What should I do if my face turns red while taking Dupixent (dupilumab)?

Facial Redness While Taking Dupixent: Management Guide

If your face turns red while taking Dupixent, start preservative-free ocular lubricants 2-4 times daily immediately, and assess whether you have any "red flag" eye symptoms (vision loss, eye pain, light sensitivity, or visible corneal damage) that require emergency ophthalmology evaluation within 24 hours. 1

Understanding Dupilumab Facial Redness

Facial redness on Dupixent occurs in approximately 4-43.8% of patients and typically develops between 8-24 weeks after starting treatment. 2, 3 This can manifest as:

• Eczematous rash of the face and neck (dupilumab facial dermatitis/redness) 2
• Eye-related redness (conjunctivitis, blepharitis, dry eye, keratitis) occurring in 6-26% of patients 4, 5
• Both conditions may occur together 6

Immediate Assessment: Determine If This Is an Emergency

RED FLAGS - Seek Emergency Ophthalmology Within 24 Hours If You Have: 1

• Redness of the conjunctiva PLUS any of:
• Acuity loss (worsening vision)
• Pain in the eye (moderate to severe, not just irritation)
• Intolerance to light (photophobia)
• Damage to cornea (visible ulceration, haze, opacity, or purulent discharge)

Important caveat: Unilateral (one-sided) eye symptoms are very unlikely to be dupilumab-related and suggest another cause requiring standard ophthalmology pathways. 1

Management Algorithm for Non-Emergency Facial Redness

Step 1: Initiate First-Line Treatment 1

• Start preservative-free ocular lubricants 2-4 times daily (even if primarily facial redness, as eye involvement is common) 1, 4
• Continue Dupixent unless symptoms are severe 1

Step 2: Classify Severity 1

Mild: Minimal redness, minimal symptoms

• Continue preservative-free lubricants 2-4 times daily 1
• Monitor for progression 1

Moderate: Noticeable redness with symptoms (irritation, discharge)

• Add topical antihistamine eyedrops (e.g., olopatadine) twice daily to lubricants 1
• Consider referral to ophthalmology if no improvement 1

Severe: Significant redness with substantial symptoms

• Continue lubricants 2-4 times daily 1
• Add tacrolimus 0.1% ointment once daily to lid margins (adults only; children 7-17 years need ophthalmology consultation first) 1
• Refer to ophthalmology for assessment within 4 weeks 1

Step 3: Additional Measures for Facial Dermatitis Component 2

If the redness is primarily facial skin (not eyes):

• Consider allergen avoidance and environmental modifications 2
• Avoid ocular irritants (smoke, pollution, cooling fans) 1
• May require skin scraping, patch testing, or biopsy to rule out other causes 2
• Facial redness typically resolves within 8-12 weeks even with continued treatment 3

When to Refer to Ophthalmology

Emergency (< 24 hours): 1

• Any red flag symptoms (RAPID criteria above)

Urgent (within 4 weeks): 1

• Severe redness at onset
• Cases requiring tacrolimus treatment
• Children < 7 years with any ocular symptoms (due to visual development concerns) 1

Standard referral: 1

• Mild-to-moderate cases not responding to lubricants and antihistamines
• Children 7-17 years not responding to simple treatments 1

Critical Clinical Pearls

• Only 4.2% of patients discontinue Dupixent due to ocular complications, so most cases are manageable while continuing therapy 4
• Bilateral (both eyes) involvement is typical for dupilumab-related issues 1
• Elevated eosinophil counts at 4 months are associated with facial redness and ocular complications 6
• History of atopic conjunctivitis or food allergies increases risk of these complications 6
• The FDA label confirms eye problems including "eye and eyelid inflammation, redness, swelling, itching" as common side effects 5

When to Stop Dupixent

Do NOT stop Dupixent without consulting your prescriber, but seek immediate medical attention if you develop: 5

• Severe allergic reactions (breathing problems, wheezing, facial swelling, hives)
• Signs of blood vessel inflammation (persistent fever, chest pain, worsening shortness of breath)
• Severe joint pain requiring hospitalization

Most facial redness cases resolve with treatment while continuing Dupixent. 3, 7