A 25-year-old atopic patient on dupilumab (anti-IL-4Rα) for moderate-to-severe atopic dermatitis develops bilateral non-infectious conjunctivitis. Which cytokine pathway is implicated in this adverse effect?

• A IL-31 upregulation causing goblet cell dysfunction
• B TNF-alpha mediated ocular inflammation
• C Off-target inhibition of IL-4 in tear production
• D IL-13 signalling in conjunctival goblet cells, suppressed by drug but causing mucosal imbalance ✓

Explanation

Dupilumab-associated conjunctivitis is the most common adverse effect (occurs in ~10% of patients). The mechanism is believed to involve disruption of IL-13 signaling in conjunctival goblet cells and the ocular surface. IL-13 is important for maintaining mucosal homeostasis; its suppression may alter goblet cell function and the ocular surface barrier. Treatment involves topical cyclosporine 0.05% eye drops or low-potency topical steroid drops. It is distinct from infectious conjunctivitis and usually bilateral.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.