Is dyshidrotic eczema a risk with pemivir (Pemivir)?

Dyshidrotic Eczema and Pemivibart Administration

Based on the available evidence, there is no documented association between dyshidrotic eczema and pemivibart administration. The medical literature does not contain specific references linking this medication to dyshidrotic eczema.

Understanding Dyshidrotic Eczema

Dyshidrotic eczema (also called pompholyx) is characterized by:

• Small, pruritic, tense vesicles primarily on palms, soles, and lateral/ventral surfaces of fingers 1
• Vesicles that can resemble "tapioca pudding" on clinical examination 2
• Recurrent nature affecting primarily young adults, with equal gender distribution 2

Known Causes and Associations of Dyshidrotic Eczema

The etiology of dyshidrotic eczema appears multifactorial:

1. Metal allergies: Considered an important potential etiologic factor 1

   • Improvement of symptoms often occurs after removing metal allergens

2. Occupational exposures: Contact sensitization is common 3

   • 72.8% of dyshidrotic patients showed positive patch test reactions
   • 30.5% had a relationship to occupational activity

3. Medication-induced cases: Rare but documented 4

   • Case reports exist for medications like secukinumab (an IL-17a inhibitor used for psoriasis)
   • Requires extended follow-up and larger patient numbers to confirm associations

4. Other factors:

   • Hyperhidrosis (excessive sweating) 1
   • Seasonal allergies (spring allergy season) 1
   • Atopic predisposition (though studies show similar rates of atopy history in dyshidrotic eczema compared to other hand eczemas) 3

Management of Dyshidrotic Eczema

For patients experiencing dyshidrotic eczema, treatment options include:

• Topical corticosteroids: High-potency steroids for thick, lichenified lesions 5

  • Apply twice daily for up to 4 weeks initially
  • Monitor for adverse effects like skin atrophy, striae, telangiectasia

• Emollients and skin care: 5

  • Apply fragrance-free emollients 3-8 times daily
  • Use immediately after bathing
  • Ointments provide maximum occlusion for very dry skin

• Infection prevention: 5

  • Consider antiseptic washes with aqueous chlorhexidine 0.05% for erosive lesions
  • Treat clinically evident infections with appropriate antibiotics

• Advanced therapies for severe cases: 5

  • Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
  • Phototherapy (narrowband UVB)
  • Biologics (dupilumab, tralokinumab)
  • JAK inhibitors (upadacitinib, abrocitinib, baricitinib)
  • Immunomodulators (cyclosporine, methotrexate, azathioprine)

Clinical Implications

When evaluating a patient with suspected medication-induced dyshidrotic eczema:

1. Assess temporal relationship: Determine if the onset of eczema correlates with medication initiation

2. Rule out other causes:

   • Metal allergies (consider patch testing)
   • Occupational exposures
   • Hyperhidrosis
   • Seasonal allergies

3. Consider medication withdrawal: If strongly suspected as the cause and if clinically appropriate

4. Monitor and document: Use standardized assessment tools like the Dyshidrotic Eczema Area and Severity Index (DASI) to track severity and treatment response 6

Conclusion on Pemivibart

While medication-induced dyshidrotic eczema has been reported with certain drugs like secukinumab 4, there is no evidence in the provided literature specifically linking pemivibart to dyshidrotic eczema. Clinicians should remain vigilant for potential new drug associations and report any suspected cases to contribute to post-marketing surveillance.