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Case Nº 055 · Dr. Christina Han

EC2Change Case FileAtopic dermatitis

055

A 22-year-old male with moderate disease

  • Skin of colour
  • Advanced systemic failure
  • Special sites: head, neck
  • Prior JAK inhibitor failure

Case byDr. Christina Han

1 follow-up visit
3 photographs

At a glanceCase Nº 055

At a glance

A 22-year-old male, moderate atopic dermatitis

ScoreBaselineLatest visit
EASI208
BSA35%—
Itch NRS82
IGA3—
DLQI16—

In this file

1
The patientCase Nº 055

22

The patient

year-old male,
moderate disease

  • Skin of colour
  • Special-site involvement
  • Advanced systemic failure

Special sites involved: Head, Neck

Race / ethnicity

Filipino

Fitzpatrick skin type

IV

Previous diagnoses

Atopic dermatitis - moderate Nut allergy - severe Allergic rhinitis
2
The patientCase Nº 055

The patient

The patient, continued

Comorbidities & context

Initially more generalized but worse in the flexural areas Progressively more difficult to manage facial eczema Flared after COVID-19 Lots of impact of itch and QOL (++ athletics, worse with sweating)
3
Treatment historyCase Nº 055

Treatment history

What came before

Treatment at presentation

Tralokinumab Q 2weekly dosing (since January 2024) Elidel 1% cream QHS Betametasone valerate 0.1% cream 2x per week

Previous topical therapy

Betamethasone valerate 0.1% ointment and cream Fucidin ointment Hydrocortisone 1% & 2.5% cream Clobetasol 0.05% ointment Pimecrolimus 1% cream Intralesional steroids
4
Treatment historyCase Nº 055

Treatment history

What came before, continued

Previous systemic therapy

Prednisone MTX 15 mg PO weekly (Oct 2021 x 3 months) Oral antibiotics to treat secondary infection of AD Hydroxyzine 25mg PO QHS PRN Uptacitinib 15-30mg - all of 2023

Previous other therapy

UVB phototherapy (2019)

Advanced systemics that failed

  • JAK inhibitorInadequate response
5
Disease assessmentCase Nº 055

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

20of 72

BSA

Body surface area

35%of 100%

Itch NRS

Peak pruritus numerical rating scale

8of 10

IGA

Investigator's Global Assessment

3of 4

DLQI

Dermatology Life Quality Index

16of 30

6
Disease assessmentCase Nº 055

Disease assessment

On the skin

Thickness

  • Papulation

Site: eyelids, perioral

Lichenification

  • Furrowing

Site: eyelids, cutaneous lip, popliteal fossa

Excoriation

    Site: flexural aspects

    7
    Disease assessmentCase Nº 055

    Disease assessment

    On the skin, continued

    Pigmentary changes

    • Post-inflammatory hyperpigmentation

    Site: eyelids, antecubital and popliteal fossa

    8
    Disease assessmentCase Nº 055

    Disease assessment

    How it shaped care

    Impact on treatment selection

    ++amount of itching led to use of a JAKi initally

    Impact on outcome measure

    NRS and DLQI impacted quite a bit
    To be clear and itch-free
    Physician goals
    9
    Disease assessmentCase Nº 055

    Disease assessment

    How it shaped care, continued

    Wants to be able to look good (face) Wants to be able to sleep and perform well at school (Computer Sciences) Wants to be able to play sports (basketball)
    Patient goals
    10
    Treatment selectionCase Nº 055

    Treatment selection

    The plan

    Patient went on to Tralokinumab on-label dosing since early 2024

    Treatment goals

    Patient wants to feel less/no itching, be able to sleep so he can do well in school and sports.

    What drove the choice

    Initially wanted to go on dupilumab due to underlying atopic comorbidities, but insurance denied coverage. Then JAKi chosen to gain rapid control of itching Failed at 30mg dose

    Safety concerns

    Some URTIs but overall all systemic agents were well tolerated so far
    11
    Treatment selectionCase Nº 055

    Treatment selection

    The plan, continued

    Target scores

    EASI
    4
    from 20
    BSA
    5%
    from 35%
    Itch NRS
    2
    from 8
    IGA
    0
    from 3
    DLQI
    3
    from 16
    12
    Follow-upCase Nº 055

    Follow-up · visit 1 of 1

    Under 6 months on treatment

    3 months

    EASI

    Eczema Area and Severity Index

    8of 72

    −12 vs baseline of 20

    Itch NRS

    Peak pruritus numerical rating scale

    2of 10

    −6 vs baseline of 8

    Lesions at this visit

    Thickness
    — Improved
    Lichenification
    — Improved
    Excoriation
    — mild
    13
    Follow-upCase Nº 055

    Follow-up · visit 1 of 1

    Visit 1, continued

    Symptoms & daily life

    Pruritus
    — Much improved
    Work impairment
    — Reported good productivity at school

    Treatment plan

    Treatment continued unchanged

    • Patient satisfied
    • Physician satisfied
    14
    Follow-upCase Nº 055

    Visit 1 photographs

    Good response on a previously problematic area Mild PIH
    Ongoing facial eczema
    15
    Follow-upCase Nº 055

    Visit 1 photographs

    Good response to the body
    16
    OutcomesCase Nº 055

    Outcomes

    Scores over time

    EASI020Target 4Baseline: EASI 2020V1: EASI 88BaselineV1Itch NRS010Target 2Baseline: Itch NRS 88V1: Itch NRS 22BaselineV1

    V = follow-up visit. Each scale starts at zero. Grey line = physician’s target.

    17

    A 22-year-old male with moderate atopic dermatitis.

    EC2Change Case File Nº 055

    Contributed by Dr. Christina Han. Compiled from the physician’s case-builder submission, in their own words.