Published online May 26, 2026. doi: 10.12998/wjcc.v14.i15.120825
Revised: April 1, 2026
Accepted: April 22, 2026
Published online: May 26, 2026
Processing time: 61 Days and 18.8 Hours
Dupilumab has shown therapeutic efficacy in bullous pemphigoid (BP) by blocking interleukin (IL)-4/IL-13 signaling; inducing a type 22 immune signature with increased AHR signaling, keratinocyte activation and IL-22 receptor upregulation; and indirectly regulating STAT3 pathway activity to reduce the need for systemic immunosuppressants and glucocorticoids. The pathogenesis of Kaposi sarcoma (KS), a rare BP complication, is closely associated with human her
An 87-year-old female was diagnosed with BP based on clinical, histopathological, and immunological findings. Good control was achieved with low-dose oral prednisone, dupilumab, and topical halometasone-triclosan cream. After 32 weeks of treatment, she developed violaceous-red papules on both feet, which were confirmed as KS by skin biopsy and immunohistochemistry. Human immunodeficiency virus, syphilis, systemic disease, and internal malignancy were excluded. The patient declined laser/cryotherapy for KS due to advanced age and poor mobility, and was treated with topical 5% imiquimod cream. At the 6-month follow-up, no new KS lesions occurred, with partial regression of existing lesions. BP remained well controlled under regular surveillance.
Further research and follow-up are needed to clarify BP-KS association and dupilumab’s safety.
Core Tip: Dupilumab was used to treat bullous pemphigoid (BP) complicated with Kaposi sarcoma (KS). The causes were analyzed, and the immune drift induction hypothesis was proposed. STAT3 plays a key role in KS pathogenesis, as it supports human herpesvirus-8 latency and viral replication. It can be activated by virally encoded interleukin-6 via gp130 receptor signaling to promote the survival and proliferation of infected cells. Dupilumab-induced immune deviation (toward Th1/Th17/Th22 pathways) and STAT3 signaling activation may contribute to KS occurrence in susceptible BP patients. Further investigation is needed.