Dupilumab-associated head and neck dermatitis resolves temporarily with itraconazole therapy and rapidly with transition to upadacitinib, with Malassezia-specific immunoglobulin E levels mirroring clinical response

To the Editor: Dupilumab-associated head and neck dermatitis (DAHND) (also known as dupilumab red face and persistent facial erythema)1,2 is defined as persistent or worsening eczematous eruption on the head and neck during dupilumab therapy.2,3 Although the precise mechanism(s) of this reaction is unknown, we have reported Malassezia-specific baseline serum immunoglobulin (IgE) as a predictive biomarker of DAHND in a prospective multicenter cohort study.3 This suggests a role for Malassezia sensitization in the pathogenesis of DAHND.