What is your approach to treating patients with dupilumab induced facial redness?

Literature is quite clear that the majority of these patients have Malassezia hypersensitivity as the etiology and the pathophysiology is essentially the same as seborrheic dermatitis. The IL-4 blockade allows upregulation of Th17 activity, which is the inflammatory pathway for seborrheic dermatitis. Certainly, a small number have contact dermatitis and a small number have rosacea, but in the majority, it is Malassezia driven.

The best approach is to do standard topical treatments for seborrheic dermatitis (an azole qd + an anti-inflammatory qd (low potency TCS, TCI, Topical JAK). Much more likely to work if you also do itraconazole (I do 200 mg qd on Sat and Sun only, which prevents having to worry about drug interactions). Assuming they c...

In addition to itraconazole, diflucan has also been used.