Background: Management of severe atopic dermatitis (AD) in pregnancy is challenging due to limited safety data for systemic therapies. Dupilumab, an IL-4/IL-13 inhibitor, used for moderate-to-severe AD,evidence in pregnancy remains limited.
Case: A 31-year-old nulliparous woman with longstanding history of AD was hospitalised at 12 weeks’ gestation with significant flare in pregnancy. She reported widespread erythema and scale on her face, trunk and limbs affecting sleep and functioning. Prior to pregnancy, disease control was achieved by topical corticosteroids, moisturisers and phototherapy. During pregnancy, intensive topical therapy failed to achieve adequate response.
Given disease severity multidisciplinary care involving dermatology, obstetric medicine, and pharmacy was undertaken. After counselling regarding safety data and potential risks, dupilumab was recommended. Significant clinical improvement occurred within eight weeks, with reduced pruritus and inflammation. There were no further flares and no adverse maternal effects.
At 41 weeks’ 2 days gestation after an otherwise uncomplicated pregnancy a healthy infant (3472g) was born via vaginal delivery. The infant remained well. Postpartum continuation of dupliumab was recommended to maintain control.
Discussion: Published case reports and small series similarly report good maternal response and no clear safety signal for adverse fetal outcomes with dupilumab exposure in pregnancy. Systematic review data have not demonstrated increased rates of congenital malformation or miscarriage compared with background risk.
Conclusion: This case adds to current literature that Dupilumab may be considered in selected cases of severe AD in pregnancy following multidisciplinary evaluation and shared decision-making. Further data is needed to establish safety and guide clinical practice.