Supplementary Material for: Acute mood episodes in patients of atopic dermatitis treated with dupilumab: insights from two cases

Introduction: Atopic dermatitis (AD) is a chronic skin disease that can affect patient’s quality of life through recurrent inflammatory skin condition, which is often associated with psychiatric effect including depression and anxiety. Treatment with biologics such as dupilumab, an anti-IL-4 receptor alpha antibody, is an effective treatment AD for both resolving skin conditions and reducing the risk of psychiatric comorbidities. However, the impact of its systemic effects on rare types of patients who were predisposed to psychiatric conditions are not fully understood. Case Presentations: We report two cases of AD patients who experienced acute mood episodes during the treatment with dupilumab. While showing remarkable improvement in their skin condition and itch, both patients reported recurrent depressive moods after each injection. The first patient extended the interval of injection from every 2 weeks to every 4 weeks after 24 injections of dupilumab. The second patient switched to another systemic treatment due to severe ocular itch after 7 times of administration of dupilumab. Both patients achieved stable control of the disease after these changes. Conclusion: These cases highlight the dupilumab’s efficacy in managing AD but also reveal potential psychological effects. It is advisable for the clinicians to exercise caution for emerging or exacerbation of the psychiatric condition during the period from the beginning of dupilumab till the patient achieve stable condition.