Dupixent Can Cause Facial Redness
Yes, Dupixent (dupilumab) can cause facial redness, which is a recognized adverse effect occurring in 4-43.8% of patients and is formally listed in the FDA drug label. 1, 2
Understanding Dupilumab-Related Facial Redness
Two Distinct Presentations
Ocular-related redness:
- Conjunctival and limbal injection (eye redness) is a common manifestation of dupilumab-related ocular surface disorders (DROSD), typically presenting bilaterally within weeks to months of starting treatment 3, 4
- This affects approximately 6-26% of patients and represents inflammation of the eye surface rather than facial skin 4
Facial skin redness (Dupilumab Facial Redness/DFR):
- An eczematous rash specifically affecting the face and neck that develops during dupilumab therapy 5, 2
- This can occur even in patients whose facial skin was clear before starting dupilumab 5, 6
- The FDA label explicitly lists "facial rash or redness" as a reported adverse effect 1
Clinical Significance and Risk Factors
Key risk factors for facial involvement include:
- Pre-existing eyelid or facial eczema increases risk of ocular complications 3
- History of atopic dermatitis is the primary indication for dupilumab but paradoxically can predispose to facial reactions 3
- Patients may develop facial erythema even when body lesions are improving with treatment 5, 6
Management Approach
For ocular redness (conjunctival injection):
- Assess for red flag symptoms using the RAPID acronym: Redness, Acuity loss, Pain, Intolerance to light, Damage to cornea 3
- If redness alone without other symptoms: initiate preservative-free ocular lubricants and monitor 3, 4
- If any red flag present: urgent ophthalmology referral within 24 hours 3
- Most cases are mild-to-moderate and manageable while continuing dupilumab 4
For facial skin redness:
- Consider tacrolimus ointment for facial dermatitis, which has shown effectiveness and safety when combined with dupilumab 7
- Evaluate for potential allergen exposure and consider patch testing if contact dermatitis is suspected 2
- In severe or persistent cases, treatment interruption may be necessary 2
Important Clinical Caveats
Unilateral redness is very unlikely to be dupilumab-related and should prompt evaluation for other causes 3, 4
Despite these adverse effects, only 4.2% of patients discontinue dupilumab due to ocular complications, and the drug maintains an excellent overall safety profile with over 10 years of follow-up data 4
Rare but important consideration: One case report documented facial erythema in a patient who was subsequently diagnosed with systemic lupus erythematosus during dupilumab treatment, highlighting the need to consider underlying autoimmune conditions in atypical presentations 6