Supplementary Material for: Case Report Janus Kinase Inhibitors as Successful Treatment Alternative in Dupilumab-induced Psoriasis

Introduction: After the introduction of dupilumab as systemic treatment for atopic dermatitis an increasing number of patients has been successfully treated. However, reports of patients developing psoriasis as a secondary skin condition have been accumulating. The most likely reason is assumed to be an immune shift from Th2 to Th1 mediated auto-inflammatory processes. Case presentation: Our patient is a 38-year old male suffering from head-neck type atopic dermatitis since childhood. As one of the first patients in Switzerland he received dupilumab in 2018 leading to a significant improvement of his skin lesions. One year later he developed progressing circular erythematous-squamous plaques which correlated histologically with psoriasis. In 2021, 3 years after initiating dupilumab, we switched systemic therapy to baricitinib. 3 months after initiation, his psoriatic lesions were completely healed, while the atopic lesions remained stable with low inflammatory activity. Conclusion: In patients treated with dupilumab for atopic dermatitis immune shift needs to be considered in case of newly appearing skin lesions. With a growing number of described cases, we conclude that baricitinib is a good alternative treatment for atopic dermatitis in patients suffering from biologic-induced psoriasis.