Dissecting Cellulitis of the Scalp Associated with Dupilumab: A Paradoxical Neutrophilic Reaction

    January 2026 in “ International Journal of Dermatology ”
    Pasquale Sorrentino, Margherita Malaspina, Vittorio Tancredi, Giuseppe Argenziano, Eugenia Veronica Di Brizzi
    TLDR Dupilumab can cause unexpected scalp issues, so early symptom recognition is important to avoid hair loss.
    A 27-year-old man developed dissecting cellulitis of the scalp (DCS) after receiving dupilumab for chronic type-2 upper-airway disease. Following the fifth dose, he experienced rapid onset of painful scalp nodules and abscesses. Laboratory tests showed leukocytosis and neutrophilia, but cultures were negative. A biopsy confirmed DCS, leading to discontinuation of dupilumab and initiation of isotretinoin and prednisone, resulting in significant improvement. This case suggests that dupilumab, while generally safe, may cause paradoxical neutrophilic reactions by altering immune responses, potentially leading to conditions like DCS. Early recognition of symptoms is crucial to prevent permanent hair loss.
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