Polymorphic eruption of pregnancy successfully treated with dupilumab in the postpartum period: A case report

Polymorphic eruption of pregnancy predominantly occurs during the last month of pregnancy or the immediate postpartum period. Dupilumab, an IgG4 monoclonal antibody, has been utilized in pregnancy and lactation. A 34-year-old gravida 2 para 1 female, on postoperative day 2 following a Cesarean section, presented with pruritic erythematous urticoid papules coalescing into plaques on the abdomen, bilateral arms, legs, and feet, suggestive of polymorphic eruption of pregnancy. A punch biopsy ruled out gestational pemphigoid. Prednisone was contraindicated given her gestational diabetes and gestational hypertension. Dupilumab was administered with betamethasone valerate ointment followed by transition to roflumilast cream. At 6-week follow-up, the skin was cleared of the rash. This case highlights a new potential utility for dupilumab in polymorphic eruption of pregnancy and may represent an alternative to oral steroids in severe or refractory disease.