Adverse Effects of Hydrocortisone and Dupilumab

Introduction to Side Effects

Dupilumab's most common adverse effects include conjunctivitis, injection site reactions, facial redness, and herpes simplex virus infection, with conjunctivitis occurring in 5-16% of patients, as reported by the British Journal of Dermatology and the Journal of Microbiology, Immunology and Infection 1, 2

Dupilumab-related ocular surface disorders (DROSD) are significant adverse effects, including conjunctivitis, blepharitis, dry eyes, and keratitis in severe cases, according to the British Journal of Dermatology 1
Risk factors for developing ocular complications with dupilumab include previous ophthalmology attendance for ocular surface disorders, higher baseline disease severity, and eyelid or facial eczema, as reported by the British Association of Dermatologists 1
The British Association of Dermatologists provides guidance for managing DROSD, including offering prophylactic preservative-free ocular lubricants to patients with current or pre-existing corneal or conjunctival eye disease, and referring patients with significant current or chronic eye disease to ophthalmology before starting treatment 1

Monitoring for ocular complications is recommended, with no specific monitoring for bruising required based on current guidelines, as stated by the British Journal of Dermatology 1
If easy bruising develops, consideration should be given to reducing hydrocortisone dose if possible, and dupilumab should not be discontinued based solely on bruising concerns unless other causes have been ruled out, according to the British Journal of Dermatology and the Journal of Microbiology, Immunology and Infection 1, 2
The American Academy of Dermatology recommends that no laboratory monitoring is required before initiation or during treatment with dupilumab for atopic dermatitis, due to its favorable safety profile 3, 1
Clinical assessment tools such as the Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), Body Surface Area (BSA) affected, and quality of life measures should be used to monitor treatment response, as real-world data shows significant improvement by weeks 12-24, as reported by the British Journal of Dermatology 1
Unnecessary laboratory testing should be avoided, as it wastes resources and may cause patient anxiety without clinical benefit, according to the British Journal of Dermatology 1

Dupilumab is used for the treatment of moderate-to-severe atopic dermatitis in adults and children who have not achieved adequate control with topical medications, administered as subcutaneous injections with an initial loading dose followed by maintenance dosing, with adults receiving a 600 mg loading dose, then 300 mg every 2 weeks, as recommended by the American Academy of Dermatology and the British Journal of Dermatology 3, 1

Conjunctivitis is a common adverse event but is typically self-limited and can be managed with artificial tears, and ophthalmology referral should be considered for severe, persistent, or refractory conjunctivitis, according to the American Academy of Dermatology 3
The British Association of Dermatologists recommends classifying DROSD severity as mild, moderate, or severe based on redness and symptoms, and urgently referring to ophthalmology patients with DROSD presenting with the RAPID signs: Redness plus any of: Acuity loss, Pain, Intolerance to light, or Damaged cornea 1
Joint pain and injection site reactions should be monitored and managed symptomatically, as reported by the British Journal of Dermatology 1