 4Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 5Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
Correspondence: Bao-chen Zhu, Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, People’s Republic of China, Email zbcbock123@sina.com Wan-tong Zhang, Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, People’s Republic of China, Email wantong_zhang@hotmail.com
Background: Lichen planus (LP) is a chronic inflammatory skin disease of unknown cause. Common subtypes include generalized LP, linear LP, annular LP, and hypertrophic LP. Current clinical evidence suggests that lichen planus is a T-cell-mediated autoimmune disorder. Therefore, an increasing number of clinicians are opting for biologics or immunomodulators to manage lichen planus, but the reported evidence on their efficacy and safety remains limited.
Case Summary: This case report describes a 32-year-old female with pre-existing localized lichen planus (LP) who developed generalized LP after IL-4Rα inhibitor dupilumab therapy. Following three dupilumab injections, progressive dissemination of pruritic pink-to-flesh-coloured or light-brown papules to the trunk and limbs was observed. The lesions regressed upon dupilumab discontinuation and pharmacological intervention. Diagnosis was confirmed by dermoscopy and histopathology.
Conclusion: A temporal correlation and Naranjo adverse drug reaction score of 8 indicated dupilumab as the trigger, likely via Th1/Th2 immune deviation. This first-documented paradoxical reaction underscores dupilumab’s potential to trigger generalized LP through immune deviation.
Plain Language Summary: What’s already known about this topic?Dupilumab is a well-established IL-4Rα inhibitor that safely improves multiple type-2 inflammatory diseases, and existing small series have documented its use either to treat lichen planus or to cause de-novo lichen planus when prescribed for other indications.Paradoxical worsening of lichen planus after dupilumab has not previously been reported.
What does this study add?This report details the first documented case in which dupilumab, given to treat pre-existing localized lichen planus, precipitated generalized lichen planus after only three injections.It provides a high-certainty causality assessment (Naranjo score 8) and emphasizes the need for close monitoring for paradoxical immune deviation when dupilumab is used in patients with lichen planus.
Keywords: lichen planus, IL-4Rα inhibitor, dupilumab, immune deviation, adverse drug reaction
1Department of Dermatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 2Second Clinical Medical School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Department of Dermatology, Peking University First Hospital, Beijing, People’s Republic of China; 4Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 5Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
Correspondence: Bao-chen Zhu, Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, People’s Republic of China, Email zbcbock123@sina.com Wan-tong Zhang, Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, People’s Republic of China, Email wantong_zhang@hotmail.com
Background: Lichen planus (LP) is a chronic inflammatory skin disease of unknown cause. Common subtypes include generalized LP, linear LP, annular LP, and hypertrophic LP. Current clinical evidence suggests that lichen planus is a T-cell-mediated autoimmune disorder. Therefore, an increasing number of clinicians are opting for biologics or immunomodulators to manage lichen planus, but the reported evidence on their efficacy and safety remains limited.
Case Summary: This case report describes a 32-year-old female with pre-existing localized lichen planus (LP) who developed generalized LP after IL-4Rα inhibitor dupilumab therapy. Following three dupilumab injections, progressive dissemination of pruritic pink-to-flesh-coloured or light-brown papules to the trunk and limbs was observed. The lesions regressed upon dupilumab discontinuation and pharmacological intervention. Diagnosis was confirmed by dermoscopy and histopathology.
Conclusion: A temporal correlation and Naranjo adverse drug reaction score of 8 indicated dupilumab as the trigger, likely via Th1/Th2 immune deviation. This first-documented paradoxical reaction underscores dupilumab’s potential to trigger generalized LP through immune deviation.
Plain Language Summary: What’s already known about this topic?Dupilumab is a well-established IL-4Rα inhibitor that safely improves multiple type-2 inflammatory diseases, and existing small series have documented its use either to treat lichen planus or to cause de-novo lichen planus when prescribed for other indications.Paradoxical worsening of lichen planus after dupilumab has not previously been reported.
What does this study add?This report details the first documented case in which dupilumab, given to treat pre-existing localized lichen planus, precipitated generalized lichen planus after only three injections.It provides a high-certainty causality assessment (Naranjo score 8) and emphasizes the need for close monitoring for paradoxical immune deviation when dupilumab is used in patients with lichen planus.
Keywords: lichen planus, IL-4Rα inhibitor, dupilumab, immune deviation, adverse drug reaction