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Dupixent face rash and redness: Causes and treatment

You can either treat Dupixent redness or consider an alternative medication
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By | Aug. 29, 2024 Medically reviewed by Josephine Bawab, Pharm.D.
A woman touching her face, holding cream and looking in a mirror: Dupixent face rash and redness: Causes and treatment

Key takeaways

  • Dupixent (dupilumab) is an injectable drug that’s approved by the Food and Drug Administration (FDA) to treat atopic dermatitis.

  • Some people who take Dupixent may experience a face rash or facial redness as a side effect.

  • Topical antifungals and corticosteroids can help manage facial rashes or redness caused by Dupixent.

  • Dupixent has several alternatives, including other monoclonal antibody medications, JAK inhibitors, and TCIs. Some of these drugs are less likely to cause facial dermatitis, but others might pose the same risk.

In this article:

Around 1 in 10 Americans have some type of eczema, which means 10% of the country deals with dry, itchy, inflamed, scaly skin or lesions. Dupixent (dupilumab) is a biologic monoclonal antibody medication that can help treat moderate-to-severe atopic dermatitis (AD), as well as asthma, chronic rhinosinusitis, and nasal polyps.

Although it can relieve some of this skin disease’s most irritating symptoms, dupilumab treatment may also cause side effects, specifically a facial rash and facial erythema (redness). Not everyone experiences these reactions, but it’s important to understand how and why a Dupixent face rash and other symptoms occur.

How Dupixent works in the body

It’s still unclear what causes atopic dermatitis, the most common form of adult and pediatric eczema, but it’s commonly regarded as an immune system and skin barrier condition. This is when the layer of the skin that would typically keep out things like allergens and bacteria doesn’t properly do its job. Those intruders trigger the immune system, which releases certain proteins that cause skin inflammation. It’s essentially an immune response gone wrong.

The proteins released by the immune system are called interleukin-4 and interleukin-13, and they’re Dupixent’s targets. It blocks them from binding to their designated receptors, curbing the immune system’s response and reducing or preventing atopic dermatitis symptoms. Systematic reviews and clinical trials have shown that Dupixent is safe and effective for patients ages 6 months and older.

Dupixent is a biologic drug, which means it’s created from living cells rather than synthetic chemicals. Biologics can target very specific cells or proteins within the immune system, giving them a more pointed attack on certain conditions. As such, Dupixent isn’t a broad immunosuppressant like other eczema drugs, so it won’t increase the risk of infections.

Does Dupixent cause a face rash?

Facial rashes and redness aren’t listed as adverse effects in Dupixent’s clinical trials, but they’re well-documented in case reports and other research. In fact, researchers have estimated that anywhere between 4% and 44% of patients may experience facial dermatitis or neck erythema after taking dupilumab, the active ingredient in Dupixent, according to the American Journal of Clinical Dermatology.

According to Michael O. McKinney, MD, primary physician at Healthy Outlook in Jacksonville, Florida, facial skin reactions may “occur due to the paradoxical local skin inflammation caused by the suppression of interleukin-4 and interleukin-13 as it interferes with erythema.”

The underlying cause of these side effects may vary by patient. “Dupilumab facial redness (DFR) has many different causes, including dupilumab hypersensitivity, inflammation from Malassezia yeast or Demodex mites, allergic contact dermatitis, and a reaction to the drug itself,” says Amy Huang, MD, board-certified dermatologist with Medical Offices of Manhattan and contributor to LabFinder.

Malassezia is a particular strain of yeast that’s common around the body’s sebaceous glands, so it can accumulate near the head, neck, and scalp, and it’s a common culprit in head and neck dermatitis. One hypothesis says that dupilumab might activate the immune system to cause Malassezia-induced inflammation.

If a Dupixent-related face rash occurs, a healthcare provider can diagnose and treat it. This characterization may require patch testing, a skin biopsy, or other tests, but diagnosis often only requires a visual examination.

Other Dupixent side effects

Facial dermatitis is one of the most visible Dupixent side effects. However, other adverse events are less obvious. Some main side effects of Dupixent include:

In rare cases, Dupixent may also cause serious side effects, such as:

  • Severe allergic reactions
  • Serum sickness (a kind of immune reaction)
  • Swelling of the cornea (keratitis)
  • Blood vessel swelling (vasculitis)

RELATED: Dupixent eye side effects

How to manage a Dupixent face rash and other side effects

Going to work or social gatherings with a facial rash isn’t ideal, so people who experience dupilumab-associated facial or neck dermatitis probably want to get rid of it fast. Fortunately, there are a few effective solutions.

“Most times, topical corticosteroids or any other anti-inflammatory agents prescribed by a healthcare provider are used in dealing with facial redness,” Dr. McKinney says. A retrospective study published by Tufts Medical Center’s Department of Dermatology in 2021 found that nearly 70% of patients with dupilumab facial redness improved after a course of itraconazole. A separate study from Dermatologic Therapy backed up those results, showing positive patient responses to oral or topical antifungals. Other azole antifungals might work, too, but they haven’t shown as much promise as itraconazole.

Topical corticosteroids (TCSes) are another common treatment for erythematous and inflamed skin, and they might work for dermatitis from Dupixent, too, although some case studies have demonstrated that steroids aren’t effective for everyone. Topical calcineurin inhibitors (TCIs) are another option. Both TCSes and TCIs are popular eczema treatments in their own right, and patients can use them alongside dupilumab therapy. However, Sanofi and Regeneron Pharmaceuticals, Inc., the developers of Dupixent, recommend reserving TCIs for “problem areas”—specifically the face, neck, and intertriginous or genital areas.

Dr. Huang adds that oral antibiotics and topical vasoconstrictors may also work for certain cases, but that “the patient will need to be evaluated by a dermatologist.” By examining your rash and determining its cause, a healthcare provider can help find the best option for you.

Home remedies can also be helpful for managing the discomfort that comes with face and neck dermatitis. Aloe vera, tea tree oil, coconut oil, and apple cider vinegar all have distinct anti-inflammatory or antimicrobial properties. Keeping the area clean and avoiding allergens or other potential irritators (like sunburn or cigarette smoke) might prevent it from getting worse.

Dupixent alternatives 

The risk of a facial rash might be a dealbreaker for some people—reason enough to say “no, thanks” to Dupixent. And that’s totally fine because there are several Dupixent alternatives, including some that might not have the same side effects.

Other monoclonal antibody drugs

Adbry (tralokinumab-ldrm) is a monoclonal drug that, like Dupixent, is injectable and targets specific immune system proteins. Clinical trials have proven Adbry to be effective in treating many cases of eczema without as many documented cases of facial dermatitis. However, it may still cause a rash, rosacea, and swelling.

JAK inhibitors

Dr. Huang recommends Janus kinase (JAK) inhibitors like Rinvoq (upadacitinib) and Cibinqo (abrocitinib) as alternatives to Dupixent. This drug class works by blocking enzymes called Janus kinase, which can contribute to inflammation. Face rash or redness isn’t one of the common side effects of JAK inhibitors, and it typically only occurs if the patient has an allergic reaction to the drug.

Topical calcineurin inhibitors

Like most other drugs on this list, TCIs like Elidel (pimecrolimus) and Protopic (tacrolimus) focus on inhibiting a specific protein, calcineurin, which contributes to eczema inflammation. Healthcare providers may also prescribe them off-label to treat psoriasis. Some of their common side effects, however, are burning, stinging, or redness at the application site.

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